Virtual reality in multiple sclerosis – A systematic review


      • VR could be an effective method of MS rehabilitation in cognitive and motor deficits.
      • VR represents a motivational alternative in the MS rehabilitation process.
      • VR combined with other technologies are also effective in MS rehabilitation.
      • VR associated factors must be considered in MS rehabilitation planning.



      Multiple sclerosis (MS) is an inflammatory disease in which the insulating cover of nerve cells in the brain and spinal cord are damaged. The methods used for motor rehabilitation of patients with neurological problems require the performance of several rehabilitation exercises. Recently, studies related to the use of video game consoles have proliferated in the field of motor rehabilitation. Virtual reality (VR) has been proposed as a potentially useful tool for motoring assessment and rehabilitation.


      The purpose of this study was to investigate the results shown in previous studies on “Multiple Sclerosis” and “Virtual Reality”.


      A bibliographic review was performed without time limitations. The research was carried out using PubMed and BVS databases. Considering keywords, we included articles that showed the terms “Multiple Sclerosis” and “Virtual Reality”. The review was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines


      The initial search yielded 41 articles. After the duplicates were removed, two authors independently evaluated the title and abstract of each of the articles with the study inclusion criteria. From these, 31 articles were excluded based on the title and abstract. Finally, 10 articles were isolated that met the inclusion criteria.


      VR represents a motivational and effective alternative to traditional motor rehabilitation for MS patients. The results showed that VR programs could be an effective method of patients with MS rehabilitation in multiple cognitive and / or motor deficits. Additional research is needed to support the rehabilitation protocols with VR and increase the effects of treatment.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Baram Y.
        • Aharon-Peretz J.
        • Simionovici Y.
        • Ron L.
        Walking on virtual tiles.
        Neural Process. Lett. 2002; 16: 227-233
        • Baram Y.
        • Aharon-Peretz J.
        • Lenger R.
        Virtual reality feedback for gait improvement in patients with idiopathic senile gait disorders and patients with history of stroke.
        J. Am. Geriatr. Soc. 2010; 58: 191-192
        • Baram Y.
        • Lenger R.
        Gait improvement in patients with cerebral palsy by visual and auditory feedback.
        Neuromodulation. 2012; 15 (discussion 52): 48-52
        • Baram Y.
        • Miller A.
        Virtual reality cues for improvement of gait in patients with multiple sclerosis.
        Neurology. 2006; 66: 178-181
        • Baram Y.
        • Miller A.
        Glide-symmetric locomotion reinforcement in patients with multiple sclerosis by visual feedback.
        Disabil. Rehabil. Assist. Technol. 2010; 5: 323-326
        • Barton G.J.
        • Hawken M.B.
        • Butler P.B.
        The effects of virtual reality game training on trunk to pelvis coupling in a child with cerebral palsy.
        J. Neuroeng. Rehabil. 2013; : 15
        • Berg P.
        • Becker T.
        • Martian A.
        • Primrose K.D.
        • Wingen J.
        Motor control outcomes following Nintendo Wii use by a child with down syndrome.
        Pediatr. Phys. Ther. 2012; 24: 78-84
        • Courbois Y.
        • Farran E.K.
        • Lemahieu A.
        • Blades M.
        • Mengue-Topio H.
        • Sockeel P.
        Wayfinding behaviour in down syndrome: a study with virtual environments.
        Res. Dev. Disabil. 2013; 34: 1825-1831
        • de Mello Monteiro C.B.
        • Massetti T.
        • da Silva T.D.
        • van der Kamp J.
        • de Abreu L.C.
        • Leone C.
        • Savelsbergh G.J.
        Transfer of motor learning from virtual to natural environments in individuals with cerebral palsy.
        Res. Dev. Disabil. 2014; 35: 2430-2437
        • dos Santos Mendes F.A.
        • Pompeu J.E.
        • Modenesi Lobo A.
        • Guedes da Silva K.
        • Oliveira Tde P.
        • Peterson Zomignani A.
        • Pimentel Piemonte M.E.
        Motor learning, retention and transfer after virtual-reality-based training in Parkinson's disease--effect of motor and cognitive demands of games: a longitudinal, controlled clinical study.
        Physiotherapy. 2012; 98 (England: 2012 Chartered Society of Physiotherapy, Published by Elsevier Ltd): 217-223
        • Doud A.J.
        • Cassady K.
        • Grande A.
        • He B.
        A thought-controlled immersive virtual reality platform for motor learning applied with cortical and basal ganglia stroke survivors.
        Circulation. 2013; 128
        • Eftekharsadat B.
        • Babaei-Ghazani A.
        • Mohammadzadeh M.
        • Talebi M.
        • Eslamian F.
        • Azari E.
        Effect of virtual reality-based balance training in multiple sclerosis.
        Neurol. Res. 2015; 37: 539-544
        • Fulk G.D.
        Locomotor training and virtual reality-based balance training for an individual with multiple sclerosis: a case report.
        J. Neurol. Phys. Ther. 2005; 29: 34-42
        • Gutierrez R.O.
        • Galan Del Rio F.
        • Cano de la Cuerda R.
        • Alguacil Diego I.M.
        • Gonzalez R.A.
        • Page J.C.
        A telerehabilitation program by virtual reality-video games improves balance and postural control in multiple sclerosis patients.
        NeuroRehabilitation. 2013; 33: 545-554
        • Hutton B.
        • Salanti G.
        • Caldwell D.M.
        • Chaimani A.
        • Schmid C.H.
        • Cameron C.
        • Moher D.
        The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.
        Ann. Intern. Med. 2015; 162: 777-784
        • Kandalaft M.R.
        • Didehbani N.
        • Krawczyk D.C.
        • Allen T.T.
        • Chapman S.B.
        Virtual reality social cognition training for young adults with high-functioning autism.
        J. Autism Dev. Disord. 2013; 43: 34-44
        • Knobloch K.
        • Yoon U.
        • Vogt P.M.
        Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias.
        J. Craniomaxillofac. Surg. 2011; 39: 91-92
        • Laver K.
        • George S.
        • Ratcliffe J.
        • Crotty M.
        Virtual reality stroke rehabilitation--hype or hope?.
        Aust. Occup. Ther. J. 2011; 58: 215-219
        • Lehrer N.
        • Attygalle S.
        • Wolf S.L.
        • Rikakis T.
        Exploring the bases for a mixed reality stroke rehabilitation system, (part I): a unified approach for representing action, quantitative evaluation, and interactive feedback.
        J. Neuroeng. Rehabil. 2011; 8: 51
        • Leocani L.
        • Comi E.
        • Annovazzi P.
        • Rovaris M.
        • Rossi P.
        • Cursi M.
        • Comi G.
        Impaired short-term motor learning in multiple sclerosis: evidence from virtual reality.
        Neurorehabil. Neural Repair. 2007; 21 (United States): 273-278
        • Lozano-Quilis J.A.
        • Gil-Gomez H.
        • Gil-Gomez J.A.
        • Albiol-Perez S.
        • Palacios-Navarro G.
        • Fardoun H.M.
        • Mashat A.S.
        Virtual rehabilitation for multiple sclerosis using a kinect-based system: randomized controlled trial.
        JMIR Serious Games. 2014; 2: e12
        • Mahajan H.P.
        • Spaeth D.M.
        • Dicianno B.E.
        • Brown K.
        • Cooper R.A.
        Preliminary evaluation of variable compliance joystick for people with multiple sclerosis.
        J. Rehabil. Res. Dev. 2014; 51: 951-962
        • Massetti T.
        • da Silva T.D.
        • Ribeiro D.C.
        • Malheiros S.R.P.
        • Re A.H.N.
        • Favero F.M.
        • de Mello Monteiro C.B.
        Motor learning through virtual reality in cerebral palsy–a literature review.
        Med. Express. 2014; 1: 302-306
        • Menezes L.D.C.D.
        • Massetti T.
        • Oliveira F.R.
        • Abreu L.C.D.
        • Herrero D.
        • Malheiros S.R.P.
        • Monteiro C.B. de M.
        Motor learning and virtual reality in down syndrome: a literature review.
        Int. Arch. Med. 2015; 8: 1-11
        • Mitchell P.
        • Parsons S.
        • Leonard A.
        Using virtual environments for teaching social understanding to 6 adolescents with autistic spectrum disorders.
        J. Autism Dev. Disord. 2007; 37: 589-600
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Int. J. Surg. 2010; 8: 336-341
        • Ortiz-Gutierrez R.
        • Cano-de-la-Cuerda R.
        • Galan-del-Rio F.
        • Alguacil-Diego I.M.
        • Palacios-Cena D.
        • Miangolarra-Page J.C.
        A telerehabilitation program improves postural control in multiple sclerosis patients: a Spanish preliminary study.
        Int. J. Environ. Res. Public Health. 2013; 10: 5697-5710
        • Panic N.
        • Leoncini E.
        • de Belvis G.
        • Ricciardi W.
        • Boccia S.
        Evaluation of the endorsement of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement on the quality of published systematic review and meta-analyses.
        PLoS One. 2013; 8: e83138
        • Pompeu J.
        • de santos Mendes F.A.
        • da Silva K.G.
        • Lobo A.M.
        • Oliveira T. de P.
        • Zomignani A.P.
        • Piemonte M.E.P.
        Effect of Nintendo Wii⨵-based motor and cognitive training on activities of daily living in patients with Parkinson's disease. A randomised clinical trial.
        Physiotherapy. 2012; 98: 196-204
        • Sampson P.
        • Freeman C.
        • Coote S.
        • Demain S.
        • Feys P.
        • Meadmore K.
        • Hughes A.M.
        Using functional electrical stimulation mediated by iterative learning control and robotics to improve arm movement for people with multiple sclerosis.
        IEEE Trans. Neural Syst. Rehabil. Eng. 2015;
        • Turekca S.
        • Schultheis M.
        • Sunderaraman P.
        B-89 comparison of driving performance, cognition, and physical symptoms in individuals with multiple sclerosis and healthy controls.
        Arch. Clin. Neuropsychol. 2014; 29: 570