- •We tested the effects of an immersive VR approach on UL rehabilitation in PwMS.
- •An immersive VR approach improved gross dexterity in less affected limb in PwMS.
- •An immersive VR approach is feasible for arm rehabilitation in PwMS.
Upper limb dysfunctions are common in people with multiple sclerosis (PwMS) and lead to limitations in activities of daily living. In this study, we investigated the feasibility and effects of an immersive commercial virtual reality system for upper limb bilateral rehabilitation.
A total of 20 participants were included in a cross over study with two arm sequences: Treatment-Waiting List (T-WL; N = 9) and Waiting List-Treatment (WT-T; N = 11). T-WL sequence performed 12 sessions of bilateral UL rehabilitation over a 4-week period, based on the use of a commercially VR immersive platform (Oculus Rift), followed by a 4-week wash-out period and a 4-week waiting list period. WL-T sequence followed the protocol in the reverse order.
Participants were tested at baseline (T0), after the end of the first 4-week period (T1), at the end of the wash-out period and finally at the end of the third 4-week period (T2). The primary outcome was the Box and Blocks test (BBT). Secondary outcome measures were: Nine Hole Peg Test (NHPT), Maximal isometric handgrip strength, Manual Ability Measure-36 (MAM-36), Modified Fatigue Impact Scale (MFIS), and the System Usability Scale (SUS).
In absence of carryover effects, we analyzed primary and secondary outcome measures with mixed linear effect models. Treatment efficacy was assessed on the within-subject differences. Specifically, we used the intra-individual differences at the end of treatment and waiting-list periods (T1 and T2) as dependent variables and sequences (T-WL or WL-T) as independent variable. In presence of carryover effects (p-value <0.05), we assessed between sequence differences by an unpaired t-test considering T0 and T1 as time points, and sequence as group factor.
We observed clinical and statistical improvements for BBT, with an overall between-sequence difference of 8.6 ± 2.6 blocks (p < 0.01) favoring treatment period in the less affected side, and a not significant change of 3.0 ± 2.6 blocks (p = 0.28) in the most affected side. Small and not significant between-sequence differences were found for 9HPT, and handgrip strength in both sides. Similarly, no differences were found for patient reported outcomes, MFIS and MAM-36. Finally, mean SUS score was 45.9 ± 11.1 points, representing a moderate usability of the system.
An immersive VR-based approach resulted useful to improve gross manual dexterity in the less affected limb in PwMS. However, such improvement did not translate into modifications in terms of self-reported ability to carry out activities of daily living nor went along with improvement in fine hand dexterity, strength or fatigue. Finally, usability of this technology was overall judged moderate, with lower scores assigned to items representing user-friendliness.
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:Subscribe to Multiple Sclerosis and Related Disorders
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- An overview of systematic reviews on upper extremity outcome measures after stroke.BMC Neurol. 2015; 15: 29https://doi.org/10.1186/s12883-015-0292-6
- Determining what individual SUS scores mean: adding an adjective rating scale.J. Usability Stud. 2009; 4: 114-123
- Unilateral and bilateral upper limb dysfunction at body functions, activity and participation levels in people with multiple sclerosis.Mult. Scler. 2015; 21: 1566-1574https://doi.org/10.1177/1352458514567553
- Upper limb motor rehabilitation impacts white matter microstructure in multiple sclerosis.Neuroimage. 2014; 90: 107-116
- Access, delivery and perceived efficacy of physiotherapy and use of complementary and alternative therapies by people with progressive multiple sclerosis in the United Kingdom: an online survey.Mult Scler Relat Disord. 2017; 12: 64-69https://doi.org/10.1016/j.msard.2017.01.002
- Reliability and validity of ratings of perceived exertion in persons with multiple sclerosis.Arch. Phys. Med. Rehabil. 2016; 97: 974-982https://doi.org/10.1016/j.apmr.2016.01.013
I. Cortés-Pérez, M. Sánchez-Alcalá, F.A. Nieto-Escámez, Y. Castellote-Caballero, E. Obrero-Gaitán, M.C Osuna-Pérez. Virtual reality-based therapy improves fatigue, impact, and quality of life in patients with multiple sclerosis. A Syst. Rev. A Meta Anal. Sens. (Basel). 2021 Nov 6;21(21):7389. doi: 10.3390/s21217389.
- Multiple sclerosis outcome assessments consortium. The nine-hole peg test as a manual dexterity performance measure for multiple sclerosis.Mult. Scler. 2017; 23: 711-720
- Upper extremity function in multiple sclerosis: improving assessment sensitivity with box-and-block and nine-hole peg tests.Arch. Phys. Med. Rehab. 1988; 69: 850-854
- High concurrent presence of disability in multiple sclerosis. Associations with perceived health.J. Neurol. 2007; 254: 767-773https://doi.org/10.1007/s00415-006-0431-5
- Serious games for arm rehabilitation of persons with multiple sclerosis. A randomized controlled pilot study.Mult. Scler. Relat. Disord. 2018; 19: 25-29https://doi.org/10.1016/j.msard.2017.10.010
- Unilateral arm rehabilitation for persons with multiple sclerosis using serious games in a virtual reality approach: bilateral treatment effect?.Mult. Scler. Relat. Disord. 2019; 35: 76-82https://doi.org/10.1016/j.msard.2019.07.010
- Effects of a new sensory re-education training tool on hand sensibility and manual dexterity in people with multiple sclerosis.NeuroRehabilitation. 2013; 32: 943-948
- Neural plasticity and neurorehabilitation: teaching the new brain old tricks.J. Commun. Disord. 2011; 44: 521-528https://doi.org/10.1016/j.jcomdis.2011.04.006
- Upper limb assessment in multiple sclerosis: a systematic review of outcome measures and their psychometric properties.Arch. Phys. Med. Rehabil. 2014; 95: 1184-1200
- Associations of upper limb disability measures on different levels of the International Classification of Functioning, Disability and Health in people with multiple sclerosis.Phys. Ther. 2015; 95: 65-75https://doi.org/10.2522/ptj.20130588
- Upper limb rehabilitation in people with multiple sclerosis: a systematic review.Neurorehabil. Neural Repair. 2016; 30: 773-793https://doi.org/10.1177/1545968315624785
- Intensity-dependent clinical effects of an individualized technology-supported task-oriented upper limb training program in multiple sclerosis: a pilot randomized controlled trial.Mult. Scler. Relat. Disord. 2019; 34: 119-127https://doi.org/10.1016/j.msard.2019.06.014
- Psychometric properties of the modified fatigue impact scale.Int. J. MS Care. 2013; 15 (Spring): 15-20
- Virtual reality for stroke rehabilitation.Cochrane Database Syst. Rev. 2011; CD008349https://doi.org/10.1002/14651858.CD008349.pub2
- Virtual reality for stroke rehabilitation.Cochrane Database Syst. Rev. 2017; 11CD008349https://doi.org/10.1002/14651858.CD008349.pub4
- Population based norms for the box and blocks test in healthy right-handed Taiwanese adults.Biomed. J. 2020; 43: 484-489https://doi.org/10.1016/j.bj.2019.10.004
- Effects of dalfampridine on multi-dimensional aspects of gait and dexterity in multiple sclerosis among timed walk responders and non-responders.J. Neurol. Sci. 2015; 356: 77-82https://doi.org/10.1016/j.jns.2015.06.008
- Van der Loos HF. Video games and rehabilitation: using design principles to enhance engagement in physical therapy.J. Neurol. Phys. Ther. 2013; 37: 166-175https://doi.org/10.1097/NPT.0000000000000017
- Effectiveness of virtual reality rehabilitation in persons with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.Mult. Scler. Relat. Disord. 2021; 54103128https://doi.org/10.1016/j.msard.2021.103128
- Longitudinal assessment of hand function in individuals with multiple sclerosis.Mult. Scler. Relat. Disord. 2019; 32: 107-113
- Adult norms for a commercially available nine hole peg test for finger dexterity.Am. J. Occup. Ther. 2003; 57: 570-573
- Measuring deterioration in international classification of functioning domains of people with multiple sclerosis who are ambulatory.Phys. Ther. 2008; 88: 176-190https://doi.org/10.2522/ptj.20070064
- Timed Up and Go in men and women with multiple sclerosis: effect of muscular strength.J. Bodyw. Mov. Ther. 2020; 24: 124-130https://doi.org/10.1016/j.jbmt.2020.06.014
- Use of wrist-worn accelerometers to quantify bilateral upper limb activity and asymmetry under free-living conditions in people with multiple sclerosis.Mult. Scler. Relat. Disord. 2021; 53: 103081https://doi.org/10.1016/j.msard.2021.103081
- Using Virtual Reality and Videogames for Traumatic Brain Injury Rehabilitation: a Structured Literature Review.Games Health J. 2014; 3: 202-214https://doi.org/10.1089/g4h.2014.0013
- Diagnostic criteria for multiple sclerosis: 2010 revisions to the “McDonald criteria.Ann. Neurol. 2011; 69: 292-302
- MAM-36 and ABILHAND as outcome measures of multiple sclerosis hand disability: an observational study.Eur. J. Phys. Rehabil. Med. 2021; 57: 520-526https://doi.org/10.23736/S1973-9087.20.06446-1
- Reliability and validity of the DynEx dynamometer.J. Hand Ther. 2005; 18: 339-347
- Haptic vs sensorimotor training in the treatment of upper limb dysfunction in multiple sclerosis: a multi-center, randomised controlled trial.J. Neurol. Sci. 2020; 412116743https://doi.org/10.1016/j.jns.2020.116743
- Box and block test, hand grip strength and nine-hole peg test: correlations between three upper limb objective measures in multiple sclerosis.Eur. J. Neurol. 2020; 27: 2523-2530https://doi.org/10.1111/ene.14427
- The use of gaming technology for rehabilitation in people with multiple sclerosis.Mult. Scler. 2015; 21: 355-371https://doi.org/10.1177/1352458514563593
- Feasibility of a home-based tablet app for dexterity training in multiple sclerosis: usability study.JMIR Mhealth. Uhealth. 2020; 8: e18204https://doi.org/10.2196/18204
- A health-related quality of life measure for multiple sclerosis.Qual. Life Res. 1995; 4: 187-206https://doi.org/10.1007/BF02260859
- Upper limb rehabilitation interventions using virtual reality for people with multiple sclerosis: a systematic review.Mult. Scler. Relat. Disord. 2021; 47102610https://doi.org/10.1016/j.msard.2020.102610
- On the proper use of the crossover design in clinical trials: part 18 of a series on evaluation of scientific publications.Dtsch. Arztebl. Int. 2012; 109: 276-281
- Virtual reality gaming in the rehabilitation of the upper extremities post-stroke.Brain Inj. 2016; 30: 855-863https://doi.org/10.3109/02699052.2016.1144146
Published online: June 29, 2022
Accepted: June 26, 2022
Received in revised form: June 22, 2022
Received: April 6, 2022
© 2022 Elsevier B.V. All rights reserved.