Original article| Volume 69, 104455, January 2023

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Effect of immersive virtual reality training on hand-to-mouth task performance in people with Multiple Sclerosis: A quantitative kinematic study

Published:December 04, 2022DOI:


      • Immersive Virtual Reality (VR) is a tool potentially useful in neurorehabilitation.
      • VR was employed to improve upper limb function in people with Multiple Sclerosis.
      • VR effects were assessed by analyzing the kinematics of the “hand-to-mouth” task.
      • After the VR treatment, time and precision of the task significantly improved.
      • The immersive VR may represent a useful add-on tool for upper limb rehabilitation.



      Although the use of Virtual Reality (VR) has received increasing interest as an add-on treatment in neurorehabilitation programs in the last fifteen years, there is scarce information about the effectiveness of fully immersive VR-based treatments on upper limb (UL) motor function in people with Multiple Sclerosis (PwMS).


      In this bicentric 2-period interventional crossover study, 19 PwMS with moderate to severe disability (mean EDSS score 5.5) and relevant UL impairment underwent 12 immersive-VR sessions over a period of 4 weeks, using commercially available VR platform (Oculus Quest) and games (Fruit Ninja, Beat Saber and Creed - Rise to Glory). Possible changes associated with the treatment were objectively assessed through instrumental kinematic analysis of the “hand-to-mouth” (HTM) movement by means of optical motion capture system. Clinical tests to assess gross and fine manual dexterity (i.e., the Box and Blocks and Nine Hole Peg Test) were also administered.


      The results of the kinematic analysis suggest that the VR training positively impacted the ability of the tested PwMS to perform the HTM task. In particular, a significant reduction of the overall time required to complete the task of approximately 20% for both most and least affected limb, and an improved degree of precision and stability of the movement, as indicated by the reduced value of adjusting sway, especially for the most affected limb (-60%).


      Based on the results of the quantitative analysis, a 4-week treatment with immersive VR is able to improve speed and stability of the HTM movement in PwMS. This suggests that such an approach might be considered suitable to facilitate an immediate transfer of the possible positive effects associated with the training to common activities of daily living.



      ADL (Activities of Daily Living), BBT (Box and Block Test), CNS (Central Nervous System), EDSS (Expanded Disability Status Scale), HTM (Hand To Mouth), MS (Multiple Sclerosis), PwMS (People with Multiple Sclerosis), T-WL (Treatment-Waiting List), UL (Upper Limb), VR (Virtual Reality), W-TL (Waiting List-Treatment)
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