The role of robotic gait training coupled with virtual reality in boosting the rehabilitative outcomes in patients with multiple sclerosis

Abstract

Motor impairment is the most common symptom in multiple sclerosis (MS). Thus, a variety of new rehabilitative strategies, including robotic gait training, have been implemented, showing their effectiveness. The aim of our study was to investigate whether an intensive robotic gait training, preceding a traditional rehabilitative treatment, could be useful in improving and potentiating motor performance in MS patients. Forty-five patients, who fulfilled the inclusion criteria, were enrolled in this study and randomized into either the control group (CG) or the experimental group (EG). A complete clinical evaluation, including the Expanded Disability Severity Scale, the Functional Independence Measure, the Hamilton Rating Scale for Depression, the time up and go test (TUG), and the Tinetti balance scale, was performed at baseline (T0), after 6 week (T1), at the end of rehabilitative training (T2), and 1 month later (T3). A significant improvement was observed in the EG for all the outcome measures, whereas the CG showed an improvement only in TUG. In contrast, from T1 to T2, only CG significantly improved in all outcomes, whereas the EG had an improvement only regarding TUG. From T2 to T3, no significant differences in Functional Independence Measure scores emerged for both the groups, but a significant worsening in Tinetti balance scale and TUG was observed for the CG and in TUG for the EG. Our study provides evidence that robotic rehabilitationn coupled with two-dimensional virtual reality may be a valuable tool in promoting functional recovery in patients with MS.

Virtual Reality-Based Therapy Improves Fatigue, Impact, and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis

“…Various systematic reviews have demonstrated the efficacy of VR-based intervention as a home training method in the COVID-19 pandemic in patients with different neurological diseases, including MS [86,87]. Scientific evidence shows that home training based on VR is a therapy that provides motivation, and it can be useful in the rehabilitation of physical and cognitive function in PwMS [88]. The use of VR at home seems to have a positive impact as a method of support for traditional rehabilitation, especially during the COVID-19 pandemic, due to the difficulty of these patients accessing classical therapies in clinical centers [89].…”

Improving Cognitive Function after Traumatic Brain Injury: A Clinical Trial on the Potential Use of the Semi-Immersive Virtual Reality

“…Doniger et al showed that VR is a useful tool in cognitive and motor rehabilitation of patients with Alzheimer's disease [30]. These positive results were also confirmed in patients with multiple sclerosis, as 2D VR was able to further boost neural plasticity and thus functional recovery [31]. A recent pilot study performed on individuals with Parkinson's disease found that VR improved cognitive functions, with regard to executive and visuospatial domains, besides mood [32].…”

What Do We Know about The Use of Virtual Reality in the Rehabilitation Field? A Brief Overview

“…Two main reviews focused on VRT-based motor benefits [31,[107][108][109]. Consistent but explorative controlled randomized studies or pilot studies were included in these reviews, suggesting that VRT may promote functional recovery in patients with MS if coupled with robotic rehabilitation [110], improve the ability to perform daily activities [111][112][113], balance and gait [21,[114][115][116][117][118][119][120][121], increase short-term motor learning [122], upper limb functionality [112], and processing and integration of sensory information, with a positive impact on motor and cognitive [118,[123][124][125]; however, training differences emerged between VR-based and conventional intervention, but these were not robust when comparing VR-based intervention and passive intervention [21,[108][109][110][111][112][113][114][115][116][117][118][119][120][121].…”