Treadmill training with VR may help MS patients – study

Training on a treadmill and use of virtual reality (VR) may improve gait and cognition and relieve depression in relapsing-remitting patients multiple sclerosis (MS), according to a new study.

Led by researchers from Sourasky Medical Center in Tel Aviv and Sackler Medical School in Tel Aviv University (TAU), it was conducted with colleagues from the University of Kansas and the University of Berlin Charité Hospital.

Around 100 multiple sclerosis patients between the ages of 18 and 65 took part in the study, some of whom were recruited from the multiple sclerosis clinics of Professor Arnon Karni, head of the hospital’s neuroimmunology department, and the Dr. Keren Regev, head of its multiple sclerosis department.

The study showed that six weeks of gait training on a treadmill improved gait speed with and without additional task, and the addition of VR during gait contributed to additional cognitive improvement and decreased depression in subjects with relapsing-remitting MS.

This was the largest randomized controlled study to demonstrate that treadmill training with or without the addition of a VR component positively affects multiple aspects of gait and mobility in MS patients.

How is a new stem cell treatment helping multiple sclerosis patients walk again? (credit: HADASSAH UNIVERSITY MEDICAL CENTER)

MS is the most common acquired chronic neurological disease in young adults, often diagnosed between the ages of 20 and 40. Although there are treatments to slow the patient’s decline, there is no known cure.

There is no known single cause of MS, but many genetic and environmental factors have been shown to contribute to its development.

In MS, the body’s immune system mistakenly attacks and damages the fatty material – called myelin – around the nerves. Myelin is important for protecting and insulating nerves so that electrical messages sent from the brain to the rest of the body travel quickly and efficiently.

As myelin breaks down during an MS attack – a process called demyelination – patches of nerves are exposed and then scarred off, rendering the nerves unable to communicate messages properly, putting them at risk for further degeneration – like an electric wire without insulation. This means the brain cannot talk to other parts of the body, leading to a range of symptoms which can include loss of motor function – such as walking and function of the hands and arms – loss of sensation , pain, changes in vision and changes in thought and memory.

The relapsing-remitting type is the most common, where the patient experiences worsening symptoms followed by recovery. The disability does not worsen between relapses, but after each relapse it may eventually worsen.

The most common symptoms of relapse include episodic episodes of fatigue, numbness, vision problems, spasticity or stiffness, bowel and bladder problems, and problems with cognition – learning and memory or processing ‘information.

MS patients also suffer from a decline in cognitive abilities

IRINA GALPERIN, currently a doctoral student at YOU‘s Faculty of Medical Sciences and Professor Jeffrey Hausdorff from the Center for the Study of Movement, Cognition and Mobility at Sourasky, explained that these MS patients not only have problems with walking and other physical functions , but that some suffer from a decline in their cognitive abilities. , which can include memory, executive functions and more.

Improving mobility abilities – such as walking speed and walking while performing another task – as well as improving cognitive abilities can lead to a significant improvement in their quality of life.

The multicenter study has just been published in the Journal of Neurology under the title “Treadmill training with virtual reality to improve walking and cognitive function in people with multiple sclerosis: a randomized controlled trial”.

The effect of walking on a treadmill compared to walking with virtual reality was tested on various functions, such as walking with and without additional task. Some 51 subjects exercised on a treadmill under the guidance of an attached physical therapist, and 53 exercised on a treadmill with the addition of a virtual reality system projected onto a screen in front of them that required stepping over “virtual” obstacles, to navigate, etc. while walking.

Training took place three times a week for six weeks. The participants arrived at Tel Aviv Medical Center and three others in the United States and Germany before, a week after and three months after the intervention was completed.

Both groups improved walking speed by about 10%, pace, and other walking parameters whether they walked with or without an additional post-workout task. Subjects who trained with the addition of VR showed a decrease in the rate of cognitive loss and level of depression, as well as an improvement in additional measures of cognition.

After three months, some of the benefits such as faster walking and better cognition obtained during the training period were still preserved.

This type of training, the researchers said, could be an alternative to supportive drug treatment for multiple sclerosis patients with cognitive problems and depression. It has also been found that patients who can walk for five minutes at a stretch, whether they have a mild or severe case of MS, can similarly improve with exercise.

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