Multiple sclerosis (Houndmills, Basingstoke, England) · 2026
Task-oriented virtual reality and brain functional plasticity in progressive multiple sclerosis: A randomized controlled trial on upper limb rehabilitation.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Hamedani Mehrnaz, Lombardi Giada, Boffa Giacomo, Pistarini Caterina, Cossa Federico Maria, Capello Elisabetta, Malucchi Simona, Anselmino Arianna, Fiabane Elena Maria, Di Sapio Alessia, Poirè Ilaria, Sciolla Chiara, Calautti Cinzia, Incollu Fabio, Spada Francesca, Bertolotto Antonio, Springhetti Isabella, Nardone Antonio, Sollazzo Riccardo, Fazio Giulia, Galetti Ginevra, Sormani Maria Pia, Boghi Andrea, Ponzano Marta, Inglese Matilde, Cellerino Maria, Mancardi Gianluigi
Аннотация
BACKGROUND: Motor rehabilitation effectiveness in progressive multiple sclerosis (PMS) remains uncertain. We assessed whether task-oriented (TO) rehabilitation, with or without non-immersive virtual reality, improves upper limb function in PMS and evaluated magnetic resonance imaging (MRI) changes related to motor performance.
METHODS: Eighty-one progressive multiple sclerosis patients on B-cell depleting therapy were randomized to task-oriented rehabilitation with virtual reality (TO-VR), TO rehabilitation, or passive mobilization (CG) for 8 weeks. Upper extremity performance was measured with the Nine-Hole Peg Test (9-HPT), Action Research Arm Test (ARAT), AbilHand Test (ABILHAND), and Manual Ability Measure-36 (MAM-36). Upper limb function, neurological status, and MRI were evaluated at baseline, after rehabilitation, and at 3 months.
RESULTS: Seventy-nine patients completed the study. No difference was observed in 9-HPT, but in the whole sample, ABILHAND improved post-treatment (p < 0.001), and ARAT improved on the left side (p = 0.014, false discovery rate adjusted p = 0.084). Additional gains appeared in several neurological tests. Brain volumes, morphometry, and diffusion indices were unchanged, while functional MRI showed increased connectivity post-treatment in TO-VR and TO groups, but not in CG. Connectivity changes were correlated, in particular, with clinical amelioration (ABILHAND) in both TO-VR (r = 0.54, p = 0.013) and TO groups (r = 0.50, p = 0.035).
CONCLUSION: In PMS treated with high-efficacy therapy, TO rehabilitation, particularly when combined with VR, can improve motor function, inducing functional gains and plasticity in cerebral networks.
METHODS: Eighty-one progressive multiple sclerosis patients on B-cell depleting therapy were randomized to task-oriented rehabilitation with virtual reality (TO-VR), TO rehabilitation, or passive mobilization (CG) for 8 weeks. Upper extremity performance was measured with the Nine-Hole Peg Test (9-HPT), Action Research Arm Test (ARAT), AbilHand Test (ABILHAND), and Manual Ability Measure-36 (MAM-36). Upper limb function, neurological status, and MRI were evaluated at baseline, after rehabilitation, and at 3 months.
RESULTS: Seventy-nine patients completed the study. No difference was observed in 9-HPT, but in the whole sample, ABILHAND improved post-treatment (p < 0.001), and ARAT improved on the left side (p = 0.014, false discovery rate adjusted p = 0.084). Additional gains appeared in several neurological tests. Brain volumes, morphometry, and diffusion indices were unchanged, while functional MRI showed increased connectivity post-treatment in TO-VR and TO groups, but not in CG. Connectivity changes were correlated, in particular, with clinical amelioration (ABILHAND) in both TO-VR (r = 0.54, p = 0.013) and TO groups (r = 0.50, p = 0.035).
CONCLUSION: In PMS treated with high-efficacy therapy, TO rehabilitation, particularly when combined with VR, can improve motor function, inducing functional gains and plasticity in cerebral networks.