Virtual Reality Dual Task Training in SCI: Effects on Cognition and Cortical Activation

Istinye University

Status: Not yet enrolling

Conditions: Spinal Cord Injury

Treatments: Behavioral: VR-Based Dual-Task Training without Motor Imagery; Behavioral: VR-Based Dual-Task Training with Motor Imagery; Behavioral: Proprioceptive Neuromuscular Facilitation

Study type: Interventional

Funder types: Other

Identifiers

NCT07019207

IstinyeUni-OCAKMAK-001

Details and patient eligibility

About

Spinal cord injury (SCI) is a severe neurological condition characterized by the loss of motor and sensory functions due to damage in the spinal cord or the nerves branching from it. Although studies investigating cognitive function after SCI are limited, it has been reported that up to 60% of individuals experience cognitive impairments. Because of impaired motor control, patients may need to invest more cognitive effort to perform even simple movements. This situation can negatively affect their ability to carry out multiple tasks at the same time and to respond effectively to environmental threats while walking, which may increase their risk of falling. Although the presence of cognitive changes after SCI is recognized in the literature, there are only a few studies examining the effects of rehabilitation on cortical activation, highlighting the need for innovative approaches to improve both motor and cognitive functions. The aim of this randomized controlled study is to investigate the effects of virtual reality (VR)-based dual-task training, both with and without motor imagery, on cortical activation, cognition, and functional level in individuals with SCI. Participants who meet the inclusion criteria will be recruited from the Turkish Spinal Cord Paralytics Association and will be randomly assigned to one of three groups: (1) a VR-based dual-task training group including motor imagery (n=15), (2) a VR-based dual-task training group without motor imagery (n=15), and (3) a control group (n=15). After obtaining informed consent and recording demographic data, pre-treatment (T0) and post-treatment (T1) assessments will be conducted. Cortical activation will be measured using functional near-infrared spectroscopy (fNIRS), grip strength with a Jamar hand dynamometer, upper extremity functional level with the Fugl-Meyer Assessment, sitting balance with the Modified Functional Reach Test, cognitive status with the Montreal Cognitive Assessment (MoCA), and occupational performance with the Canadian Occupational Performance Measure (COPM). Patient satisfaction and general health status will also be recorded. In addition to upper extremity strengthening exercises, patients in the VR groups will perform a cognitive-motor dual-task game developed by the researchers, which is played with VR glasses. The motor imagery group will complete the tasks while visualizing themselves standing and walking, while the other group will play the same game without walking imagery, from a wheelchair perspective. The game will involve motor tasks such as crossing the street between moving cars and walking on the sidewalk without bumping into people, as well as cognitive tasks based on the Stroop test, which will become progressively more difficult through three stages. Completing all stages will take approximately 20 minutes. Patients in the control group will only receive upper extremity strengthening exercises. The intervention will last for 12 sessions, conducted twice a week. The findings of this study are expected to emphasize the importance of simultaneous motor and cognitive rehabilitation in individuals with SCI and to contribute scientifically to the use of VR-supported innovative approaches in rehabilitation practices.

Enrollment: 45 estimated patients

Sex: All

Ages: 18 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Being between 18-60 years old
• Having full or partial paraplegia
• Having an injury level of T1 or below
• Having at least 90° active shoulder flexion and abduction
• Having at least 3 months since the injury

Exclusion criteria

• Musculoskeletal pain greater than 5 out of 10 on the Visual Analog Scale
• Patients who cannot sit in a chair for at least 30 minutes
• Presence of deformities or color changes in joints that prevent upper extremity movements
• Patients who have had fractures or operations on the upper extremity within the last 6 months
• History of head trauma
• Presence of a disease known to affect cognitive impairment
• Severe deafness, blindness or significant physical illnesses that cause communication disorders and prevent patients from participating in the study
• Presence of any known cardiovascular disease
• Conditions in which virtual reality glasses are contraindicated (epilepsy; vertigo and similar severe movement disorders)
• Patients with a history of stroke or progressive neurodegenerative disease
• Patients with neuromuscular disease
• Patients with uncontrolled epilepsy
• Concurrent participation in other studies or treatments

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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45 participants in 3 patient groups

VR-Based Dual-Task Training with Motor Imagery Group

Experimental group

Description:

In addition to the treatment to be applied to the participants in this group for upper extremity strengthening, they will complete a dual-task game designed by the researchers and involving cognitive-motor activity-based motor imagery that can be used with virtual reality glasses. Patients in this group will perform motor tasks during the game by seeing themselves standing and walking. Simultaneously with the game, an environment where the wheelchair can move safely will be created to prevent symptoms such as dizziness and nausea in patients and the wheelchair will be moved by the researcher in this environment. Participants will perform the game consisting of 3 different stages during one session. The motor task will be the same in all phases, the cognitive task will change.

Treatment:

Behavioral: VR-Based Dual-Task Training with Motor Imagery

VR-Based Dual-Task Training without Motor Imagery Group

Experimental group

Description:

Participants in this group will perform upper extremity strengthening exercises, similar to the other groups. Additionally, they will engage in a game that is identical in design to that used in the first group, but without incorporating motor imagery. The key distinction from the first group is that during the game, participants will achieve mobility via a wheelchair instead of performing the motor task of walking. Consequently, no motor imagery related to walking will be involved. To prevent symptoms such as dizziness and nausea during the game, a safe environment will be created in which the wheelchair can move securely. The wheelchair will be moved within this environment by the researcher. The main difference between the stages will be the progressively increasing difficulty of the cognitive tasks.

Treatment:

Behavioral: VR-Based Dual-Task Training without Motor Imagery

Control Group

Active Comparator group

Description:

This group is designated as the control group. Participants will receive only standard rehabilitation interventions, consisting of resistance band strengthening exercises based on proprioceptive neuromuscular facilitation (PNF) patterns and techniques commonly used in clinical practice.

Treatment:

Behavioral: Proprioceptive Neuromuscular Facilitation