Combined Motor Imagery and Vestibular Rehab for MS

NCT07230015 | Recruiting

• 1 other identifier: E-10840098-202.3.02-1593
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

This trial investigates the first combined use of motor imagery and vestibular rehabilitation in multiple sclerosis, aiming to evaluate their joint effect on balance, cognition, and quality of life.

Conditions

Multiple Sclerosis (MS) - Relapsing-remitting

Keywords

physical therapy; neurological rehabilitation; MS; Vestibular rehabilitation; Motor imagery; balance; QOL; Cognation; randomized control trial; physical therapy modalities; Physical therapy and rehabilitation; physical performance; Multiple Sclerosis

Outcome Measures

Primary Outcomes (7)

• Change in Cognitive Function (Montreal Cognitive Assessment [MoCA] Score)

  It is a cognitive screening tool commonly used in clinics and research to assess individual cognitive impairment and its severity. It helps therapists evaluate a patient's cognitive function and identify changes over time by assessing mental capacity functions and takes about 10-15 minutes to complete., which includes Attention \& Concentration, Executive Functions, Memory, Language, Visuospatial Skills and Orientation (19). 1. The test is scored out of 30 points. 2. A score of 26 or higher is considered normal. 3. Scores below 26 may indicate mild cognitive impairment or early dementia.

  Baseline and 8 weeks after intervention

• Change in Balance Berg Balance Scale \[ABBS] Score)

  To assess balance and fall risk in Arabic-speaking patients with neurological disorders, lower scores indicate more severe balance problems (23). 1. 41-56: Low fall risk 2. 21-40: Moderate fall risk. 3. 0-20: High fall risk."

  Baseline (Week 0) and Post-intervention (Week 8)

• Change in Vestibular Function (Dynamic Visual Acuity [DVA] Test)

  DVA assesses visual acuity during head movement to evaluate vestibulo-ocular reflex integrity.It is a functional test designed to evaluate the integrity of the vestibulo-ocular reflex (VOR), which stabilizes the eyes during head motion. DVA is commonly employed to detect vestibular dysfunction and is particularly useful for evaluating vestibular function in patients experiencing dizziness, balance disorders, or conditions such as multiple sclerosis (MS), where vestibular dysfunction is common

  Baseline and Week 8.

• Change in Vestibular Function (Head Impulse Test [HIT])

  Bedside assessment of semicircular canal/VOR function. Outcome recorded as presence/absence of corrective saccades and qualitative clinician rating of gain; improvement indicates better vestibular function.It is a clinical test used to identify deficits in the semicircular canals, especially the horizontal canal, and is useful for detecting peripheral vestibular deficits. It assesses the ability of the vestibulo-ocular reflex (VOR) to maintain stable vision during rapid, unpredictable head movements

  Baseline and Week 8

• Change in Cognitive Function (Brief International Cognitive Assessment for MS \[BICAMS] Composite Score

  Cognition will be assessed using BICAMS (SDMT, CVLT-II, BVMT-R). A composite and subtest scores will be calculated; This test is valdiated in Egyption dialect. It is a specialized tool designed for patients with multiple sclerosis to assess their cognitive function. It is reliable, quick, and sensitive, making it useful for both clinical settings and research. The tool focuses on cognitive domains that are commonly affected in multiple sclerosis, such as memory, speed, and learning. It includes tests like the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test-II (CVLT-II), and Brief Visuospatial Memory Test-Revised (BVMT-R)

  Baseline (Week 0) and Post-intervention (Week 8)

• Change in balance (Timed Up and Go [TUG] Time)

  Seconds to stand up, walk 3 m, turn, return, and sit. Lower times indicate better mobility; ≥12 s suggests increased fall risk.

  Baseline and Week 8

• Change in Disability Status (Patient-Determined Disease Steps \[PDDS] Score)

  Self-reported disability (0-8); higher scores indicate greater disability.

  Baseline and Week 8.

Secondary Outcomes (1)

• Change in Quality of Life (Multiple Sclerosis Impact Scale-29 \[MSIS-29]

  Baseline and Week 8.

Study Arms (2)

Motor Imagery + Vestibular Rehabilitation Group

EXPERIMENTAL

Participants receive a combined intervention of motor imagery and vestibular rehabilitation. Sessions last 55 minutes, including 5 min breathing warm-up, 20 min motor imagery training, 20 min vestibular exercises for balance and dizziness reduction, and 10 min cool-down/relaxation. The program aims to improve balance, cognitive function, and quality of life in patients with Multiple Sclerosis. Symptoms are monitored to avoid overexertion or symptom exacerbation.

Behavioral: Motor Imagery + Vestibular Rehabilitation group

Conventional Group

OTHER

Participants receive conventional care for Multiple Sclerosis, including routine medical follow-up and standard physiotherapy if applicable. No specific motor imagery or vestibular rehabilitation exercises are administered. This group serves as a comparison to evaluate the effects of the experimental intervention.

Behavioral: Conventional therapy group

Interventions

Conventional therapy group BEHAVIORAL

This 8-week program, 3 sessions/week, 55- 60 min each, includes: Warm-up: Seated/standing marching, neck and shoulder stretching. Strength \& Functional Movements: Sit-to-stand, side leg raises, step-ups. Core \& Upper Body: Bridge exercise, seated core activation, seated leg lifts, wall push-ups, seated shoulder press. Flexibility \& Balance: Calf and hamstring stretches, spinal flexibility, single-leg stance, lunges, tandem walking. Cool-down: Deep breathing and gentle stretching.

Conventional Group

Motor Imagery + Vestibular Rehabilitation group BEHAVIORAL

This 8-week program, 3 sessions/week, 55- 60 min each, includes 4 steps: Warm-up (5 min): Breathing exercises progressing from basic diaphragmatic and pursed-lip breathing (weeks 1-2), light movement with breathing (weeks 3-4), to Inspiratory Muscle Training device (weeks 5-8). Motor Imagery (15 min): Foundational phase (weeks 1-2) imagining basic movements, skills building (weeks 3-4) with functional daily tasks, advanced phase (weeks 5-8) imagining complex tasks, environmental and cognitive challenges (e.g., sports, obstacle navigation, walking on uneven surfaces). Vestibular Rehabilitation (15 min): Foundational (weeks 1-2) gaze stabilization and static balance (VOR, VSR, VCR), dynamic balance and dual-task exercises (weeks 3-6), advanced functional balance and vestibular-cognition integration (weeks 7-8). Cool-down (10 min): Relaxation and symptom monitoring to prevent overexertion, dizziness, or fatigue.

Motor Imagery + Vestibular Rehabilitation Group

Eligibility Criteria

• Age: 18 Years - 45 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Diagnosis of Multiple Sclerosis (MS) Confirmed using McDonald Criteria
• Patient diagnosed relapsing-remitting multiple sclerosis (RRMS).
• Mild MS between 0-3 according to PDDS.
• Age from (18-45)
• Mild cognitive impairment
• Balance impairment (mild to moderate impairment)
• Vestibular dysfunction Related to MS (dizziness, vertigo , gaze instability ) 8. Native language is Arabic to ensure clear communication during cognitive tasks and exercise instructions
• \. Be able to joined the treatment (motor imagery, vestibular rehabilitaiton )

You may not qualify if:

• Other neurological disorder, progressive multiple sclerosis Non-MS related vestibular disorders (e.g., BPPV, Meniere's disease) that would interfere with vestibular rehab.
• Severe Psychiatric Conditions (schizophrenia, bipolar, etc) Sever balance disorder Sever fatigue Medical instability eg (cardiovascular disease, respiratory, infections, severe uncontrolled diabetes, or severe visual impairments.) Sever cognitive impairment Pregnant Advance disability ( wheelchair , unable to stand ) Use of Vestibular-Suppressing Medications Non - speaker Arabic

Sponsors & Collaborators

• Medipol University: lead

Study Sites (1)

Gehad Salem Mohamed Mohamed Menshawi

Istanbul, Beykoz/İstanbul, 34810, Turkey (Türkiye)

RECRUITING

Related Publications (14)

• Ozgen G, Karapolat H, Akkoc Y, Yuceyar N. Is customized vestibular rehabilitation effective in patients with multiple sclerosis? A randomized controlled trial. Eur J Phys Rehabil Med. 2016 Aug;52(4):466-78. Epub 2016 Apr 6.

  PMID: 27050082 BACKGROUND

• Abraham A, Hart A, Andrade I, Hackney ME. Dynamic Neuro-Cognitive Imagery Improves Mental Imagery Ability, Disease Severity, and Motor and Cognitive Functions in People with Parkinson's Disease. Neural Plast. 2018 Mar 14;2018:6168507. doi: 10.1155/2018/6168507. eCollection 2018.

  PMID: 29725348 BACKGROUND

• Aljarallah S, Alkhathlan H, Almushawah A, Badahdah A, Alfaifi N, Abdulmaged-Ahmed DA, Alkhawajah NM. Performance of an Arabic translation of the patient determined disease steps (PDDS) scale in Saudi patients with multiple sclerosis. Medicine (Baltimore). 2023 Nov 3;102(44):e35889. doi: 10.1097/MD.0000000000035889.

  PMID: 37932990 BACKGROUND

• Rahman TT, El Gaafary MM. Montreal Cognitive Assessment Arabic version: reliability and validity prevalence of mild cognitive impairment among elderly attending geriatric clubs in Cairo. Geriatr Gerontol Int. 2009 Mar;9(1):54-61. doi: 10.1111/j.1447-0594.2008.00509.x.

  PMID: 19260980 BACKGROUND

• Manago MM, Schenkman M, Berliner J, Hebert JR. Gaze stabilization and dynamic visual acuity in people with multiple sclerosis. J Vestib Res. 2016;26(5-6):469-477. doi: 10.3233/VES-160593.

  PMID: 28262642 BACKGROUND

• Mulder T. Motor imagery and action observation: cognitive tools for rehabilitation. J Neural Transm (Vienna). 2007;114(10):1265-78. doi: 10.1007/s00702-007-0763-z. Epub 2007 Jun 20.

  PMID: 17579805 BACKGROUND

• Urgesi C, Moro V, Candidi M, Aglioti SM. Mapping implied body actions in the human motor system. J Neurosci. 2006 Jul 26;26(30):7942-9. doi: 10.1523/JNEUROSCI.1289-06.2006.

  PMID: 16870739 BACKGROUND

• Volz MS, Suarez-Contreras V, Portilla AL, Fregni F. Mental imagery-induced attention modulates pain perception and cortical excitability. BMC Neurosci. 2015 Mar 15;16:15. doi: 10.1186/s12868-015-0146-6.

  PMID: 25887060 BACKGROUND

• Khan F, Amatya B. Rehabilitation in Multiple Sclerosis: A Systematic Review of Systematic Reviews. Arch Phys Med Rehabil. 2017 Feb;98(2):353-367. doi: 10.1016/j.apmr.2016.04.016. Epub 2016 May 20.

  PMID: 27216225 BACKGROUND

• Efendi H. Clinically Isolated Syndromes: Clinical Characteristics, Differential Diagnosis, and Management. Noro Psikiyatr Ars. 2015 Dec;52(Suppl 1):S1-S11. doi: 10.5152/npa.2015.12608. Epub 2015 Dec 1.

  PMID: 28360754 BACKGROUND

• McGinley MP, Goldschmidt CH, Rae-Grant AD. Diagnosis and Treatment of Multiple Sclerosis: A Review. JAMA. 2021 Feb 23;325(8):765-779. doi: 10.1001/jama.2020.26858.

  PMID: 33620411 BACKGROUND

• Habbestad A, Willumsen JS, Aarseth JH, Grytten N, Midgard R, Wergeland S, Myhr KM, Torkildsen O. Increasing age of multiple sclerosis onset from 1920 to 2022: a population-based study. J Neurol. 2024 Apr;271(4):1610-1617. doi: 10.1007/s00415-023-12047-9. Epub 2023 Dec 14.

  PMID: 38097800 BACKGROUND

• Walton C, King R, Rechtman L, Kaye W, Leray E, Marrie RA, Robertson N, La Rocca N, Uitdehaag B, van der Mei I, Wallin M, Helme A, Angood Napier C, Rijke N, Baneke P. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Mult Scler. 2020 Dec;26(14):1816-1821. doi: 10.1177/1352458520970841. Epub 2020 Nov 11.

  PMID: 33174475 BACKGROUND

• Garcia-Munoz C, Cortes-Vega MD, Heredia-Rizo AM, Martin-Valero R, Garcia-Bernal MI, Casuso-Holgado MJ. Effectiveness of Vestibular Training for Balance and Dizziness Rehabilitation in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis. J Clin Med. 2020 Feb 21;9(2):590. doi: 10.3390/jcm9020590.

  PMID: 32098162 RESULT

Related Links

• Clinical characteristics of patients with multiple sclerosis enrolled in a new registry in Egypt
• Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy
• Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment
• Book Multiple Sclerosis Rehabilitation From Impairment to Participation Edited ByMarcia Finlayson
• Effectiveness of Motor Imagery on Motor Recovery in Patients with Multiple Sclerosis: Systematic Review
• The Effectiveness of Vestibular Rehabilitation on Balance Related Impairments among Multiple Sclerosis Patients: A Systematic Review
• Motor imagery in multiple sclerosis: exploring applications in therapeutic treatment
• Effectiveness of Vestibular Training for Balance and Dizziness Rehabilitation in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis
• Vestibular Rehabilitation
• Reliability and validity of Arabic version of the brief international cognitive assessment for multiple sclerosis: Egyptian dialect
• Advances in dynamic visual acuity test research
• Validation of the Arabic version of the Berg Balance Scale (A-BBS) among elderly residents in a rural community
• The reliability and validity of the Timed Up and Go as a clinical tool in individuals with and without disabilities across a lifespan: a systematic review
• Validation of the Arabic Version of the Multiple Sclerosis Impact Scale (MSIS-29): a Rasch Analysis Study
• Combined upper limb and breathing exercise programme for pain management in ambulatory and non-ambulatory multiple sclerosis individuals: part II analyses from feasibility study
• Exercise and multiple sclerosis
• Best practice for motor imagery: a systematic literature review on motor imagery training elements in five different disciplines
• Effects of Motor Imagery Training on Balance and Gait in Older Adults: A Randomized Controlled Pilot Study
• Rehabilitation to improve gaze and postural stability in people with multiple sclerosis: study protocol for a prospective randomized clinical trial
• Vestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with booklet based vestibular rehabilitation for vestibulopathy and a 12 month observational cohort stu
• Exercises for multiple sclerosis : a safe and effective program to fight fatigue, build strength, and improve balance

MeSH Terms

Conditions

Multiple Sclerosis, Relapsing-Remitting; Multiple Sclerosis

Condition Hierarchy (Ancestors)

Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Nervous System Diseases; Demyelinating Diseases; Autoimmune Diseases; Immune System Diseases

Study Officials

• Merve Yılmaz Menek, Assoc. Prof

  Assoc. Prof. Merve Yılmaz Menek

  STUDY DIRECTOR

Central Study Contacts

Gehad Salem menshawi, PT, MSc (Cand.)

CONTACT

+201040131964; j.menshawi@hotmail.com

aliaa Salem menshawi, PT, MSc (Cand.)

CONTACT

+9055244212805; aliaamenshawi@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: Participants will not be informed of their group allocation. Due to the nature of the intervention, the investigator and care provider will be aware of the assignments, and the outcome assessments will also be conducted by the investigator."
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: PT, MSc (Cand.)

Model Details: This is a parallel group randomized controlled trial with two arms: an intervention group receiving motor imagery plus vestibular rehabilitation and a control group receiving conventional therapy only.

Study Record Dates

• First Submitted: September 23, 2025
• First Posted: November 17, 2025
• Study Start: December 1, 2025
• Primary Completion (Estimated): May 30, 2026
• Study Completion (Estimated): July 20, 2026
• Last Updated: April 30, 2026

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)