Nonimmersive Virtual Reality, Telerehabilitation Improve Function in MS

The use of V-TOCT and TR can improve upper limb function, trunk control, and ataxia severity among patients with MS.

Virtual reality supported task-oriented circuit therapy (V-TOCT) and telerehabilitation (TR) improved the upper limb, trunk, and hand function and decreased ataxia severity in patients with multiple sclerosis (MS), according to study findings published in the journal Multiple Sclerosis & Related Disorders.

Researchers in Turkey conducted a randomized controlled study from February 2021 to July 2022 at the Faculty of Physical Therapy and Rehabilitation at Hacettepe University in Ankara. Of the 34 eligible participants with MS, 32 completed the 8-week study with 17 (11 women, 6 men) in the V-TOCT group and 15 (13 women, 2 men) in the TR group. All patients received 1-hour treatment sessions 3 times a week for 8 weeks.

The same trained physical therapist guided all TR sessions, altering the difficulty according to patient tolerance by increasing weight or number of repetitions or changing the surface in which the patient was standing from hard to soft to challenge balance.

The V-TOCT sessions were guided by the same trained physical therapist in a clinical environment. The circuit was set up as ten workstations with 5 minutes of exercise at each station plus 1 minute of rest. A virtual reality with a touch screen and 7 computer games simulated daily activities and increased difficulty by changing the speed, distance, ground surface, and other game characteristics.

V-TOCT was more effective than TR in improving the dynamic trunk control and kinetic function.

Outcome assessments at baseline and 8 weeks included the Trunk Impairment Scale (TIS), the kinetic function sub-parameter of the International Cooperative Ataxia Rating Scale (K-ICARS), the Minnesota Manual Dexterity tests (MMDT), the ABILHAND Hand Function Questionnaire-Stroke, and upper limb and trunk kinematic assessments using Awinda sensors for motion analysis.

After 8 weeks of treatment, both the V-TOCT and TR groups demonstrated improvements in trunk and upper limb function and decreased ataxia severity (all P <.05). Dynamic trunk control and K-IRCARS scores improved more in the V-TOCT group compared with the TR group (P <.05).

Transverse shoulder and wrist functional range of motion and sagittal shoulder functional range of motion improved only in the V-TOCT group. The functional range of motion of the trunk joints in the coronal and transverse planes improved in the TR group.

“The results of the study showed that V-TOCT and TR improved upper extremity skills, trunk functions, and ataxia symptoms,” the researchers noted. “V-TOCT was more effective than TR in improving the dynamic trunk control and kinetic function,” they added.

One study limitation included the lack of real-time feedback on exercise accuracy during TR, such as wearable sensors, image processing, or artificial intelligence, which could verify correct movement patterns. Another limitation was difficulty interpreting the kinematic parameters of forward function reaching due to heterogeneous characteristics, methods, and measurements and lack of standardized reference values in the literature.


Doğan M, Ayvat E, Kılınç M. Telerehabilitation versus virtual reality supported task-oriented circuit therapy on upper limbs and trunk functions in patients with multiple sclerosis: a randomized controlled study. Mult Scler Relat Disord. Published online February 10, 2023. doi:10.1016/j.msard.2023.104558