Treadmill training with virtual reality to enhance gait and cognitive function among people with multiple sclerosis: a randomized controlled trial

Irina Galperin, Anat Mirelman, Tanja Schmitz-Hübsch, Katherine L. Hsieh, Keren Regev, Arnon Karni, Marina Brozgol, Pablo Cornejo Thumm, Sharon G. Lynch, Friedemann Paul, Hannes Devos, Jacob Sosnoff, Jeffrey M. Hausdorff

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Motor and cognitive impairments impact the everyday functioning of people with MS (pwMS). The present randomized controlled trial (RCT) evaluated the benefits of a combined motor–cognitive virtual reality training program on key motor and cognitive symptoms and related outcomes in pwMS. Methods: In a single-blinded, two-arm RCT, 124 pwMS were randomized into a treadmill training with virtual reality (TT + VR) group or a treadmill training alone (TT) (active-control) group. Both groups received three training sessions per week for 6 weeks. Dual-tasking gait speed and cognitive processing speed (Symbol Digit Modalities Test, SDMT, score) were the primary outcomes. Secondary outcomes included additional tests of cognitive function, mobility, and patient-reported questionnaires. These were measured before, after, and 3 months after training. Results: Gait speed improved (p < 0.005) in both groups, similarly, by about 10 cm/s. The TT + VR group (n = 53 analyzed per-protocol) showed a clinically meaningful improvement of 4.4 points (95% CI 1.9–6.8, p = 0.001) in SDMT, compared to an improvement of only 0.8 points in the TT (n = 51 analyzed per-protocol) group (95% CI 0.9–2.5 points, p = 0.358) (group X time interaction effect p = 0.027). Furthermore, TT + VR group-specific improvements were seen in depressive symptoms (lowered by 31%, p = 0.003), attention (17%, p < 0.001), and verbal fluency (11.6% increase, p = 0.002). Discussion: These findings suggest that both TT and TT + VR improve usual and dual-task gait in pwMS. Nonetheless, a multi-modal approach based on VR positively impacts multiple aspects of cognitive function and mental health, more than seen after treadmill-treading alone. Trial registered at ClinicalTrials.Gov NCT02427997.

Original languageEnglish
Pages (from-to)1388-1401
Number of pages14
JournalJournal of Neurology
Issue number3
StatePublished - 1 Mar 2023
Externally publishedYes


  • Dual task
  • Gait
  • Multiple sclerosis
  • Treadmill training
  • Virtual reality

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology


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