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

Summary

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.

Conditions

• Spinal Cord Injury

Interventions

BEHAVIORAL

VR-Based Dual-Task Training with Motor Imagery

Participants will perform the game consisting of 3 different stages during one session. The motor task will include crossing the street between cars and walking on the sidewalk without hitting people. The difference between the stages will be the cognitive task, which becomes more difficult with each stage. The cognitive task in the first stage of the game will involve the colors that the patient will see and the simultaneous sound of the colors. The cognitive task in the second stage of the game will involve writing the names of some colors with black paint and reading them simultaneously. In the third stage of the game, the patient will see color names written with some colors. Every 5 seconds a new match will appear and the number of errors made during the matches will be recorded. In addition, upper extremity strengthening with PNF methods such as hold relaxation, rhythmic stabilization and repetitive stretches will be studied.

BEHAVIORAL

VR-Based Dual-Task Training without Motor Imagery

The difference of this group from the first group is that they will see that they provide mobility with a wheelchair instead of walking, which is a motor task. In this case, there will be no motor imagery of walking. Simultaneously with the game, an environment where the wheelchair can move safely will be created in order to prevent symptoms such as dizziness and nausea in the patients and the wheelchair will be moved in this environment by the researcher. The difference between the stages will be the cognitive task that becomes more difficult at each stage and it will take a total of 20 minutes to complete all stages of the game. In addition, upper extremity strengthening will be practiced with PNF methods of hold and relax, rhythmic stabilization and repetitive stretches.

BEHAVIORAL

Proprioceptive Neuromuscular Facilitation

The patients in the group will be applied only the resistance band strengthening methods including the upper extremity proprioceptive neuromuscular facilitation (PNF) patterns and methods applied as standard in rehabilitation. Strengthening will be worked on in all upper extremity PNF patterns using the resistance band with the PNF methods of hold-relax, rhythmic stabilization and repetitive stretching.

Sponsors & Collaborators

• Istinye University

  lead OTHER

Principal Investigators

• NURGÜL DÜRÜSTKAN ELBAŞI · Istinye University

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

60 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-06-16

Primary Completion

2026-01-25

Completion

2026-03-26

Countries

• Turkey (Türkiye)

Study Locations