Integrated Cognitive Training and Vestibular Rehabilitation Therapy in Management of Imbalance in Patients with Remitting Relapsing Multiple Sclerosis

Ebrahim, Manar Attia; Mekki, Soha Abdelraouf; Ibraheem, Ola Abdallah; Ibeahim, Waleed; Ismail, Mohamed Hamdy

doi:10.21608/zumj.2025.334708.3680

Integrated Cognitive Training and Vestibular Rehabilitation Therapy in Management of Imbalance in Patients with Remitting Relapsing Multiple Sclerosis

Document Type : Original Article

Authors

¹ Audio-Vestibular Medicine Unit, Department of Otorhinolaryngology, Al-Ahrar Teaching Hospital

² Audio-Vestibular Medicine Unit, Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Zagazig, Egypt

³ Neurology, faculty of medicine Zagazig University

10.21608/zumj.2025.334708.3680

Abstract

ABSTRACT

Background:Patients with remitting-relapsing multiple sclerosis (RRMS) may experience vestibular, visual, and somatosensory symptoms that affect their balance. The impact of cognitive training and vestibular rehabilitation therapy (VRT) on their postural control and quality of life is not well understood. This research aims to assess vestibular and cognitive function in these patients and evaluate the effectiveness of integrated cognitive training and customized VRT in enhancing balance and overall quality of life.

Methods:This study involved 48 patients with RRMS experiencing imbalance, divided into three groups: Group I received disease-modifying therapy (DMT) with a placebo; Group II received customized VRT and DMT; and Group III received computer-based cognitive training, customized VRT, and DMT. Evaluations included medical history, neurological exams, MRI, and assessments of otological, audiological, vestibular, and cognitive functions. The six-week intervention's effectiveness was measured using the Dizziness Handicap Inventory (DHI) and the Dynamic Gait Index (DGI).

Results: Patients with RRMS show notable central vestibular abnormalities and moderate cognitive impairment. VRT significantly enhances balance and reduces dizziness-related disability. Additionally, cognitive training using RehaCom software improves cognitive function. Integrated cognitive training and VRT are more effective in enhancing balance than customized VRT alone. There are moderate correlations between the dizziness duration and pure tone average on thepost-intervention DHI (positive) and DGI (negative) scores.

Conclusion: Combining cognitive training and VRT has proven more effective in improving balance function in patients with RRMS than VRT alone, highlighting the essential role of cognitive abilities in maintaining balance.

Keywords

Main Subjects