Innovative Virtual Reality Application Using Proprioceptive 'Facilitation and Inhibition' to Enhance Upper Limb Function, Postural Control, and Quality of Life in Multiple Sclerosis: A Study of Neuroplasticity and Epigenetic Mechanisms

AZV ČR 2024-2030 - MZ NW26-09-00096 [Registered results] 2026 - 2029

Principal Investigator: Prof. PhDr. Kamila Řasová, Ph.D., FTN
ICS Coinvestigator: doc. RNDr. Patrícia Martinková, Ph.D.

Multiple Sclerosis (MS) causes progressive neurological impairments, requiring lifelong treatment. Upper limb dysfunction affects up to 75% of people with MS, significantly limiting their daily activities.

Targeted physiotherapy (PT) interventions, including Virtual Reality (VR) approaches based on sensorimotor learning principles, have been shown to enhance motor function. However, neuroproprioceptive principles of "facilitation and inhibition" remain underutilized - an area our team is actively exploring.

We hypothesize that the VR application we developed (VIREFYMS) will improve clinical function and promote adaptive neuroplastic changes, as evidenced by alterations in long non-coding RNAs, dendritic cells, and subsequent functional and structural brain changes.

Investigating these imaging, molecular, and immunological factors may provide deeper insights into MS recovery and the potential of PT to enhance it. In this single-blind, randomized controlled trial, 105 participants with MS will be randomized into three groups to receive PT interventions targeting upper limb function: VIREFYMS (VR-based PT incorporating neuroproprioceptive 'facilitation and inhibition'), the same therapy without VR, and standard PT. Additionally, 35 age - and gendermatched healthy controls will be recruited.

Data will be collected before and after 15 outpatient PT sessions over two months. Primary outcomes will include upper limb function (assessed using both clinical tests and advanced tools such as kinematic and tremor analyses) and postural function. Secondary outcomes will assess quality of life, health status, and goal achievement.

Magnetic resonance imaging will include struto intervention groupctural imaging, resting-state fMRI, and diffusion tensor imaging. Monocyte-derived dendritic cells and lncRNA will be analyzed from blood samples. Statistical analyses will include t-tests, ANOVA, regression models, and item response theory to evaluate treatment effects and compare outcomes.

Supported by the Ministry of Health of the Czech Republic in cooperation with the Czech Health Research Council under project No. NW26-09-00096.