Real-time cortical activity during virtual reality practice in people with multiple sclerosis: a pilot fNIRS study

Abstract

Background: Multiple sclerosis (MS) is a neuroinflammatory disorder affecting motor and cognitive functions. Virtual reality (VR) is increasingly used in rehabilitation, offering controlled environments for motor training and for integrating cognitive challenges into physical tasks through dual-task paradigms. Functional near-infrared spectroscopy (fNIRS) is a promising tool for assessing cortical activation in VR-based rehabilitation, yet its application in people with MS (pwMS) remains underexplored. This study aimed to examine cortical activation in pwMS during an upper-limb daily life activity performed in VR versus actual performance (AP), and to assess the additional impact of an explicit cognitive challenge implemented as a memory recall and sequencing task performed simultaneously with the motor activity.

Methods: A pilot fNIRS case-control study was conducted with 14 pwMS and 14 healthy controls, matched for age and sex. Participants completed a dishwashing task under four conditions: (1) VR, (2) VR with a cognitive challenge (VR-cog), (3) AP, and (4) AP with a cognitive challenge (AP-cog). fNIRS measured relative changes in the concentrations of oxyhemoglobin (ΔHbO), deoxyhemoglobin (ΔHbR), and total hemoglobin (ΔHbT) in the supplementary motor area (SMA), premotor cortex (PMC), and somatosensory association cortex (SAC). A general linear model and repeated-measures ANOVA assessed cortical activation across conditions.

Results: PwMS exhibited reduced ΔHbT concentrations in the SMA and PMC compared to healthy controls during both VR and AP tasks (p = 0.019 and p = 0.038, respectively), suggesting diminished neurovascular activation. Within-group analyses revealed significant task-dependent modulation in healthy controls, with greater neurovascular responses in the SMA and PMC. In contrast, pwMS showed no significant differences in cortical activation across task conditions, indicating impaired neurovascular adaptability. No significant differences between groups were observed in the VR-cog and AP-cog conditions, suggesting that the cognitive challenge did not further differentiate neurovascular responses.

Conclusions: While no significant differences in overall cortical activation were found between VR and real-world tasks, pwMS exhibited reduced neurovascular responses compared to healthy controls, indicating impaired adaptability. These findings support VR's feasibility for motor rehabilitation while highlighting the need for further studies on neuroplasticity, cognitive-motor integration, and lesion-related neurovascular changes in pwMS.

Keywords: Cortical activation; Multiple sclerosis; Upper-limb; Virtual reality; fNIRS.

Fig. 1

Dishwashing task as viewed via the immersive VR kitchen application

Fig. 2

Illustration of the experimental design

Fig. 3

Performance (dishwashing) via the VR device

Fig. 4

Actual performance (dishwashing) setup and setting

Fig. 5

The mean relative ΔHbO concentration in both groups and each task condition for the SMA and PMC

Fig. 6

The mean relative ΔHbO concentration in both groups and each task condition for the SAC