Mental Rotation and Motor Imagery Training in Multiple Sclerosis

Fifty-four participants were randomly assigned to the intervention or control group. Both groups received 45-minute sessions three times per week for six weeks. Mental rotation ability was the primary outcome, while upper-extremity function, manual ability, motor imagery, grip strength, dexterity, and information-processing speed were assessed as secondary outcomes. Assessments were performed before and after the intervention by a researcher blinded to group allocation.

Inclusion criteria

• Diagnosed with definite relapsing-remitting multiple sclerosis by a neurologist according to the revised McDonald criteria
• Not experiencing an acute MS relapse
• Mini Mental State Examination score ≥24
• No clinical MS relapse within the previous 3 months
• No corticosteroid treatment for an MS relapse within the previous 3 months
• Expanded Disability Status Scale score between 1.5 and 6.0
• Modified Ashworth Scale score ≤2
• Sufficient communication ability to understand visual and verbal instructions and follow the training protocol
• Able to attend at least 80% of the planned sessions
• Able to complete the Movement Imagery Questionnaire-3

Exclusion criteria

• Any medication change within the previous 3 months
• Uncorrected severe visual or hearing impairment
• A communication disorder preventing the perception of or response to the visual and verbal stimuli used in the study
• Participation in another structured upper-extremity rehabilitation program or interventional study during the study period
• Presence of an additional neurological disorder
• Advanced sensory loss or proprioceptive impairment that could affect participation in the intervention
• Botulinum toxin injection within the previous 3 months