Comparison of Structured Exercise and Exergaming in Pediatric-Onset Multiple Sclerosis

Time to rise from a chair, walk 3 m, turn, return, and sit. Shorter times indicate better mobility. It is an objective test used to assess functional mobility and balance in people with MS. Before the assessment, the patient is shown how the test will be performed. The patient is then asked to get up from a chair, walk 3 meters at a comfortable pace, and return to the chair and sit down. The test is repeated three times. The time taken in each attempt is recorded in seconds using a stopwatch.

The Mini-BESTest consists of 14 items or activities grouped into 4 sections: expected postural control (sitting to standing, toe-standing, standing on one leg), reactive postural control (compensatory stepping forward, backward, and sideways), sensory orientation (standing with eyes open on a firm surface, standing with eyes closed on a foam surface, standing with eyes closed on an inclined ramp), and dynamic gait (changing walking speed, walking with head turns, walking with pivot turns, stepping over an obstacle, timed stand and go with a dual task). The quality of performance on an item is represented by specific item scores (normal = 2, moderate = 1, and severe = 0) that add up to a total score ranging from 0 to 28. The expected postural control, reactive postural control, and sensory orientation section scores each range from 0 to 6, while the dynamic walking section score ranges from 0 to 10. Higher total and section scores indicate better balance control.

It is a simple, practical test applied according to the standard protocol of the American Thoracic Society to measure walking capacity. It has been reported that the test is valid and reliable in MS patients with mild and moderate disability. In our study, 6 MWTs will be performed in accordance with the standards set in the guidelines for MS patients. The participant will be asked to walk as fast as possible at his own walking pace on the 30-meter track for 6 minutes. Before starting the test, participants will be explained that they can rest if they develop excessive fatigue or respiratory distress during the test and that this time is included in the test period. As a result of the test, the distance traveled by the participant will be recorded in meters.

The arms are placed crosswise at chest level, and the patient is asked to sit down and stand up 5 times as quickly as possible from a standard chair. The test begins in a sitting position and ends in a sitting position. The result is recorded in seconds. This method, which is valid and reliable in MS, has been shown to be related to lower extremity muscle strength and balance. Lower times indicate higher performance. It is reliable in assessing lower extremity function.

It is an objective device used to assess physical activity levels and record the number of steps taken. Participants in the study will be provided with the Omron HJ-321-E brand pedometer, which is lightweight and easy to carry. All pedometers are calibrated with personalized measurements (step length, weight, height). Patients are asked to attach the pedometer to their non-dominant leg, either on a belt or clothing. The number of steps taken by participants over the course of one week will be recorded.

This two-question survey measures individuals' physical activity behavior. The GBZEA is a simple, valid, and effective primary outcome measure for defining activity levels and tracking changes after an intervention. The first question asks how often light, moderate, and vigorous activities lasting over 15 minutes are performed in a typical week. The second asks how often activities causing sweating occur. To calculate the score, weekly frequencies are multiplied by 3, 5, and 9 metabolic equivalents (METs) for light, moderate, and vigorous activity, respectively. The moderate + vigorous score is obtained by adding moderate and vigorous points, while the total score is the sum of light, moderate, and vigorous activity points.

It provides a more quantitative assessment than the EDSS. The Timed 25-Foot Walk (T25W) evaluates lower limb function by measuring the time needed to walk 8 meters (25 feet); it is repeated twice and averaged. The Nine Hole Peg Test (NHPT) measures upper limb function by timing how fast pegs are placed into nine holes; it is repeated twice for each hand and averaged. Cognitive function is assessed with the 3-second Paced Auditory Serial Addition Test (PASAT-3), where patients add each new number they hear to the previous one during a 3-minute test with 60 responses. The MSFC score combines results from all three tests into a single composite score using calculated z-scores.

PedsQL-MFS total score (0-100 transformed).This scale is a valid and reliable measure for assessing fatigue levels in the pediatric population. It consists of two separate forms: self-report and proxy report. The versions for the 13-18 and 18-25 age groups will be used in this study. The 18-item symptom-focused scale assesses three areas of fatigue (general, sleep/rest, and cognitive). Items are reverse-scored, rated, and converted linearly to a 0-100 scale: 0 = 100, 1 = 75, 2 = 50, 3 = 25, 4 = 0. Higher scores indicate higher levels of fatigue. Higher scores represent less fatigue.

It includes two parallel forms for children and families to complete and consists of sections on physical functions (8 items), emotional functions (5 items), social functions (5 items), and school functions (5 items). The child form has been developed for the 5-7, 8-12, 13-18, and 18-25 age groups, while the family form has been developed for the 2-4, 5-7, 8-12, 13-18, and 18-25 age groups. The inventory, prepared according to a five-point Likert scale, indicates that 0 = never caused a problem, 1 = hardly ever caused a problem, 2 = sometimes caused a problem, 3 = often caused a problem, and 4 = always caused a problem. A linear conversion is applied in calculating the total score of the scale, and the evaluation is made on a scale of 0-100 points (0=100, 1=75, 2=50, 3=25, 4=0). A high PedsQL score indicates better health-related quality of life. In our study, both the child and parent versions of the PedsQL will be used.