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Sponsor: Uludag University

Conditions: Multiple Sclerosis

Interventions: Motor imagery, Sensorimotor Training, Conventional therapy

Countries: Turkey (Türkiye)

Many types of pain can occur in Multiple Sclerosis (MS), one of the most common types is neuropathic pain. Neuropathic pain is directly related to the disease's demyelination process and is associated with dysesthetic pain, allodynia, hyperalgesia. For neuropathic pain in MS, there are numerous physical therapy and rehabilitation interventions focused on proprioception, balance reaction time management. Loss of proprioception is commonly observed in MS, this loss results from the demyelination of the central somatosensory pathways. Proprioception-the ability to perceive the position of the body and limbs relative to the environment-is also related to balance performance. Balance problems can be detected in the early stages of the disease, even if the patient has no disability. Another effect of MS is observed in reaction time. In MS, which is characterized by demyelination, axonal damage, a slowing of nerve conduction velocity leads to a decrease in information processing speed, resulting in prolonged reaction times. Neuromuscular training models designed to train the Central Nervous System (CNS) can be used to address these effects.Motor Imagery (MI) is one of the neuromuscular training models. Imagery can be defined as the use of all one's senses to create a mental image of an activity. MI is referred to as a brain-training method and utilizes the neuromatrix theory to inhibit pain. MI training aims to retrain the neural networks that activate the neuromatrix so that they become less sensitive to stimuli that would not normally cause pain. Lateralization is a method used in conjunction with MI to distinguish between the right and left sides of the painful area. The imagery phase involves visualizing the positions and movements of the painful areas. MI is a neuromuscular training model, and another neuromuscular training method is Sensorimotor (SM) training. It is known that SM, which applies repetitive sensorimotor stimulation, passively improves sensorimotor performance. Known as perceptual learning, this approach involves simple exposure to SM stimulation for several hours. While the term "perceptual" encompasses various senses, including sight and hearing, the term "sensorimotor training" is used here specifically to refer to methods focused on SM stimulation. SM training typically does not require participants to actively focus on external stimuli, which makes it easily applicable in neuro-rehabilitation settings. It does not focus solely on increasing muscle strength in a specific area; rather, it aims to improve movement quality and patterns by training the CNS. This training model, which emphasizes the importance of sensory input in developing motor skills, plays an effective role in improving balance, enhancing functionality, and reducing pain. Studies demonstrating the effectiveness of SM interventions in MS are available. The literature shows that both MI and SM have effects on neuropathic pain, proprioception, balance, and reaction time in individuals with MS. These two methods involve different neurophysiological mechanisms. For example, MI sends a "top-down" message to the brain. It first uses laterality (right/left distinction), then imagery, and prepares the brain for movement. SM, however, sends a "bottom-up" message to the brain. It focuses primarily on sensory input. Furthermore, while MI is an approach that aims to activate central motor networks without peripheral afferent input, SM supports central motor control processes by enhancing peripheral sensory input. In addition to these differences, it is known that both methods actually train CNS.The literature shows that both MI and SM have effects on neuropathic pain, proprioception, balance, and reaction time in individuals with MS. These two methods involve different neurophysiological mechanisms. For example, MI sends a "top-down" message to the brain. It first uses laterality (right/left distinction), then imagery, and prepares the brain for movement. SM, however, sends a "bottom-up" message to the brain. It focuses primarily on sensory input. Furthermore, while MI is an approach that aims to activate central motor networks without peripheral afferent input, SM supports central motor control processes by enhancing peripheral sensory input. There are only a few studies comparing these two methods.No studies have been found in the literature that compare these two methods in patients with MS and examine their effects. The aim of our study is to examine the effects of MI and SM training administered to individuals with MS. Motor control in patients with MS is a process resulting from the interaction of central and peripheral mechanisms. For this reason, it is believed that comparing the relative effects of central-focused (MI) and peripheral-focused (SM) approaches could contribute to the development of rehabilitation interventions.