Mental Rotation and Motor Imagery Training in Multiple Sclerosis

This randomized controlled trial investigated the effects of sequential laterality, motor imagery, and mental rotation training in individuals with relapsing-remitting multiple sclerosis. Both groups received conventional physiotherapy, while the intervention group received structured cognitive-motor training and the control group received active visual-attention training.

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