Cognitive Rehabilitation In Multiple Sclerosis Using Xbox Kinect Gaming: A Pilot Study

Background: The prevalence of cognitive deficits in multiple sclerosis (MS) necessitates effective rehabilitation paradigms; however, relatively few studies have investigated cognitive training in this population, and evidence of its effectiveness is equivocal. Recent evidence has suggested that physical activity may have a positive effect on cognition. Furthermore, increased technology associated with commercially available gaming devices has enabled videogame play to stimulate both cognitive and motor function. The recently released XBOX 360 Kinect sensor allows full body movement during gameplay to be monitored. 

Objectives: This pilot study examined the effect of 10 weeks of gameplay using the XBOX 360 Kinect game "Body & Brain Connection" on cognitive function in people with MS. Since the game requires arm, leg and full body movement to respond to various cognitive tasks, successful play thus combines motor response with cognitive stimuli.

Methods: Nine female and 2 male participants (51.8±10.8 years) with MS and cognitive deficits underwent the Paced Auditory Serial Addition Test (PASAT) and Symbol Digit Modalities Test (SDMT) prior to treatment. The experimental group (n=7) followed the initial assessment with 10 weeks of "Body & Brain Connection" videogame play (3 sessions/week, 30-45 min/session; 2 weeks supervised, 8 weeks home-based training) while the control group (n=4) followed with 10 weeks of habitual activity. Both groups then participated in a follow-up cognitive assessment. 

Results: Four of the initial participants in the training group dropped out of training for various reasons; therefore, only 3 participants completed 10 weeks of training. Nevertheless, training was associated with a greater effect size for SDMT scores (n=3, d’=0.93) compared to dropouts (n=4, d’=-0.06) and controls (n=3, d’=-0.02). A similar trend was observed for PASAT scores (d’= 0.22, -0.22, -0.13; training, dropouts, and controls, respectively). 

Conclusions: Recruiting difficulties and participant drop-out resulted in poor study completion rates. Those who did complete the study found the training to be helpful (n=3) and each decided to invest in the XBOX gaming system and the “Body and Brain Connection” game to allow continued training. Results suggest that training with this system may improve cognition in MS, but further study is necessary.