Causal Model of Psychological Awareness Based on Visual Spatial Transformation, Sports Mindfulness and Perceived Physical Fitness in Patients with Amyotrophic Lateral Sclerosis (ALS); The Mediating Role of Mental Balance
DOI:
https://doi.org/10.12974/2313-1047.2026.13.05Keywords:
Perceived physical fitness, Visual-spatial development, Mental balance, Psychological awareness, Sports mindfulness, Amyotrophic lateral sclerosisAbstract
The aim of the present study was to present a model of psychological awareness in patients with amyotrophic lateral sclerosis (ALS) based on visual-spatial development, sports mindfulness, and perceived physical fitness with the mediating role of mental balance. The research design was a quantitative correlational type. The statistical population was all patients with ALS in the city of Al-Shatar (Lorestan province) in 2024-2025, and 300 people were selected for the sample using the Krejci-Morgan table using the available sampling method. The scales of visual-spatial development, sports mindfulness, perceived physical fitness, and mental balance were used. The obtained data were analyzed using SPSS24 and AMOS software. The findings showed that the standard coefficients of the path of visual-spatial development (β = 0.77), perceived physical fitness (β = 0.55), sports mindfulness (β = 0.50), and mental balance (β = 0.60) were significantly related to psychological awareness (P < 0.001). The findings also showed that 28% of the variance in mental balance and 37% of the variance in psychological awareness were explained by the present model. In addition, the use of the bootstrap method showed that mental balance has a mediating role in the relationship between exogenous variables and psychological awareness. Therefore, based on the results obtained, it is suggested that relevant authorities should pay more attention to the predictive role of visual-spatial development variables, sports mindfulness, and perceived physical fitness and the mediating role of mental balance in promoting psychological awareness in patients with ALS.
References
Abasıyanık, Z., Özdoğar, A. T., Sağıcı, Ö., Kahraman, T., Baba, C., Ertekin, Ö., & Özakbaş, S. (2020). Explanatory factors of balance confidence in persons with multiple sclerosis: Beyond the physical functions. Multiple sclerosis and related disorders, 43, 102239. https://www.sciencedirect.com/science/article/abs/pii/S2211034820303151. https://doi.org/10.1016/j.msard.2020.102239
Adamson, B. C., Adamson, M. D., Littlefield, M. M., & Motl, R. W. (2018). ‘Move it or lose it’: perceptions of the impact of physical activity on multiple sclerosis symptoms, relapse and disability identity. Qualitative Research in Sport, Exercise and Health, 10(4), 457-475. https://www.tandfonline.com. https://doi.org/10.1080/2159676X.2017.1415221
Barin, L., Salmen, A., Disanto, G., Babačić, H., Calabrese, P., Chan, A., ... & von Wyl, V. (2018). The disease burden of multiple sclerosis from the individual and population perspective: which symptoms matter most?. Multiple sclerosis and related disorders, 25(18), 112-121. https://www.sciencedirect.com/science/article/abs/pii/S2211034818302220. https://doi.org/10.1016/j.msard.2018.07.013
Carletto, S., Cavalera, C., Sadowski, I., Rovaris, M., Borghi, M., Khoury, B., ... & Pagnini, F. (2020). Mindfulness-based interventions for the improvement of well-being in people with multiple sclerosis: a systematic review and meta-analysis. Psychosomatic medicine, 82(6), 600-613. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2017.02083/full. https://doi.org/10.1097/PSY.0000000000000819
Carletto, S., Tesio, V., Borghi, M., Francone, D., Scavelli, F., Bertino, G., ... & Ostacoli, L. (2017). The effectiveness of a body-affective mindfulness intervention for multiple sclerosis patients with depressive symptoms: a randomized controlled clinical trial. Frontiers in psychology, 8(6),19-34. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2017.02083/full. https://doi.org/10.3389/fpsyg.2017.02083
Davis, B. E., Lakin, L., Binns, C. C., Currie, K. M., & Rensel, M. R. (2021). Patient and provider insights into the impact of multiple sclerosis on mental health: a narrative review. Neurology and Therapy, 10, 99-119. https://doi.org/10.1007/s40120-021-00240-9
DeOliveira, G., Fernandes, M. D. C. C. G., de Faria Oliveira, J. D., Rodrigues, M. R., & Santaella, D. F. (2016). Yoga training has positive effects on postural balance and its influence on activities of daily living in people with multiple sclerosis: a pilot study. Explore, 12(5), 325-332. https://www.sciencedirect.com/science/article/abs/pii/S1550830716300672. https://doi.org/10.1016/j.explore.2016.06.005
Dietmaier, J. M., von dem Knesebeck, O., Heesen, C., & Kofahl, C. (2022). Personality and its association with self-management in multiple sclerosis. Multiple Sclerosis and Related Disorders, 12(5),61-76. https://www.sciencedirect.com/science/article/abs/pii/S221103482200267Xhttps://www.sciencedirect.com/science/article/abs/pii/S221103482200267X. https://doi.org/10.1016/j.msard.2022.103752
Ensari, I., Sandroff, B. M., & Motl, R. W. (2016). Effects of single bouts of walking exercise and yoga on acute mood symptoms in people with multiple sclerosis. International journal of MS care,. https://meridian.allenpress.com/ijmsc/article/18/1/1/33263/Effects-of-Single-Bouts-of-Walking-Exercise-and. https://doi.org/10.7224/1537-2073.2014-104
Frank, R., & Larimore, J. (2015). Yoga as a method of symptom management in multiple sclerosis. Frontiers in neuroscience, 20(6), 123-133. https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2015.00133/full. https://doi.org/10.3389/fnins.2015.00133
Fraser, C., & Stark, S. (2003). Cognitive symptoms and correlates of physical disability in individuals with multiple sclerosis. Journal of Neuroscience Nursing, 35(6), 314-320. https://journals.lww.com/jnnonline/abstract/2003/12000/cognitive_symptoms_and_correlates_of_physical.5.aspx. https://doi.org/10.1097/01376517-200312000-00005
Ghasemi, N., Razavi, S., & Nikzad, E. (2017). Multiple sclerosis: pathogenesis, symptoms, diagnoses and cell-based therapy. Cell Journal (Yakhteh), 19(1), 1-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241505/
Gilad, R., Sadeh, M., Boaz, M., & Lampl, Y. (2006). Visual spatial neglect in multiple sclerosis. Cortex, 42(8), 1138-1142. https://www.sciencedirect.com/science/article/abs/pii/S0010945208702260. https://doi.org/10.1016/S0010-9452(08)70226-0
Gil-González, I., Martín-Rodríguez, A., Conrad, R., & Pérez-San-Gregorio, M. Á. (2020). Quality of life in adults with multiple sclerosis: a systematic review. BMJ open, 10(11), 167-187. https://www.sciencedirect.com/science/article/abs/pii/S1360859214000564. https://doi.org/10.1136/bmjopen-2020-041249
Gomelsky, A., Stolzle, A. C., & Armstrong, W. P. (2023). Pathophysiology of Female Micturition Disorders. In Female Genitourinary and Pelvic Floor Reconstruction (pp. 1-14). Cham: Springer International Publishing. https://www.sciencedirect.com/science/article/abs/pii/S1360859214000564. https://doi.org/10.1007/978-3-031-19598-3_4
Gontkovsky, S. T. (2023). Understanding visual-spatial perceptual deficits in individuals with multiple sclerosis: an analysis of patient performance on the Hooper Visual Organization Test and Visual Form Discrimination. International Journal of Neuroscience, 133(6), 636-641. https://www.tandfonline.com/doi/abs/10.1080/00207454.2021.1954642. https://doi.org/10.1080/00207454.2021.1954642
Govindarajan, P. S. I. R. (2020). A Case of Cervical Spondylotic Amyotrophy Mimicking Amyotrophic Lateral Sclerosis. https://journals.lww.com/jnnonline/abstract/2003/12000/cognitive_symptoms_and_correlates_of_physical.5.aspx
Grippa, E., Sellitto, M., Scarpazza, C., Mattioli, F., & di Pellegrino, G. (2017). Multiple sclerosis reduces sensitivity to immediate reward during decision making. Behavioral Neuroscience, 131(4), 325-342. https://www.liebertpub.com/doi/abs/10.1089/acm.2015.0015. https://doi.org/10.1037/bne0000206
Guner, S., & Inanici, F. (2015). Yoga therapy and ambulatory multiple sclerosis assessment of gait analysis parameters, fatigue and balance. Journal of bodywork and movement therapies, 19(1), 72-81. https://www.sciencedirect.com/science/article/abs/pii/S1360859214000564. https://doi.org/10.1016/j.jbmt.2014.04.004
Habek, M., Adamec, I., Barun, B., Crnošija, L., Gabelić, T., & Krbot Skorić, M. (2017). Clinical neurophysiology of multiple sclerosis. Multiple Sclerosis: Bench to Bedside: Global Perspectives on a Silent Killer, 25(7),129-139. https://link.springer.com/chapter/10.1007/978-3-319-47861-6_8. https://doi.org/10.1007/978-3-319-47861-6_8
Han, A. (2021). Mindfulness-and acceptance-based interventions for symptom reduction in individuals with multiple sclerosis: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 102(10), 2022-2031. https://www.sciencedirect.com/science/article/abs/pii/S0003999321002604. https://doi.org/10.1016/j.apmr.2021.03.011
Hasanpour-Dehkordi, A., Jivad, N., & Solati, K. (2016). Effects of yoga on physiological indices, anxiety and social functioning in multiple sclerosis patients: A randomized trial. Journal of clinical and diagnostic research: JCDR, 10(6), 1-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4963747/. https://doi.org/10.7860/JCDR/2016/18204.7916
Herson, M., & Kulkarni, J. (2022). Hormonal agents for the treatment of depression associated with the menopause. Drugs & Aging, 39(8), 607-618. https://www.mdpi.com/2227-9059/11/3/673. https://doi.org/10.1007/s40266-022-00962-x
Jakimovski, D., Benedict, R. H., Weinstock-Guttman, B., Ozel, O., Fuchs, T. A., Lincoff, N., ... & Zivadinov, R. (2021). Visual deficits and cognitive assessment of multiple sclerosis: confounder, correlate, or both? Journal of Neurology, 268(7), 2578-2588. https://link.springer.com/article/10.1007/s00415-021-10437-5. https://doi.org/10.1007/s00415-021-10437-5
Jhang, J. F., Jiang, Y. H., & Kuo, H. C. (2023). Discriminating Different Bladder and Bladder Outlet Dysfunctions by Urinary Biomarkers in Women with Frequency–Urgency Syndrome. Biomedicines, 11(3), 673. https://www.mdpi.com/2227-9059/11/3/673. https://doi.org/10.3390/biomedicines11030673
Kalron, A., Menascu, S., Frid, L., Aloni, R., & Achiron, A. (2020). Physical activity in mild multiple sclerosis: contribution of perceived fatigue, energy cost, and speed of walking. Disability and rehabilitation, 42(9), 1240-1246. https://www.tandfonline.com/doi/abs/10.1080/09638288.2018.1519603. https://doi.org/10.1080/09638288.2018.1519603
Kang, W. (2022). Understanding the Effect of Multiple Sclerosis on General and Dimensions of Mental Health. Journal of Clinical Medicine, 11(24), 74-83. https://www.mdpi.com/2077-0383/11/24/7483. https://doi.org/10.3390/jcm11247483
Lakin, L., Davis, B. E., Binns, C. C., Currie, K. M., & Rensel, M. R. (2021). Comprehensive approach to management of multiple sclerosis: addressing invisible symptoms—a narrative review. Neurology and therapy, 10(8), 75-98. https://link.springer.com/article/10.1007/s40120-021-00239-2. https://doi.org/10.1007/s40120-021-00239-2
Lopes Costa, S., Gonçalves, O. F., DeLuca, J., Chiaravalloti, N., Chakravarthi, R., & Almeida, J. (2016). The temporal dynamics of visual processing in multiple sclerosis. Applied Neuropsychology: Adult, 23(2), 133-140. https://link.springer.com/article/10.1007/s00415-021-10437-5. https://doi.org/10.1080/23279095.2015.1020157
Mayo, C. D., Miksche, K., Attwell-Pope, K., & Gawryluk, J. R. (2019). The relationship between physical activity and symptoms of fatigue, mood, and perceived cognitive impairment in adults with multiple sclerosis. Journal of clinical and experimental neuropsychology, 41(7), 715-722. https://www.tandfonline.com/doi/abs/10.1080/13803395.2019.1614535. https://doi.org/10.1080/13803395.2019.1614535
Mazancieux, A., Souchay, C., Casez, O., & Moulin, C. J. (2019). Metacognition and self-awareness in multiple sclerosis. Cortex, 98-111, 238-255. https://scholar.google.com/scholar?hl=fa&as_sdt=0%2C5&q=Siegel%2C+B.+%282022%29.+Altered+States+of+a+Lifesaving+Creative+Trance.+The+Creative+Trance%3A+Altered+States+of+Consciousness+and+the+Creative+Process%2C+174.%E2%80%8F&btnG. https://doi.org/10.1016/j.cortex.2018.11.012
Mertens, J. (2023). Walking to beats in music and metronomes in persons with progressive MS: preliminary pilot study results. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241505/
Naisby, J., Wilson-Menzfeld, G., Baker, K., Morris, R., Robinson, J., & Barry, G. (2023). Yoga and Multiple Sclerosis: Maintaining engagement in physical activity. PloS one, 18(7), 124-150.. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0288319. https://doi.org/10.1371/journal.pone.0288319
Napier-Hemy, T. P., Feyisetan, O., Stewart, H., Chamsin, A., Floyd Jr, M. S., Samsudin, A., & Omar, A. M. (2023). Prophylactic intravenous gentamicin with sedation-free cystoscopic injection of BoNT-A: No demonstrable adverse extravesical neuromuscular effects in a pilot safety study of 220 idiopathic overactive bladder patients. Journal of Clinical Urology, 16(2), 91-95. https://journals.sagepub.com/doi/abs/10.1177/20514158211016651. https://doi.org/10.1177/20514158211016651
Nguyen, J., Rothman, A., Fitzgerald, K., Whetstone, A., Syc-Mazurek, S., Aquino, J., ... & Saidha, S. (2018). Visual pathway measures are associated with neuropsychological function in multiple sclerosis. Current eye research, 43(7), 941-948. https://www.tandfonline.com/doi/abs/10.1080/02713683.2018.1459730. https://doi.org/10.1080/02713683.2018.1459730
Ogunwale, O. R. (2023). Mathematics Education: Reducing Effects of Dyscalculia in Children and Adults With Hearing Impairment. Rethinking the Teaching and Learning of Mathematics in the Pandemic Era, 56/209-211 https://www.researchgate.net/profile/Kamoru-k-Usman/publication/374447272_Rethinking_the_Teaching_and_Learning_of_Mathematics_in_the_Pandemic_Era_Festschrift_in_Honour_of_Professor_Kamoru_Olayiwola_Usman_mni_ff_fman/links/651e49d1b0df2f20a211942f/Rethinking-the-Teaching-and-Learning-of-Mathematics-in-the-Pandemic-Era-Festschrift-in-Honour-of-Professor-Kamoru-Olayiwola-Usman-mni-ff-fman.pdf#page=231
Rae-Grant, A. D. (2013). Unusual symptoms and syndromes in multiple sclerosis. Continuum: Lifelong Learning in Neurology, 19(4), 992-1006. https://journals.lww.com/continuum/abstract/2013/08000/unusual_symptoms_and_syndromes_in_multiple.13.aspx. https://doi.org/10.1212/01.CON.0000433287.30715.07
Reuter, F., Del Cul, A., Malikova, I., Naccache, L., Confort-Gouny, S., Cohen, L. & Audoin, B. (2009). White matter damage impairs access to consciousness in multiple sclerosis. Neuroimage, 44(2), 590-599. https://doi.org/10.1016/j.neuroimage.2008.08.024
Rogers, K. A., & MacDonald, M. (2015). Therapeutic yoga: symptom management for multiple sclerosis. The Journal of Alternative and Complementary Medicine, 21(11), 655-659. https://www.liebertpub.com/doi/abs/10.1089/acm.2015.0015. https://doi.org/10.1089/acm.2015.0015
Sadri Damirchi, E., & Aghazadehasl, M. (2018). The effectiveness of cognitive-behavioral group therapy on coping and self-control styles in multiple sclerosis patients. Armaghane Danesh, 22(6), 792-803.
Senders, A., Borgatti, A., Hanes, D., & Shinto, L. (2018). Association between pain and mindfulness in multiple sclerosis: a cross-sectional survey. International journal of MS care, 20(1), 28-34. https://meridian.allenpress.com/ijmsc/article/20/1/28/33399/Association-Between-Pain-and-Mindfulness-in. https://doi.org/10.7224/1537-2073.2016-076
Siegel, B. (2022). Altered States of a Lifesaving Creative Trance. The Creative Trance: Altered States of Consciousness and the Creative Process, , 174(19), 659-670. https://books.google.com/books?hl=fa&lr=&id=ThlyEAAAQBAJ&oi=fnd&pg=PA174&dq=Siegel,+B.+(2022).+Altered+States+of+a+Lifesaving+Creative+Trance.+The+Creative+Trance:+Altered+States+of+Consciousness+and+the+Creative+Process,+174.%E2%80%8F&ots=aBdqwzJLqF&sig=lwhRYTeaSpba8CFifroEMbMtYlo#v=onepage&q&f=false
Silveira, C., Guedes, R., Maia, D., Curral, R., & Coelho, R. (2019). Neuropsychiatric symptoms of multiple sclerosis: state of the art. Psychiatry investigation, 16(12), 877. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6933139/. https://doi.org/10.30773/pi.2019.0106
Simpson, R., Simpson, S., Ramparsad, N., Lawrence, M., Booth, J., & Mercer, S. W. (2020). Effects of Mindfulness-based interventions on physical symptoms in people with multiple sclerosis–a systematic review and meta-analysis. Multiple sclerosis and related disorders, 28(5), 346-350https://www.sciencedirect.com/science/article/abs/pii/S2211034819304821. https://doi.org/10.1016/j.msard.2019.101493
Simpson, R., Simpson, S., Ramparsad, N., Lawrence, M., Booth, J., & Mercer, S. W. (2019). Mindfulness-based interventions for mental well-being among people with multiple sclerosis: a systematic review and meta-analysis of randomised controlled trials. Journal of Neurology, Neurosurgery & Psychiatry. https://jnnp.bmj.com/content/90/9/1051.abstract. https://doi.org/10.1136/jnnp-2018-320165
Surulinathi, M., Kumari, N. P., & Walke, R. (2021). Covid-19 and Neurosciences: A Scientometric assessment of Global publications output during 2020–2021. International Journal of Information Dissemination and Technology, 11(4), 181-188. https://www.indianjournals.com/ijor.aspx?target=ijor:ijidt&volume=11&issue=4&article=005. https://doi.org/10.5958/2249-5576.2021.00031.5
Tervonen, T., Fox, R. J., Brooks, A., Sidorenko, T., Boyanova, N., Levitan, B., ... & Phillips-Beyer, A. (2023). Treatment preferences in relation to fatigue of patients with relapsing multiple sclerosis: A discrete choice experiment. Multiple Sclerosis Journal–Experimental, Translational and Clinical, 9(1), https://journals.sagepub.com/doi/full/10.1177/20552173221150370. https://doi.org/10.1177/20552173221150370
Thakur, P., Mohammad, A., Rastogi, Y. R., Saini, R. V., & Saini, A. K. (2020). Yoga as an intervention to manage multiple sclerosis symptoms. Journal of Ayurveda and Integrative Medicine, 11(2), 114-117. https://www.sciencedirect.com/science/article/pii/S0975947618309239. https://doi.org/10.1016/j.jaim.2019.04.005
Tollár, J., Nagy, F., Tóth, B. E., Török, K., Szita, K., Csutorás, B., ... & Hortobágyi, T. (2020). Exercise effects on multiple sclerosis quality of life and clinical-motor symptoms. Med Sci Sports Exerc, 52(5), 1007-1014. https://research.rug.nl/en/publications/exercise-effects-on-multiple-sclerosis-quality-of-life-and-clinic. https://doi.org/10.1249/MSS.0000000000002228
