The study involves a two-arm, Phase 1, randomized controlled clinical trial designed to establish the feasibility and effects of a Functional Balance Intervention (FBI) on physical and cognitive function, as well as measures of daily living among persons with multiple sclerosis (PwMS).
Combined Specific Aims:
Aim 1: Examine the effect of the FBI (Intervention Group) on physical function in PwMS compared to a stretching program (Control Group).
Hypothesis 1: After four months of training, the FBI group will show significantly greater improvements in physical function compared to the stretching group.
Aim 2: Examine the effect of the multicomponent FBI on cognitive function in PwMS compared to the stretching program.
Hypothesis 2: After four months of training, the FBI group will show significantly greater improvements in cognitive function compared to the stretching group.
Aim 3: Examine the effects of the multicomponent FBI compared to the Control Group among PwMS on measures of daily living (dual-task performance, balance confidence, community mobility, and quality of life).
Hypothesis 3: After four months of training, the FBI group will show significantly greater improvements in measures of daily living compared to the stretching group.
All assessment sessions will be conducted virtually via Zoom. All measures collected during the initial screening, pre-training assessment, training progression, and mid- and post-training assessment sessions will be administered either via Zoom with a Helper Buddy present or through survey links sent to participants via the UIC REDCap system. The training sessions will be performed independently by the participants in the presence of a Helper Buddy.
The investigators will recruit 75 people with multiple sclerosis (PwMS) for this study. Eligible participants will be randomized to either the FBI (Intervention) or stretching (Control) group, followed by an onboarding session with a designated Helper Buddy. Training will occur twice weekly for four months. Based on the anticipated attrition rate, the investigators aim for 40 PwMS to complete the post-training assessments and finish the study.
Age 40-90 years.
Self-reported diagnosis of Multiple Sclerosis.
On stable disease-modifying therapy for ≥6 months.
No PT/OT balance-related therapy in the past 6 months.
MS relapse or exacerbation within the past 3 months.
Recent major surgery (<6 months) or hospitalization (<3 months).
Resting shortness of breath or uncontrolled pain >3/10.
Uncontrolled hypertension or diabetes.
Parallel
Multicomponent balance intervention consisting of four components including dual-tasking, functional strength, vestibular and dynamic balance.
BehavioralThe Functional Balance Intervention (FBI) is a multicomponent, home based cognitive motor training program designed specifically for persons with Multiple Sclerosis. It integrates four structured constructs-functional agility, functional strength, dual task cognitive motor exercises, and vestibular training-within each 1 hour session. The program uses custom designed interactive dual task stepping games that require simultaneous motor stepping responses and cognitive tasks such as arithmetic, category fluency, and visuospatial cue discrimination. Vestibular components include gaze stabilization, head turn walking, and figure of eight patterns. Progression is individualized using predefined home evaluation criteria (step count, chair stands, tandem stance, single leg stance, and perceived stability). Training is completed independently at home with a helper buddy present and supported by weekly Zoom sessions.
Stretching
BehavioralThe stretching program is a non-progressive, home based flexibility protocol designed to serve as an active control condition. Unlike the Functional Balance Intervention, this program does not include agility, strength, dual task, vestibular, or cognitive motor components, and it does not use computerized games or progressive home evaluations. Participants complete 1 hour sessions, 2 days per week for 4 months, consisting solely of static stretches targeting major upper extremity, lower extremity, trunk, and back muscle groups. All stretches are performed in standing to match the positional demands and session duration of the experimental arm without engaging balance or cognitive systems. The program emphasizes gentle range of motion, posture, breathing, and relaxation rather than neuromotor challenge. No equipment is required beyond the printed stretching manual, and exercises do not progress in complexity or intensity.
Safety: occurrence of adverse events
Non-serious adverse events may include transient muscle soreness, fatigue, mild dizziness, temporary loss of balance corrected by the helper buddy, or minor joint discomfort during home exercise. These events do not require medical intervention and are reported during weekly check ins or directly to study staff. Serious adverse events include any event resulting in injury requiring medical care, hospitalization, life-threatening symptoms, severe cardiovascular responses (chest pain, uncontrolled shortness of breath, hypertensive crisis), oxygen desaturation below safety thresholds, or falls causing significant injury. The helper buddy is instructed to stop activity immediately, call emergency services when necessary, and notify the research team. All adverse events are monitored throughout screening, assessments, and training sessions, and are reviewed by the PI with prompt IRB reporting as required.
Adherence
Adherence will be monitored by tracking completion of all scheduled home training sessions, weekly Zoom check ins, and timely completion of progression evaluations and questionnaires. Participants are expected to complete 2 sessions per week for 4 months, and adherence will be defined as completing at least 75 percent of planned sessions. Attendance logs, helper buddy confirmation, and participant self reports are reviewed weekly by study staff to document adherence and address barriers to participation.
Change in Physical Function measured by Short Physical Performance Battery
The Short Physical Performance Battery (SPPB) is a validated measure of lower extremity physical function that includes three components: standing balance, gait speed, and repeated chair stands. Balance is assessed using side by side, semi tandem, and tandem stances; gait speed is measured over a short walking distance; and strength/mobility is evaluated using five repeated chair rises. Scores from each component are combined into a 0-12 total score, with higher scores indicating better physical function. For this study, the SPPB is administered remotely over Zoom with camera positioning and helper buddy support to ensure safety during all standing and mobility tasks.
Change in Walking Function: Dynamic Gait Index (DGI)
The Dynamic Gait Index (DGI) is a clinical measure of functional gait performance that assesses an individual's ability to adapt walking to varying task demands. The test includes eight walking tasks such as changing gait speed, head turns, pivot turns, stepping over obstacles, and stair climbing. Each task is scored on a 0-3 scale, with a maximum total score of 24; higher scores indicate better dynamic gait stability. In this study, the DGI is administered remotely with helper buddy supervision to ensure safety during all gait tasks.
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