This interventional clinical trial aims to investigate the effects of internal and external focus-based exercise training combined with cognitive dual-task training in individuals diagnosed with multiple sclerosis. The primary objective is to determine whether these exercise approaches improve gait, balance, and cognitive functions.
The main research questions are:
Does dual-task training combined with internal focus-based exercises improve gait, balance, and cognitive performance? Does dual-task training combined with external focus-based exercises lead to greater improvements compared to internal focus strategies?
Participants will be divided into two groups, and the researchers will compare the effects of internal focus-based and external focus-based dual-task exercise training on functional outcomes.
Participants will:
Perform structured exercise sessions under the supervision of a physiotherapist Engage in dual-task activities by combining motor exercises with simple cognitive tasks (e.g., backward counting, word generation) Participate in an 8-week training program, with sessions held twice a week lasting approximately 45-60 minutes Undergo assessments of gait, balance, and cognitive function before and after the intervention
This study does not involve invasive procedures or biological sample collection. The findings are expected to contribute to the development of more effective dual-task rehabilitation strategies for individuals with multiple sclerosis.
Diagnosis of Multiple Sclerosis according to the revised McDonald criteria
Aged between 20 and 60 years
Ability to understand and follow simple instructions
Ability to stand and walk independently or with an assistive device
MS relapse within the last 30 days
Presence of any other neurological disease besides Multiple Sclerosis
Any musculoskeletal condition that may affect walking or balance
History of uncontrolled cardiorespiratory conditions within the last 3 months (e.g., hypertension, arrhythmia, tachycardia, or acute cardiopulmonary events)
Parallel
Internal Focus Dual-Task Training
BehavioralParticipants perform dual-task exercise training with instructions focusing on their own body movements during task execution. The program includes gait, balance, and cognitive tasks.
External Focus Dual-Task Training
BehavioralParticipants receive dual-task exercise training with external focus instructions directed to movement effects or external targets. The program includes gait, balance, and cognitive tasks performed simultaneously.
Gait Performance Under Dual-Task Conditions
Gait performance will be assessed using the Zebris FDM System (FDM 1.5). Parameters will include step length, stride length, step width, step time, stride time, cadence, gait speed, stance phase percentage, swing phase percentage, and double support phase percentage under dual-task conditions.
Cognitive Function (BICAMS)
Cognitive function will be assessed using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), including the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test (CVLT), and Brief Visuospatial Memory Test (BVMT). Assessments will be conducted by a clinical psychologist.
Balance Performance
Balance will be assessed using the Zebris FDM System (FDM 1.5). Parameters will include center of pressure (COP) path length, COP velocity, and forefoot and rearfoot load distribution percentages.
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