Dual-Task Training in Pediatric Multiple Sclerosis

Pediatric‐onset multiple sclerosis (PBMS) is a chronic inflammatory demyelinatingdisorder of the central nervous system that begins in childhood or adolescence. It cancause significant long‐term motor deficits, balance problems, fatigue, and cognitiveimpairments that negatively affect school performance, social participation, and overallquality of life (Ghezzi et al., 2017; McKay et al., 2019).Traditional rehabilitation approaches in PBMS often address motor and cognitive domainsseparately, whereas most daily life activities require the simultaneous integration ofmotor and cognitive skills. Dual‐task training, which involves performing motor andcognitive tasks concurrently, has been shown to improve the interaction between thesesystems, enhance neuroplasticity, and lead to better functional outcomes in adultmultiple sclerosis populations (Abasıyanık & Kahraman, 2022; Ekici et al., 2025; Beste etal., 2018).However, evidence regarding the effectiveness of dual‐task training specifically inpediatric‐onset multiple sclerosis remains limited. This single‐center, randomizedcontrolled trial aims to fill this gap by comparing the effectiveness of a structureddual‐task exercise program versus a dose‐matched conventional functional exercise programin adolescents with PBMS.Study Design and InterventionA total of 20 participants (10 per group) will be recruited. After baseline assessment,participants will be randomly allocated to one of two groups:Dual‐Task Exercise Group: Participants will perform aerobic, strengthening, and balanceexercises while simultaneously engaging in cognitive tasks. Cognitive tasks includebackward counting, color/object matching, mental arithmetic, alphabet‐based word finding,and short storytelling. Task difficulty will be progressively increased over the 8 weeks.Conventional Functional Exercise Group: Participants will receive a traditionalphysiotherapy program consisting of warm‐up, aerobic stepping exercises, progressivestrengthening (bridge, squats, lunges, etc.), balance training (tandem stance, single‐legstance), and cool‐down exercises without concurrent cognitive loading.Both interventions will last 8 weeks, with sessions held twice weekly for approximately45 minutes each (5 min warm‐up, 35 min main exercises, 5 min cool‐down). All sessionswill be supervised by a physiotherapist at Istanbul University‐Cerrahpaşa Faculty ofHealth Sciences, Department of Physiotherapy and Rehabilitation.Outcome MeasuresAssessments will be conducted before and after the intervention period using thefollowing validated tools:Motor function and walking endurance: 6‐Minute Walk Test (6MWT) Functional mobility:Timed Up and Go Test (TUG) Balance: Mini‐BESTest Cognitive functions: Brief InternationalCognitive Assessment for Multiple Sclerosis (BICAMS) battery Fatigue: PedsQLMultidimensional Fatigue Scale (MFS) Health‐related quality of life: Pediatric Quality ofLife Inventory (PedsQL) Generic Core Scales (child and parent forms) Multiple SclerosisFunctional Composite (MSFC)This study is expected to provide important evidence on whether incorporating dual‐tasktraining into pediatric MS rehabilitation yields greater benefits on motor, cognitive,and functional outcomes compared to conventional exercise. The findings may contribute tothe development of more effective, motivating, and holistic rehabilitation strategies forchildren and adolescents with PBMS.