Selective associations between cognitive practice effects and reactive balance adaptation in multiple sclerosis

Cognitive and balance impairments are common in multiple sclerosis (MS). Practice effects may reflect neuroplasticity and predict rehabilitation responsiveness. This study examined cognitive practice effects and their relationship to reactive balance adaptation in MS.

Twenty-seven people with MS and 17 neurotypical adults completed 2 baseline cognitive assessments over 2 weeks, followed by a 2-week perturbation-based balance training program over 6 progressive sessions. Verbal learning and processing speed were assessed using the California Verbal Learning Test-II (CVLT-II) and the Symbol Digit Modalities Test. Reactive balance was evaluated using backward margin of stability, step latency, and step length, pre-, post-, and 2 months after training.

People with MS improved on verbal learning (CVLT-II Total Recall: F (1, 42) = 83.11, p < .001, η2p = 0.66) and processing speed (F(1, 42) = 4.68, p = .036, η2p = 0.10). The magnitude of improvement did not differ significantly between groups; however, standardized regression-based scores indicated the MS group's gains were smaller than normatively expected (t(26) = -2.60, p = .015, d = -0.50). Only delayed recall predicted immediate improvements in backward margin of stability (β = 0.71, p = .033, η2p = 0.22) and, with some sensitivity to influential observations, retained improvements at two-month follow-up (β = 1.12, p = .015, η2p = 0.29).

Cognitive practice effects in MS are largely preserved. Delayed verbal recall was selectively associated with reactive balance adaptation, suggesting a possible role for consolidation-dependent memory in balance rehabilitation, though this association requires confirmatory replication.