Home-Based Balance Training for Multiple Sclerosis

Inclusion Criteria Telephone Screening Inclusion Criteria: 1. Age 40-90 years. 2. Self-reported diagnosis of Multiple Sclerosis. 3. On stable disease-modifying therapy for ≥6 months. 4. No PT/OT balance-related therapy in the past 6 months. 5. Able to stand from a chair independently (with or without hand support). 6. Score 25-75% on the 12-item MS Walking Scale. 7. No other neurological, cardiopulmonary, musculoskeletal, or systemic conditions affecting standing/walking. 8. English speaking. 9. Willing to complete all study procedures including Zoom sessions. 10. Has reliable internet access. 11. Has a helper buddy available for all sessions. 12. Possible mild cognitive impairment based on self-report. Initial Screening Inclusion Criteria: 1. Moderate disability: ePR-EDSS score 4.0-6.5. 2. Mild cognitive impairment: MoCA 18-25, or Jak/Bondi criteria for those scoring 26-30. 3. Physically inactive or moderately active (Godin score \<24). 4. Cardiovascular safety parameters within acceptable limits. 5. No global aphasia (Mississippi Aphasia Screening Test ≥71 percent). 6. Berg Balance Scale score ≥40/56. 7. Able to walk 1 block with or without an assistive device. Helper Buddy Inclusion Criteria: 1. Age ≥18 years. 2. Lives within close proximity to the participant. 3. No self-reported major medical conditions limiting safety assistance. 4. English speaking. 5. Able to attend all training and assessment sessions. 6. Able to assist with basic safety, positioning, and communication with the research team. 7. Has internet access and can use Zoom. Exclusion Criteria Telephone Screening Exclusion Criteria: 1. MS relapse or exacerbation within the past 3 months. 2. Recent major surgery (\<6 months) or hospitalization (\<3 months). 3. Resting shortness of breath or uncontrolled pain \>3/10. 4. Uncontrolled hypertension or diabetes. 5. Bone fracture in the past 6 months. 6. Disability limiting activities of daily living. 7. History of epilepsy or uncontrolled seizures in past year. 8. Sedative medication use that may interfere with training. 9. Use of Alzheimer's/dementia-modifying drugs or enrollment in AD clinical trials. 10. Use of antidepressants or anxiety medications. 11. Moderate or high risk on PAR-Q (≤1 "yes" response). 12. Severe cognitive impairment (TICS-M ≥18). 13. Currently receiving cognitive or physical rehabilitation. 14. Pacemaker use. Initial Screening Exclusion Criteria: 1. Cardiovascular parameters outside safety limits (HR, BP, O₂ saturation). 2. Global aphasia (Mississippi \<71 percent). 3. Peripheral nerve injury. 4. Berg Balance Scale \<40/56. 5. Inability to walk one block with or without an assistive device. Population Exclusions: 1. Non-English speakers (protocol delivered only in English). 2. Individuals under 18 years. 3. Pregnant individuals. 4. Prisoners or other vulnerable populations.