Cognitive dysfunction can adversely impact the walking ability of people with multiple sclerosis. However, valid and reliable standardized clinical tools to measure cognitive-motor interference or dual-tasking in people with multiple sclerosis remain lacking. This study evaluated the validity and reliability of the modified Walking and Remembering Test (mWART) in people with multiple sclerosis. Eleven adults (mean ± SD age, 51.1 ± 13.4 years) with multiple sclerosis (Expanded Disability Status Score, 2.0–6.0) and six adults (mean ± SD age, 41.5 ± 17.2 years) without multiple sclerosis were administered the mWART twice over a 2-week period. Participants were tested on gait and digit span length under single-task and dual-task conditions according to the mWART procedures over a 10-m walkway. intraclass correlation coefficient_2,k were 0.961 for single-task gait velocity (P < 0.001), 0.968 for dual-task gait velocity (P < 0.001), 0.829 for single-task digit span (P = 0.004), and 0.439 for dual-task digit span (P = 0.154). Single-task gait velocity (P = 0.001) and dual-task gait velocity (P = 0.002) were able to discriminate between groups but dual-task costs were similar between participants with and without multiple sclerosis. Those with severe disability demonstrated the greater dual-task cost of gait velocity (P = 0.030). This study provides preliminary evidence of the mWART’s validity and reliability in measuring dual-task performance in patients with multiple sclerosis with mild to severe disability. More research is required in more heterogeneous samples of persons with multiple sclerosis.

Purpose: This study aimed to quantify the severity of fear of falling (FOF) in people with low vision (LV) compared with age–gender-matched healthy individuals during gait initiation (GI). Methods: A total of 14 adults with LV and 14 age–gender-matched healthy adults were recruited from local communities. The Falls Efficacy Scale International was used to evaluate FOF. We compared temporal events between healthy and LV groups. For the healthy group, GI under normal vision was further compared to conditions using a low-vision sight simulator (SS) and an immersive virtual reality (VR) environment designed to simulate a fear-evoking experience. Independent t-test and one-way repeated measure ANOVA were conducted for statistical analysis (p < 0.05). Results: People with LV showed a significantly greater FOF than healthy individuals (p < 0.05). During GI, participants with LV exhibited significantly prolonged anticipatory postural adjustment (APA) durations compared to healthy normal and SS conditions (p < 0.05). While VR-evoked fear in healthy participants primarily prolonged the push-off (PO) phase, the delay in the LV group was characterized by a significantly extended initial anticipation (AP) phase. Notably, the APA duration in the LV group showed no significant difference compared to the healthy VR condition, indicating that the inherent fear in LV produces postural delays as severe as those induced by extreme VR-evoked fear of heights (p > 0.05). Conclusions: This study demonstrates that individuals with LV adopt a chronically conservative motor program during the transition from standing to walking. These postural hesitations are statistically comparable to those observed under fear-evoking, VR-induced environments. These findings suggest that LV is associated with a distinct biomechanical strategy that prioritizes static stability over dynamic movement. Accordingly, multidisciplinary rehabilitation approaches that emphasize sensory reweighting, including vestibular training, alongside interventions targeting FOF, may be essential for mitigating altered postural control and reducing fall risk in the LV population.

Background and Purpose: Advancements in health care education have emphasized the need for innovative, effective, and scalable educational tools. Virtual reality simulation-based learning experiences (VR SBLEs) offer immersive, repeatable training opportunities. However, many VR SBLE implementations lack framework-guided development, compromising replicability and educational rigor in physical therapist education. This article presents a systematic framework to develop and implement an interprofessional VR SBLE aligned with the Healthcare Simulation Standards of Best Practice (HSSBP). Method/Model Description and Evaluations: A multiphase process used the HSSBP to guide planning, development, validation, and implementation of a VR SBLE for Doctor of Physical Therapy students in an acute care course. The process included needs assessment, outcome alignment, scenario design, branching decision pathways, multimedia production, platform integration, and learner pre-briefing/debriefing. The development emphasized feasibility, educational rigor, and interprofessional collaboration. Outcomes: The product delivered a modular, scalable VR SBLE featuring immersive 360° video, interactive branching scenarios, embedded assessments, and adaptable content suited for varied educational settings. Methodological outputs include documentation of guideline adherence, iterative refinements, and strategies for sustainability and replication. Learner feedback highlighted usability, learning value, and the advantage of repeated access, supporting the simulation's educational utility beyond standard practice. Discussion and Conclusion: This work advances VR SBLE development by demonstrating a structured, evidence-based development framework that supports replicability, quality, and pedagogy. Although student performance improvements were noted, the primary contribution lies in delivering a replicable development methodology adaptable across health care education. Future efforts should focus on broad scalability, technological optimization, and longitudinal assessment of clinical impact.

BACKGROUND Virtual reality (VR) platforms have demonstrated small-to-moderate effect sizes for motor, balance, and dual-task outcomes across neurological conditions, yet fewer than one-third of physical therapists regularly integrate VR into practice, citing limited space, inadequate training, and uncertainty about clinical utility. The Instrumented Multitask Assessment System (IMAS) is a compact VR platform combining a 360° omnidirectional walking surface, an immersive headset, and integrated biophysical sensors for real-time adaptive cognitive-motor dual-task training. Preliminary work demonstrated feasibility for dual-task assessment in military service members with mild traumatic brain injury, but clinician perspectives on acceptability and implementation for routine neurorehabilitation remain unexplored. OBJECTIVE This study explored practicing neurorehabilitation clinicians’ perceptions of the feasibility, acceptability, and implementation requirements of the IMAS platform. Guided by the Theoretical Framework of Acceptability (TFA), we sought to understand how clinicians perceive the coherence, burden, and potential effectiveness of the IMAS to inform iterative design modifications for subsequent patient-focused pilot testing. METHODS A qualitative descriptive design using semi-structured interviews was employed. Eighteen licensed neurorehabilitation clinicians (physical therapists, occupational therapists, and speech-language pathologists) with a minimum of 2 years’ experience treating adults with neurological disorders were recruited via purposive sampling across diverse US clinical settings. Interviews were conducted via videoconference. Data were analyzed using reflexive thematic analysis with 2 investigators independently coding transcripts and resolving discrepancies through structured consensus meetings. Reporting followed the Standards for Reporting Qualitative Research guidelines. RESULTS Participants were predominantly female (11/18, 61%), physical therapists (12/18, 67%), held professional doctorates (12/18, 67%), and worked in outpatient settings (11/18, 61%), with a mean of 11.11 (SD 9.05) years of neurorehabilitation experience. Saturation was reached by the sixteenth interview. Analysis yielded four themes: (1) System Design and Customization Needs, reflecting emphasis on principles of neuroplasticity and environmental customization as essential features; (2) Implementation Challenges and Barriers, encompassing learning curves, safety concerns, resource constraints, workflow considerations, and technical limitations as burden dimensions; (3) Perceived Benefits and Advantages, including enhanced therapeutic outcomes, patient safety, engagement through gamification, and immediate feedback; and (4) Training and Support Requirements, highlighting comprehensive hands-on training and tiered technical support as requisites for clinician self-efficacy. CONCLUSIONS Clinicians perceived the IMAS as coherent with established neurorehabilitation principles and therapeutically promising; however, substantial barriers related to cost, space, workflow disruption, and technical reliability were identified as limiting factors for adoption. The TFA revealed that high coherence and perceived effectiveness alone cannot overcome high burden when organizational capacity, financial resources, and technical support remain inadequate. Successful implementation requires coordinated efforts to address safety, reduce costs, validate effectiveness through patient outcome studies, and embed comprehensive training within clinical settings.