Incremental Vestibulo-ocular Reflex Adaptation As a Novel Treatment for Dizziness in People with Multiple Sclerosis

Inclusion Criteria:

• Neurologist-confirmed diagnosis of primary progressive or relapsing and remitting MSper the 2017 Revision of the McDonald Criteria and the Magnetic Resonance Imaging inMS

• Fluent in speaking and understanding English

• Have self-reported vestibular symptoms of dizziness, imbalance, and/or a history ofat least two falls in the prior 12 months

Exclusion Criteria:

• Clinically isolated syndrome or radiologically isolated syndrome.

• Worsening MS symptoms during the prior 60 days

• Immunotherapy change in the prior 60 days

• Self-reported cognitive impairment that limits independence with basic andinstrumental activities of daily living

• Systolic blood pressure > 180 mmHg and/or diastolic blood pressure > 90 mmHg at rest

• Static visual acuity with correction of worse than 1.0 logMAR

• Manifest ocular misalignment ≥ 5 diopters (e.g., tropia, lazy eye, strabismus}

• Convergence insufficiency

• Intra-nuclear ophthalmoplegia

• Benign paroxysmal positional vertigo

• Major orthopedic conditions that limit cervical spine range of motion or that alterwalking

• Self-reported current or potential for pregnancy during enrollment

• Ongoing participation in vestibular rehabilitation for dizziness