Improving Hand Movement and Coordination in People With Multiple Scler
Restoring Manual Dexterity in Multiple Sclerosis: A Feasibility Study Combining Muscle Electrostimulation and Transcranial Magnetic Stimulation To Enhance Neuroplasticity
What it found
No result yet.
What was tested
Treatment tested
- TMS and FES- based rehabilitation
Compared with
- FES-based rehabilitation
What it measured
Main measures
9-Hole Peg Test (9HPT)
Before (T0) and after (T1) the rehabilitation treatment (15 sessions of 45 minutes each, 3 times per week for 5 weeks), and at 3 months from T1 (T2).
Disability progressionArm and hand function
Other measures (7)
Box and Block Test (BBT)
Before (T0) and after (T1) the rehabilitation treatment (15 sessions of 45 minutes each, 3 times per week for 5 weeks), and at 3 months from T1 (T2).
Arm and hand functionArm Function in Multiple Sclerosis Questionnaire (AMSQ)
Before (T0) and after (T1) the rehabilitation treatment (15 sessions of 45 minutes each, 3 times per week for 5 weeks), and at 3 months from T1 (T2).
Arm and hand functionSymbol Digit Modalities Test (SDMT)
Before (T0) and after (T1) the rehabilitation treatment (15 sessions of 45 minutes each, 3 times per week for 5 weeks), and at 3 months from T1 (T2).
Thinking and memory12-Item Short Form Survey (SF-12)
Before (T0) and after (T1) the rehabilitation treatment (15 sessions of 45 minutes each, 3 times per week for 5 weeks), and at 3 months from T1 (T2).
Fatigue Scale of Motor and Cognitive Functions (FSMC)
Before (T0) and after (T1) the rehabilitation treatment (15 sessions of 45 minutes each, 3 times per week for 5 weeks), and at 3 months from T1 (T2).
Thinking and memoryFatigueIntrinsic Motivation Inventory (IMI)
Before (T0) and after (T1) the rehabilitation treatment (15 sessions of 45 minutes each, 3 times per week for 5 weeks), and at 3 months from T1 (T2).
System Usability Scale (SUS)
After (T1) the rehabilitation treatment (15 sessions of 45 minutes each, 3 times per week for 5 weeks).
Who could take part
MS (type not specified) · 18 and over
Show the full criteria
Inclusion criteria
* age >18; * diagnosis of MS (according to McDonald criteria); * stable disease course without a worsening greater than 1 point on the Expanded Disability Status Scale (EDSS) in the past 4 months; * right-handed; * score on the Box and Block test lower than the normative value adjusted for sex and age +2 standard deviations; * score on the cerebellar functional system of the EDSS scale \<2; * ability to provide written informed consent.
Exclusion criteria
* score on the Mini-Mental State Examination \<24; * Beck Depression Inventory-II >19; * other neurological or orthopedic conditions that would interfere with upper limb exercises; * contraindications to the application of TMS: history of epilepsy or non-febrile seizures; presence of metallic or electronic implants in the cranial or cervical region; presence of pacemakers or implantable defibrillators; severe uncontrolled psychiatric disorders (e.g., psychosis, mania); current or suspected pregnancy; * contraindications to the application of FES: skin integrity issues at the site of electrode placement; implanted electronic devices.
As registered. Criteria can change, so ask the trial team or your neurologist.
Contact details on the registryAbout this trial
In the sponsor's words
The goal of this interventional study is to test whether combining transcranial magnetic stimulation (TMS) with functional electrical stimulation (FES) can improve hand and upper limb function in adults with Multiple Sclerosis (MS). The clinical trial aims to determine the following points: 1. Whether TMS combined with FES produces greater effects compared to FES alone. 2. Changes in brain and muscle activity related to hand function after treatment. 3. Specific clinical or neurophysiological factors that predict who will benefit most from the intervention. Researchers will compare the TMS-FES group (receiving brain magnetic stimulation and muscle electrostimulation) with the FES group (receiving only muscle electrostimulation) to assess whether TMS provides additional benefits in improving upper limb function Participants will: * Be assigned to a group (TMS-FES group or FES group) * Attend 15 sessions (45 minutes each, 3 times per week for 5 weeks) of task-based hand and arm exercises, during which FES, or TMS and FES, will be administered to the participant. * Undergo assessments before, after, and 3 months after training to measure hand function, brain and muscle responses, fatigue, and daily activity performance.
Papers
Background
Sirbu CA, Thompson DC, Plesa FC, Vasile TM, Jianu DC, Mitrica M, Anghel D, Stefani C. Neurorehabilitation in Multiple Sclerosis-A Review of Present Approaches and Future Considerations. J Clin Med. 2022 Nov 27;11(23):7003. doi: 10.3390/jcm11237003.Background
Severijns D, Lamers I, Kerkhofs L, Feys P. Hand grip fatigability in persons with multiple sclerosis according to hand dominance and disease progression. J Rehabil Med. 2015 Feb;47(2):154-60. doi: 10.2340/16501977-1897.Background
Sampson P, Freeman C, Coote S, Demain S, Feys P, Meadmore K, Hughes AM. Using Functional Electrical Stimulation Mediated by Iterative Learning Control and Robotics to Improve Arm Movement for People With Multiple Sclerosis. IEEE Trans Neural Syst Rehabil Eng. 2016 Feb;24(2):235-48. doi: 10.1109/TNSRE.2015.2413906. Epub 2015 Mar 24.Background
Reeves BC, Wells GA, Waddington H. Quasi-experimental study designs series-paper 5: a checklist for classifying studies evaluating the effects on health interventions-a taxonomy without labels. J Clin Epidemiol. 2017 Sep;89:30-42. doi: 10.1016/j.jclinepi.2017.02.016. Epub 2017 Mar 27.Background
Neira VE, Niemietz TD, Farrell JW 3rd. THE EFFECTS OF EXERCISE TRAINING ON UPPER EXTREMITY FUNCTION FOR PERSONS WITH MULTIPLE SCLEROSIS: A SYSTEMATIC REVIEW. J Rehabil Med Clin Commun. 2022 Sep 29;5:2306. doi: 10.2340/jrmcc.v5.2306. eCollection 2022.Background
Lo DF, Palhang M, Gawash A, Zia H, Goodwin BJ, Patel K, White CP. Unlocking Therapeutic Potential: The Role of Theta Burst Stimulation in Multiple Sclerosis Management. Prim Care Companion CNS Disord. 2024 Apr 18;26(2):23r03645. doi: 10.4088/PCC.23r03645.Background
Leodori G, Mancuso M, Maccarrone D, Tartaglia M, Ianniello A, Certo F, Baione V, Ferrazzano G, Malimpensa L, Belvisi D, Pozzilli C, Berardelli A, Conte A. Neural bases of motor fatigue in multiple sclerosis: A multimodal approach using neuromuscular assessment and TMS-EEG. Neurobiol Dis. 2023 May;180:106073. doi: 10.1016/j.nbd.2023.106073. Epub 2023 Mar 9.Background
Koch G, Rossi S, Prosperetti C, Codeca C, Monteleone F, Petrosini L, Bernardi G, Centonze D. Improvement of hand dexterity following motor cortex rTMS in multiple sclerosis patients with cerebellar impairment. Mult Scler. 2008 Aug;14(7):995-8. doi: 10.1177/1352458508088710. Epub 2008 Jun 23.Background
Kim Y, Steiner P. Quasi-Experimental Designs for Causal Inference. Educ Psychol. 2016;51(3-4):395-405. doi: 10.1080/00461520.2016.1207177. Epub 2016 Sep 2.Background
Kamm CP, Uitdehaag BM, Polman CH. Multiple sclerosis: current knowledge and future outlook. Eur Neurol. 2014;72(3-4):132-41. doi: 10.1159/000360528. Epub 2014 Jul 30.
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History
Started
Oct 2025
Main results due
Dec 2026
Finished
May 2027