To test whether remotely supervised transcranial direct current stimulation (RS-tDCS) paired with an at-home hand exercise program can improve manual dexterity in individuals with progressive multiple sclerosis (MS).

MS is characterized by demyelination, immune-mediated inflammation, and neurodegeneration within the central nervous system. Individuals with progressive subtypes have greater disability, but fewer therapeutic options. Reduced manual dexterity occurs as a direct result of disease activity; affecting more than 75% of all individuals with MS.

tDCS can be used to improve motor learning, especially when employing a motor-somatosensory (M1-SO) montage. Importantly, tDCS mechanisms may enhance outcomes with low-intensity training or rehabilitation, as compared to other motor rehabilitation routines that require higher intensity exercise and effort. Our RS-tDCS design allows treatment to be completed from any location; increasing daily compliance and access.

Participants living with primary or secondary progressive MS with reduced manual dexterity are recruited and randomly assigned to active (2.0 mA M1-SO montage) or sham tDCS paired with a 30-minute hand exercise program. Each participant receives 20-minutes of either active or sham tDCS followed by 10 minutes of post-tDCS training. Sessions are remotely supervised via real-time, HIPAA compliant videoconferencing. Changes in grip strength and grip adaptability are measured across sessions and measures of fine motor speed are administered at baseline and study end.

This trial is ongoing with n=10 participants and n=173 sessions complete to date. 96% of sessions have been completed without rescheduling or cancellation, verifying protocol feasibility. Preliminary data analysis shows that participants in the active condition experienced strong benefit from tDCS treatment (group cohen’s d = 0.53).

At-home hand exercises paired with the tDCS shows promise in improving manual dexterity symptoms in progressive MS. At-home treatment delivery with real-time remote clinical supervision allows for increased access to trial participation and to rehabilitative services in general.