Maybe you already use your phone, a wearable, or one of the many MS-related apps to track your symptoms or support your daily routines. But when it comes to rehabilitation, the real question is: which digital tools actually help — and which ones are just noise?
In this ECTRIMS session, researchers from around the world explored how technology can enhance rehabilitation for people with MS. Their message was clear: digital tools can open new doors, but only when they are designed well, grounded in science, and truly support your everyday life.
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1. Alon Kalron – Israel
Talk: How can digital technologies be incorporated within rehabilitation to enhance or improve rehab outcomes?
Alon Kalron opened the session with the big picture.
What was this about?
During COVID, physiotherapists suddenly had to deliver rehab at a distance. That pushed a huge shift toward:
home exercise videos
rehab apps
online exercise classes
remote monitoring
Alon Kalron showed that this wasn’t just a temporary emergency fix. It was the start of a real digital transformation in rehabilitation.
What did he find?
There are hundreds of thousands of health apps, but only a tiny fraction are widely used.
Many apps disappear quickly – they’re poorly designed, not evidence-based, or simply not helpful.
Tools that do survive tend to have:
clinical studies behind them
good ratings from people using them
endorsement by professionals or patient organisations
He also reminded us how powerful a modern smartphone really is. Inside that small device are sensors that can track:
movement (accelerometer, gyroscope)
location and activity patterns (GPS)
sleep and heart rate (via connected devices)
voice, reaction time, fine motor control (touch screen, microphone, camera)
In MS, these sensors are already being used to:
measure walking speed and balance at home
run digital versions of cognitive tests
track fatigue and mood
detect changes that might suggest a relapse or disease progression
Some apps go even further. For example, there are programs that use AI to analyse your symptom reports and suggest personalised self-management strategies, or tools that deliver online cognitive-behavioural therapy for depression or fatigue.
Why does this matter for you?
The key message from Alon Kalron is reassuring:
Digital tools are not meant to replace your rehab team – but they can extend what your team can see and do.
Used well, apps and sensors can:
make it easier to keep track of symptoms between clinic visits
give you more objective feedback on your progress
allow you to train at home with more structure and motivation
But they are not all equal. When you look at an app, it’s worth asking:
Is there any research behind it?
Do recognised MS organisations or clinicians recommend it?
Does it actually fit my needs and abilities?
If the answer is “no” to all three, it’s probably not worth your time or data.
2. Andrea Tacchino – Italy
Talk: How can digital tools be used to support outcome measurement in rehabilitation research?
Andrea Tacchino focused on something that sounds dry but is absolutely central:
how we measure whether rehab is working.
What was this about?
In MS, we usually rely on clinical outcome measures like:
EDSS
walking tests
balance scales
cognitive questionnaires
They’re useful, but they’re just snapshots taken in the clinic. MS, however, is a 24/7 condition. Your function can vary from hour to hour. Traditional tests miss most of that.
Digital health technologies (DHTs) – wearables, smartphone apps, sensor systems – can fill this gap by collecting data:
frequently (sometimes every second)
in real life, not just in a lab
passively, without you having to do much
What did he find?
Andrea Tacchino showed that research with digital tools has exploded, especially in neurology. Sensors are being used to:
track gait and balance in MS and Parkinson’s
monitor daily activity in stroke and dementia
pick up subtle changes long before they are obvious in the clinic
But he also stressed that this has to be done properly.
He outlined a roadmap:
User-centred design
Start by talking to people with MS.
Make sure the tech is actually usable (low fatigue, clear instructions, no tiny buttons).
Usability testing
Systematic feedback, questionnaires, “think-aloud” sessions.
If a tool is too exhausting or confusing, it will not work in real life.
From raw data to meaningful digital biomarkers
Sensors generate enormous amounts of numbers.
These need to be translated into digital biomarkers – specific measures (e.g. stride variability, typing speed, reaction time) that clearly relate to disease activity or rehab response.
Those biomarkers then have to be validated against MRI, traditional tests, and – importantly – how you feel.
He showed examples where digital measures from daily life correlated strongly with:
brain atrophy and lesion load on MRI
future risk of falls or worsening mobility
changes in fatigue or cognition
Andrea Tacchino also spoke about future concepts like the “digital twin” – a virtual copy of you that is continuously updated with your sensor and clinical data. This could one day help tailor rehabilitation very precisely.
Why does this matter for you?
The obvious question you might have is:
“If I wear all these sensors, will the results actually change my care?”
Andrea Tacchino’s answer is: that’s exactly what the field is working on.
Digital tools can help:
detect change earlier, so rehab or medication can be adjusted sooner
show which parts of your rehab are truly helping you
support shared decision-making with objective data
But: we are still in the validation and integration phase. Many of these systems live in research projects. They’re coming – but not every clinic has them yet.
For you as a person with MS, it’s worth:
asking your team whether they use any digital outcome measures
being honest about what kind of devices or apps you’re realistically willing to use
giving feedback if something is too tiring, confusing or intrusive
Your experience is part of the “user-centred design” Andrea Tacchino described.
3. Gabriele Perachiotti – Italy
Talk: High-intensity task-oriented circuit training and telerehabilitation in severely disabled people with MS
This study zoomed in on a group that often gets left out of research:
people with severe mobility limitations (EDSS ≥ 6.5).
What was this about?
Gabriele Perachiotti and his team wanted to know:
Is a high-intensity, task-oriented circuit training feasible and safe in people who need bilateral support or a wheelchair?
Does it improve balance, fatigue and quality of life?
Can home-based exercises plus simple digital tools help maintain the gains after inpatient rehab?
How did the program look?
In-hospital phase – 4 weeks
3 days per week
3 sessions per day
51 minutes per session
6 blocks of 6 minutes training + 3 minutes rest
People rotated through six functional stations, matched to their ability level:
bed mobility
wheelchair skills
stepping / sitting
sit-to-stand
standing
walking / upper limb tasks
Each station had four difficulty levels – more range of motion, less base of support, more postural challenge, more dynamic control.
Home-based phase – 3 months
At home, participants continued to train key skills like standing and sit-to-stand.
They used:
a simple timer app to pace the exercises
an online questionnaire to record repetitions and perceived exertion
monthly video check-ins with the rehab team
No fancy hardware. Just structured follow-up and a low-tech digital link.
What did they find?
Even in this severely disabled group:
Balance improved clinically and statistically.
Especially in people with the lowest functional level.
Subjective physical fatigue decreased.
Motor part of quality of life improved.
The program was rated as safe and highly acceptable.
No serious adverse events.
People generally felt it was worthwhile and not overwhelming.
Some of the gains in walking tests were less stable over time, and the sample was small, so we need larger studies. But the signal is clear:
Intensive, meaningful, task-oriented training is possible and useful even when disability is high – and simple home-based digital support can help carry the effects into everyday life.
Why does this matter for you?
If you’re using a walking aid or wheelchair, you might sometimes feel that research doesn’t really include “people like you”. Gabriele Perachiotti’s work pushes back against that.
Key take-aways:
High-intensity rehab isn’t only for “mild” MS.
What matters is that tasks are meaningful (bed mobility, transfers, standing, wheelchair skills), and that the dose is high enough.
A basic smartphone and occasional tele-visits can be enough to keep you connected to your rehab team.
If this resonates with you, it could be worth asking your physio or neurologist:
whether circuit-based, task-oriented training could be adapted for your level
whether there is any possibility of structured home programs with remote follow-up
4. Andrea Baroni – Italy
Talk: Prediction of motor outcome following rehabilitation in people with MS: a machine learning study
While Gabriele Perachiotti asked, “What kind of training works?”, Andrea Baroni asked a different question:
“Can we predict how much someone will benefit from rehabilitation?”
What was this about?
Andrea Baroni pooled data from seven clinical trials of gait rehabilitation in progressive MS (EDSS 4–7).
The interventions included:
robot-assisted gait training
overground gait training
high-intensity task-oriented training
blood-flow-restriction gait training
videogame-based rehab
conventional therapy
He used machine-learning (Random Forest) models to predict:
Timed Up and Go (TUG) time after rehab (standing up from a chair, walking 3 m, walking back, and sit down again)
6-Minute Walk distance after rehab (6MWT)
based on:
age, sex
MS type and duration
EDSS
type and duration of treatment
baseline TUG or 6MWT
What did he find?
The models predicted post-rehab performance quite accurately.
But the most important – and maybe slightly sobering – result was:
The pre-treatment functional level (your starting TUG or 6MWT) was by far the strongest predictor of your outcome.
Other factors (treatment type, robotics vs no robotics, age, disease duration) still mattered, but much less.
How can that help you?
This doesn’t mean rehabilitation is pointless if you start from a worse place.
Instead, it means:
realistic goal-setting becomes easier,
your team can compare “people like you” in their data and estimate what kind of improvement is likely,
resources (e.g. very expensive robotic treatments) can be targeted where they make the biggest difference.
In the future, Andrea Baroni’s group wants to turn this into software that clinicians can use during rehab planning, and they plan to validate the models in multiple centres.
As a patient, the simple takeaway is:
Your current function really matters – and doing what you can to stay active between rehab blocks probably improves what rehab can achieve for you next time.
5. Diogo Haddad Santos – Brazil
Talk: Gaze instability as an indicator of patient-reported visual challenges in MS
Many people with MS say, “My vision is strange – but my MRI and eye exam don’t fully explain it.”
Diogo Haddad Santos set out to see whether detailed eye-movement tracking could bridge that gap.
What was this about?
The team recruited 104 people with MS, mostly mildly disabled (average EDSS 1.0).
They combined:
a comprehensive, portable eye-tracking battery
tests of fixation, random saccades, smooth pursuit, vergence, anti-saccades, optokinetic responses, reaction time, and pupil reflexes
How steadily can your eyes stay focused on one spot?
How quickly can your eyes jump from one target to another?
How smoothly can your eyes follow a moving object?
How well do your eyes work together when you shift focus from far to near?
Can you look away from a target when you’re told to (instead of toward it)?
How do your eyes react when you watch moving patterns?
How quickly do your eyes respond when something appears?
How do your pupils react when light changes?
with the NEI VFQ-25 questionnaire, which measures how you feel your vision is affecting you in daily life.
What did they find?
Several clear patterns emerged:
More square-wave jerks (tiny unwanted eye movements during fixation) were linked to worse self-reported vision.
Poor gaze stability during fixation correlated with worse perceived visual function.
More intrusive saccades during vergence (when the eyes move together to focus on near objects) were associated with poorer subjective vision.
A higher proportion of jerky saccadic movements instead of smooth eye tracking predicted worse visual function.
Fewer self-paced saccades (voluntary, rapid eye movements) were linked to worse visual performance in daily activities.
In short:
The strange, hard-to-describe visual problems many people with MS report really do correspond to measurable oculomotor dysfunctions.
Why does this matter for you?
Eye-tracking is still mainly a research tool, but this work suggests:
your subjective visual complaints are valid and measurable, even if MRI or standard eye exams look “OK”;
portable systems – and later even smartphone-based eye-tracking – could one day become digital biomarkers for MS;
they might help monitor treatment response or detect early changes.
If you struggle with reading, screens, or visual overload, it’s worth mentioning this specifically to your neurologist or neuro-ophthalmologist. Research like Santos’ is building the evidence that these symptoms deserve detailed assessment, not a shrug.
6. Katrin Parmar – Switzerland
Talk: Comparison of lab-based measurement of static and dynamic balance ability and corresponding clinical assessments in patients with MS
Finally, Katrin Parmar explored something very practical:
When we test your balance in the clinic, which tests actually reflect what high-tech lab systems see?
What was this about?
Twenty-five people with MS (average EDSS ~3.6) completed:
lab-based measures
CoP (centre of pressure) for static balance
MoS (margin of stability) for dynamic balance
a set of clinical balance tests
Berg Balance Scale (BBS)
Clinical Test for Sensory Interaction in Balance (CTSIB)
miniBEST
Timed Up & Go (TUG)
Dynamic Gait Index (DGI)
Side Step Speed Test (SSST)
What did she find?
First, static and dynamic balance are only partly linked. Someone may stand quite stable but still be unstable when walking – or the other way around.
Then she looked at which clinical tests best reflect which lab parameter:
Static balance (CoP)
BBS and CTSIB showed good correlations with the lab data.
miniBEST also correlated moderately.
→ These are reliable tests if your therapist wants to know how stable you are when standing.
Dynamic balance (MoS)
MoS in the forward/backward direction correlated well (negatively) with TUG, SSST and CTSIB.
→ TUG, in particular, is a strong indicator of dynamic balance when you move.
→ CTSIB seems to reflect both static and dynamic aspects.
Why does this matter for you?
Next time you’re doing balance tests in the clinic and someone times your TUG or scores your BBS, you can know:
these aren’t just rough guesses – they have a solid relationship with detailed lab measurements;
it’s important that your assessment covers both standing and moving;
CTSIB, BBS and TUG together give a fairly complete picture.
If you feel your balance problems only show up in certain situations (e.g. turning quickly, walking in crowds), tell your therapist. It may prompt them to choose the right mix of tests and perhaps add digital tools later.
Putting it all together – what can you take away?
Across all these talks, a few big themes emerge:
Digital tools are here to stay – but they must earn their place.
Not every app is helpful. Quality, evidence, and usability matter. Don’t be afraid to ask for those.Measurement is shifting from snapshots to movies.
Sensors and apps can capture your everyday life – your good days, bad days, and everything in between. That can make rehabilitation more personalised and more timely.Even with high disability, meaningful progress is possible.
Perachiotti’s work shows that intensive, task-oriented training, supported by simple digital tools, can improve balance, fatigue, and motor quality of life, even when EDSS is high.Your starting point strongly shapes your rehab journey.
Baroni’s machine-learning models tell us that baseline function is the best predictor of change. Staying as active as you realistically can between rehab phases is not “bonus work” – it’s part of building your future response.Subjective symptoms deserve objective investigation.
Santos’ eye-tracking study validates the visual challenges many people describe. Similar digital biomarkers are emerging for cognition, mood, and fatigue.Simple clinical tests still matter – and are getting smarter.
Parmar shows that well-chosen bedside tests align nicely with sophisticated lab metrics. The future isn’t “lab or clinic”, it’s lab + clinic + digital, working together.
And now?
If you’d like to bring some of this into your own care, you might:
Ask your neurologist or therapist which digital tools they already use or recommend.
If you’re overwhelmed by apps, start with one that targets something concrete you care about (fatigue, mood, home exercise, walking).
Give honest feedback about usability – you’re helping shape better tools for everyone.
Remember that your body, your goals and your daily life come first. Technology is there to serve you, not to become another burden.
See you soon and try to make the best out of your life,
Nele
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