Powerball® Gyroscope Training for Hand Function in Multiple Sclerosis: What a Randomized Clinical Trial Found

Table of Contents

• Key Points
• Background: Why Upper Limb Problems in MS Matter
• What Is the Powerball® System?
• The Goal of This Study
• How the Study Was Designed
• Who Could Take Part — and Who Could Not
• What the Training Actually Involved
• How Researchers Measured Results
• How Many Patients Were Needed
• How the Numbers Were Analyzed
• Key Findings: What Changed and What Did Not
• Satisfaction and Attendance
• What This Means for Patients
• Limitations: What the Study Could Not Prove
• Practical Recommendations
• Frequently Asked Questions
• Source Information

Key Points

• In a 25-patient trial, adding Powerball® gyroscope training to physiotherapy led to within-group improvements in hand coordination and dexterity on the Box and Block Test.
• When the Powerball® group was compared directly with the control group, no statistically significant differences appeared for any measure, so added benefit over physiotherapy alone was not proven.
• Participants who used the device reported high satisfaction (mean 89.10 out of 100) and 100% attendance; no adverse effects were reported.
• The trial was small, conducted at two MS associations in Madrid, and the groups differed in age, disease duration, and gender, limiting how widely results apply.
• Gains were seen in coordination and dexterity, not in grip or pinch strength; larger trials are needed before Powerball® training can be recommended as standard.

Background: Why Upper Limb Problems in MS Matter

Multiple sclerosis (MS) is a chronic, neurodegenerative (progressively damaging to nerve tissue), and inflammatory disease of unknown cause. It mainly attacks the myelin (the protective coating around nerve fibers) in the central nervous system, which is made up of the brain and spinal cord. The hallmark tissue change is the formation of plaques — patches of damage.

When these lesions form, more than just myelin is affected. Patients may also lose oligodendrocytes (the cells that build myelin), develop gliosis (scarring of nervous tissue), and suffer scattered injury to axons (the long fibers that carry nerve signals) throughout the central nervous system. Damage tends to cluster in particular areas: the optic nerves, the brainstem, the spinal cord, the cerebellum, and the periventricular white matter (the tissue surrounding the fluid-filled spaces in the brain).

MS is the leading cause of non-traumatic disability in young adults in Europe and North America. Worldwide, about 2.8 million people are affected. Symptoms most commonly first appear between the second and fourth decades of life. Cognitive deficits (problems with thinking, memory, or attention) are present in 50% of patients.

The disease produces a wide range of symptoms and follows different progression patterns, which can seriously affect quality of life and carry social and economic consequences. While lower limb problems in MS have been studied extensively, the upper limbs (the arms and hands) are also frequently affected. Upper limb issues can include ataxia (loss of coordination), spasticity (muscle stiffness), sensory changes, and loss of strength.

The scale of the problem is large. A study by Kister and colleagues, involving more than 20,000 people diagnosed with MS, found a high prevalence of hand motor function disorders. These were seen in 60% of individuals with MS from the earliest stages of the disease, and their frequency climbed as the disease progressed.

Several research teams have linked upper limb problems directly to everyday life. Lamers and colleagues reported that strength is the single most important variable for performing activities of daily living (ADLs) in people with MS. Cattaneo and colleagues found that manual dexterity is crucial for performing household tasks, and that participation limitations are associated with a higher predisposition to developing cognitive deficits.

The research also shows that strength and dexterity track with disease severity. Severijins and colleagues found that people with MS who scored less than 6 on the Expanded Disability Status Scale (EDSS, a standard 0–10 measure of MS disability) had lower maximum grip strength and more fatigue during static contractions (sustained muscle squeezes) than healthy people. Solaro and colleagues found correlations between isometric hand grip strength (force generated without moving the joint), Box and Block Test (BBT) scores, and the time needed to complete the Nine Hole Peg Test (NHPT) with the length of time since disease onset. They also found that BBT scores and NHPT times correlated with EDSS scores.

Taken together, these findings make one thing clear: upper limb involvement in MS is common, and both muscle strength and manual dexterity are reduced. Both affect function and quality of life. That is the gap this new study set out to address.

What Is the Powerball® System?

The Powerball® system works on the principle of a gyroscope (a spinning wheel that resists changes in orientation). It was developed to strengthen the upper extremity and has already shown positive results in increasing grip strength and reducing non-specific wrist pain.

The physics matter for understanding the exercise. The device consists of a sphere containing a 200-gram rotor with an eccentric mass located 2 cm from its axis. The inner cylinder rotates around a vertical axis, creating centrifugal force. The gyroscope is accelerated by rotation of the wrist, and the user activates the internal rotation of the device. As wrist rotation increases, so does the speed of the gyroscope and the centrifugal force — which means the user must control the rotation using muscle control.

Importantly, the authors state that, to the best of their knowledge, no previous research has evaluated the clinical effects of the Powerball® system in any type of neurological disorder. That makes this study the first of its kind in MS rehabilitation.

The Goal of This Study

The purpose of the study was to investigate the effects of the Powerball® system, combined with a conventional physiotherapy intervention, on muscle strength, coordination, fatigue, functionality, and quality of life in people with MS.

How the Study Was Designed

This was a double-blind randomized controlled trial (RCT) — meaning participants were randomly assigned to treatment groups, and neither the people assessing the results nor the participants knew which group was which. The trial was registered as NCT05895734 and conducted according to the CONSORT guidelines, the international standard for reporting clinical trials.

Participants were randomly assigned to either the control group or the experimental group by a blinded investigator who was not involved in delivering the intervention. Randomization used the Research Randomizer Version 4.0 program.

The two groups were:

• Control group: received conventional physiotherapy treatment only.
• Experimental group: received the same conventional physiotherapy treatment plus training with the Powerball® system.

All outcome measures in both groups were evaluated by assessors who were blinded to which group each participant belonged to. The study received ethical approval from the Human Ethics Committee of the Rey Juan Carlos University, and all patients voluntarily signed an informed consent form.

Who Could Take Part — and Who Could Not

All participants were recruited from two multiple sclerosis patient associations in the Community of Madrid, Spain: ALEM and AFEM.

To be included, participants had to meet all of the following criteria:

• Between 20 and 70 years of age.
• Diagnosed with multiple sclerosis according to the McDonald criteria, with a disease duration of more than two years.
• An EDSS score between 2 and 7. A score of 2 means minimal disability in one functional system; a score of 7 means inability to walk more than 5 meters even with assistance, limited to wheelchair mobility but able to propel oneself and transfer without assistance, and active in a wheelchair for at least 12 hours per day.
• Stable medical treatment for at least six months before the intervention.
• Upper limb muscle tone no greater than 2 points on the modified Ashworth scale (moderate hypertonia — increased muscle tone during most of the range of motion, but the limb can still be moved passively with ease).
• Upper limb muscle balance equal to or greater than 3.
• A score of 4 or less on the "Pyramidal Function" section of the EDSS functional scale.
• No cognitive impairment.
• Ability to understand instructions and a score of 4 or greater on the Mini-Mental State Examination.
• A score of 2 or less on the "Mental Functions" section of the EDSS.

People were excluded if they had any of the following:

• A diagnosis of any neurological or musculoskeletal disease other than multiple sclerosis.
• A diagnosis of any cardiovascular, respiratory, or metabolic disease, or any other condition that might interfere with the study.
• A history of exacerbation (flare-up) or hospitalization within the three months before the assessment protocol began, or during the therapeutic intervention.
• A history of botulinum toxin treatment within the six months before the study started.
• Uncorrected visual impairment.

What the Training Actually Involved

Both groups received 45 minutes of intervention per session and the same total number of sessions: 16 sessions, 2 per week, over 8 weeks. This equal-session design matters because it means any extra benefit in the experimental group came from the Powerball® training itself, not from simply receiving more therapy time.

The conventional physiotherapy treatment contained the following components:

1. Osteokinematic mobilizations of the shoulder, elbow, and wrist joints (hands-on movement of the joints through their range).
2. Training activities targeting upper limb manipulative and functional skills for activities of daily living.
3. An upper limb strengthening program, followed by a stretching program for the involved muscles.

The experimental group received the Powerball® 250 Hz gyroscope system in addition to conventional physiotherapy. The dosing schedule was progressive:

• First 4 weeks: 3 sets of 1-minute duration with each hand.
• Subsequent sessions until the end of the study: 5 sets with each hand.
• The intervention always started with the dominant hand, or the less affected hand.

Because different Powerball® models and activation methods exist, the researchers used the manual activation model with a frequency of 250 Hz. During Powerball® sessions, the physiotherapist was responsible for activating the device and starting the rotation of the system.

Positioning was carefully standardized. During all sessions with the device, the patient sat upright in a chair with a backrest and no armrests, so that nothing interfered with the position of the working upper limb. The exercise was performed with both upper limbs, alternating between the more affected and less affected side (the neurologist determined which side was more affected based on the EDSS and physical examination).

The rotation of the gyroscope was clockwise for the right upper limb and counterclockwise for the left upper limb. The arm performing the exercise was supported on a table, with:

• The elbow flexed at 90 degrees.
• The shoulder flexed at 20 degrees.
• The shoulder abducted at 30 degrees.
• The wrist in slight extension, with forearm pronation (palm facing down) and slight radial deviation (tilting toward the thumb side), maintaining a comfortable position throughout the exercise.

The non-exercising upper limb rested in the patient's lap. Before starting the sessions, each patient received a demonstration session with the device to become familiar with the Powerball® system.

Fatigue was actively managed. All interventions took into account the level of fatigue the patient experienced, allowing for longer rest intervals if fatigue exceeded a score of 7 on the Modified Borg Scale (a standard 0–10 measure of perceived exertion).

How Researchers Measured Results

Assessments were carried out at the beginning and end of the intervention in both groups by researchers not involved in delivering the treatment. Patients were then reassessed 3 weeks after stopping Powerball® — but while continuing conventional physiotherapy.

Isometric grip strength. The JAMAR® hand dynamometer was used. It is widely recognized as the gold standard for grip strength assessment and has shown excellent test-retest and inter-rater reliability across different populations. The patient held the dynamometer with the upper limb in 0° abduction and rotation, the elbow flexed at 90°, and the forearm in a neutral position. The wrist was held between 0 and 15° of radial deviation, and a maximum grip was exerted for 3 seconds using all five fingers. Force was measured in kilograms. Three measurements were taken with each hand, always starting with the dominant hand, and the average of the three was calculated.

Isometric pinch strength. A Baseline Pinch Gauge® assessed three different types of pinch grip:

• Two-finger opposition grip (tip pinch): the anterior and distal surfaces of the first finger contact the anterior surface of the pinch gauge, and the anterior and distal surfaces of the second finger contact the posterior surface.
• Lateral pinch grip (key pinch): the anterior surface of the distal phalanx of the first finger contacts the anterior surface of the pinch gauge, and the radial edge of the second finger contacts the posterior surface.
• Three-finger pinch grip: the anterior and distal surfaces of the first finger contact the posterior surface of the pinch gauge, and the anterior and distal surfaces of the second and third fingers contact the anterior surface.

Three maximum force pinches were performed for 3 seconds each, alternating between the dominant and non-dominant hand. Force was measured in kilograms, and the average of the three results was calculated.

Box and Block Test (BBT). This test assesses manual coordination and dexterity. The patient sits in front of a wooden box divided into two identical halves containing 150 wooden blocks of 2.5 cm in different colors, positioned on the midline. The task is to transfer as many blocks as possible from one half of the box to the other within 60 seconds. The test is performed first with the dominant hand, then with the non-dominant hand. It is a standardized tool for measuring gross motor function of the upper limbs, validated for sex and age in healthy subjects, and it shows low ceiling and floor effects in people with MS (meaning it doesn't easily max out or bottom out). Test-retest reliability and minimal detectable change have been studied in other neurological conditions, showing excellent reliability, with a cut-off point of 6 blocks for minimal detectable change — the smallest change that is likely to be real rather than measurement error.

Nine Hole Peg Test (NHPT). This test assesses upper limb function, specifically fine motor skills of the hand. The subject sits in front of a pegboard and inserts and removes nine pegs, one at a time, into the nine holes as quickly as possible. The dominant hand is tested first. The non-tested hand can stabilize the pegboard. The score is measured in seconds and represents the time taken to complete the task. The NHPT has excellent test-retest, inter-rater, and intra-rater reliability, plus adequate internal consistency. Scores greater than 0.27 seconds per pin indicate severe hand dysfunction. The minimum detectable change is 7.46 seconds for the non-dominant hand and 4.38 seconds for the dominant hand. The standard deviation of the measurement is 2.69 seconds for the non-dominant hand and 1.58 seconds for the dominant hand.

Abilhand. A self-administered questionnaire that assesses manual dexterity — the ability to perform a series of tasks regardless of the strategies used. It contains 23 items scored from 0 to 2, covering different activities of daily living, and the patient reports the level of difficulty experienced. Scores range from 0 to 46, with higher scores indicating better manual dexterity. It has excellent inter-rater and intra-rater reliability, internal consistency, and construct validity.

Fatigue Severity Scale (FSS). A self-administered scale assessing the severity of fatigue during specific daily activities. It has 9 items scored from 1 to 7, giving a minimum score of 9 and a maximum of 63. A higher score means a greater impact of fatigue on the patient's life. The standard error of measurement is 0.7 points, and the minimum detectable change is 1.9 points. Test-retest reliability is moderate, and construct validity is excellent in people with MS.

Multiple Sclerosis Impact Scale (MSIS-29). A self-administered scale assessing the impact of the disease on the patient's life over the two weeks before it is completed. It consists of 29 questions: 20 assess the physical aspects of MS and 9 assess the psychosocial aspects. There are 5 possible answers, scored from 1 to 5, indicating lower to higher impact of the disease. Two total scores are generated, corresponding to the physical and psychological impact subscales. Scores range from 0 to 100, with a higher score indicating a greater degree of disability. The physical domain has shown high internal consistency and good construct validity, while the cognitive domain has good internal consistency. The scale has low ceiling and floor effects, excellent Cronbach's alpha (a measure of internal consistency) for both parts, and a strong correlation between the physical and psychological domains.

Likert satisfaction questionnaire. At the end of the study, participants in the experimental group completed a 20-item satisfaction survey developed by the research team. Items covered user satisfaction with the system, including attributes of the tool itself, ease of use, accessibility, session design, schedules, duration, as well as attributes of the center and the physiotherapist involved. Each item scored 1 to 5 points, with a maximum possible total of 100 points; higher scores meant greater satisfaction.

Finally, the researchers recorded the percentage of patients in both groups who adhered to treatment, and any adverse effects that occurred.

How Many Patients Were Needed

Grip strength was selected as the main outcome for the sample size calculation. The researchers estimated a medium effect size for grip strength (f = 0.3) and assumed a correlation of 0.5 between repeated measures. With three measurements planned (pre-intervention, post-intervention, and one-month follow-up), the sphericity correction was set at 0.5. Using a statistical power of 0.80 and an alpha level of 0.05, the estimated total sample size was 20 patients. Accounting for a 25% attrition rate (dropout rate), 25 patients were considered necessary. Sample size was calculated using G*Power 3.1.7 software.

How the Numbers Were Analyzed

All data were entered into the SPSS v.28.01 statistical package. Qualitative data were described using means, percentages, and ranges. The Kolmogorov-Smirnov test assessed whether study variables followed a normal distribution.

For variables with a normal distribution, a parametric analysis was performed using repeated measures analysis of variance (ANOVA) with Bonferroni post hoc adjustments. The group parameter was set as the between-subjects factor (comparing experimental versus control), while the within-subjects factors included each of the measurements and the treated side. A one-factor ANOVA was used to compare satisfaction and treatment attendance. Statistical analysis was performed at the 95% confidence level, with p-values less than 0.05 considered statistically significant.

Key Findings: What Changed and What Did Not

Twenty-five patients completed the study: 12 in the experimental group and 13 in the control group.

The groups differed somewhat in their baseline characteristics:

• In the experimental group, 66.6% were male and 33.4% were female.
• In the control group, 46.2% were male and 53.8% were female.
• The mean age in the experimental group was 53.00 years (standard deviation 2.06), while in the control group the mean age was 46.33 years (standard deviation 1.89).
• The mean disease duration in the experimental group was 17.75 years (standard deviation 3.2), while in the control group the mean disease duration was 14 years (standard deviation 3.47).

Between-group comparison. This is the most important caveat to understand. The ANOVA analysis showed no statistically significant differences for any of the variables analyzed in the group × side × time comparison. In plain language: when the Powerball® group was compared directly against the control group at each time point, the difference was not statistically significant for any measure.

Within-group comparison. The experimental group showed significant improvements in coordination and manual dexterity of the more affected upper limb as measured by the Box and Block Test:

• Comparing pre-treatment to post-treatment: p = 0.048 (statistically significant).
• Comparing pre-treatment to follow-up: p = 0.001 (highly statistically significant).

The experimental group also improved on the less affected upper limb:

• Comparing pre-treatment to follow-up: p < 0.001 (highly statistically significant).
• Comparing post-treatment to follow-up: p = 0.034 (statistically significant).

These p-values tell you how likely a result would be if there were truly no effect. A p-value below 0.05 means there is less than a 5% probability the finding was due to chance alone. A p-value of 0.001 means there is less than a 0.1% probability — a very strong signal. Critically, though, these improvements were documented within the experimental group over time, not between the two groups.

Satisfaction and Attendance

The Likert-type satisfaction questionnaire produced a mean score of 89.10 out of 100 (standard deviation 8.54) — an excellent satisfaction rating from the participants who used the device.

Attendance also favored the experimental group. The mean adherence rate in the experimental group was 100%, while in the control group it was 87.96%. This difference was statistically significant in favor of the experimental group (p = 0.002).

What This Means for Patients

The study's conclusion was that an upper limb treatment protocol using the Powerball® system, in combination with conventional physiotherapy for 8 weeks, resulted in significant improvements in the within-group analysis for upper limb coordination and manual dexterity — in favor of the experimental group. The experimental group also reported excellent satisfaction with the treatment.

The authors' own highlight statements summarize the clinical message:

• Powerball® can be used for upper limb rehabilitation in persons with multiple sclerosis.
• Coordination and manual dexterity may be improved after a treatment protocol with the Powerball®.
• Persons with multiple sclerosis showed excellent satisfaction after a treatment protocol with the Powerball®.

For patients, this is encouraging but should be read carefully. The device was safe and well tolerated in this group, no adverse effects were flagged in the reported results, and adherence was perfect in the Powerball® group — which suggests the exercise was tolerable and engaging for people with mild to moderate disability (EDSS 2 to 7). The gains seen were specifically in coordination and manual dexterity tasks — the kinds of hand skills used in everyday activities like dressing, eating, and household tasks — rather than in raw grip strength or pinch force, where no significant changes were reported in the results presented.

It is also worth noting that the improvements on the less affected side appeared in the comparison between post-treatment and follow-up (p = 0.034), and between pre-treatment and follow-up (p < 0.001). This pattern suggests the benefits may continue to build or be maintained after the training period, since patients continued conventional physiotherapy during the 3-week follow-up window.

Limitations: What the Study Could Not Prove

The most important limitation is the absence of statistically significant between-group differences for any analyzed variable. This means the study could not demonstrate that adding Powerball® training produced better results than conventional physiotherapy alone when the two groups were compared head to head. Improvements over time within the experimental group could partly reflect natural recovery, the effects of the conventional physiotherapy both groups received, or the extra attention given to the Powerball® group.

The small sample size — 25 patients completing the study, split into 12 and 13 — limits how confidently results can be generalized. Small trials are more vulnerable to chance findings and to imbalances between groups.

Those imbalances are visible in the data. The experimental group was older on average (53.00 years versus 46.33 years) and had a longer average disease duration (17.75 years versus 14 years). The gender split also differed (66.6% male in the experimental group versus 46.2% male in the control group). These differences may have influenced the results.

The outcome measures also have their own noise. The BBT has a minimal detectable change cut-off of 6 blocks, and the NHPT has minimum detectable changes of 7.46 seconds (non-dominant hand) and 4.38 seconds (dominant hand). The FSS has a minimum detectable change of 1.9 points. Changes smaller than these thresholds may not represent real improvement.

Finally, the trial was conducted at two MS patient associations in Madrid, Spain, so results may not apply to all patients with MS, particularly those with different disability levels, different MS types, or different rehabilitation access.

Practical Recommendations

Based on this trial, here is what patients and their care teams can reasonably take away:

1. Powerball® training appears safe and acceptable for people with MS. Every participant in the experimental group completed the protocol, and satisfaction averaged 89.10 out of 100. No adverse effects were reported in the results.
2. Expect coordination gains, not necessarily strength gains. The improvements documented were in coordination and manual dexterity on the BBT, not in grip or pinch strength.
3. Follow the dosing used in the study if you try it. That means 3 sets of 1 minute per hand for the first 4 weeks, progressing to 5 sets per hand, always starting with the dominant or less affected hand, in addition to — not instead of — conventional physiotherapy.
4. Respect fatigue. The study allowed longer rest intervals when fatigue exceeded 7 on the Modified Borg Scale. Fatigue management is part of the protocol, not an afterthought.
5. Use proper positioning. Seated upright in a chair with a backrest and no armrests, the exercising arm supported on a table, elbow at 90 degrees, shoulder flexed to 20 degrees and abducted to 30 degrees, forearm pronated, wrist in slight extension with slight radial deviation.
6. Start with a supervised demonstration session. The researchers provided one to every participant before the protocol began.
7. Discuss it with your neurologist or physiotherapist first. The study excluded people with other neurological or musculoskeletal conditions, cardiovascular, respiratory or metabolic disease, recent exacerbations or hospitalizations within three months, recent botulinum toxin treatment within six months, or uncorrected visual impairment.

The bigger message is that upper limb rehabilitation in MS deserves attention. Hand function problems affect 60% of people with MS from the early stages, and strength and dexterity are directly tied to independence and quality of life. This trial adds one more option to the toolbox — but larger, better-powered trials are needed before Powerball® training can be recommended as a standard addition to MS rehabilitation.

Frequently Asked Questions

Who was eligible to take part in this trial of Powerball® training for MS?

Participants had to be 20 to 70 years old, diagnosed with MS for more than two years, with an EDSS score between 2 and 7, stable medication for six months, no cognitive impairment, and upper limb tone and strength within set limits. People with other neurological, musculoskeletal, heart, lung, or metabolic conditions were excluded.

What did the Powerball® training actually involve?

Both groups received 16 sessions of conventional physiotherapy over 8 weeks. The Powerball® group added gyroscope training: 3 sets of 1 minute per hand for the first 4 weeks, then 5 sets per hand. A physiotherapist started the rotation, and patients sat upright with the arm supported on a table.

Did adding Powerball® training improve hand function more than physiotherapy alone?

When the Powerball® group was compared directly with the control group, no statistically significant differences appeared for any measure. The Powerball® group did improve over time on the Box and Block Test for coordination and dexterity, but those gains were seen within that group, not between the two groups.

What does a p-value of 0.048 mean in this trial?

A p-value of 0.048 means there is less than a 5% probability the result was due to chance alone. In this trial, that value came from comparing the Powerball® group before and after treatment on the Box and Block Test for the more affected arm. It does not mean the device beat conventional physiotherapy.

Were there any side effects or risks from using the Powerball® device?

No adverse effects were reported in the results, and every participant in the Powerball® group completed the protocol. Fatigue was actively managed: longer rest intervals were allowed if fatigue exceeded 7 on the Modified Borg Scale. The device appeared safe and well tolerated in this group of people with mild to moderate disability.

What are the main limitations of this trial?

The trial included only 25 patients from two MS associations in Madrid, so results may not apply to everyone. The groups differed in age, disease duration, and gender. Most importantly, no statistically significant differences were found between the Powerball® group and the control group for any measure, so it could not prove added benefit over physiotherapy alone.

I have MS and hand coordination problems — should I get a second opinion before adding Powerball gyroscope training to my physiotherapy?

A second opinion can help you weigh whether adding Powerball gyroscope training to conventional physiotherapy fits your situation. In a double-blind randomized trial of 25 patients, the Powerball group improved on the Box and Block Test for coordination and manual dexterity within the group over 8 weeks, with satisfaction averaging 89.10 out of 100 and no adverse effects reported. However, no statistically significant differences appeared when the Powerball group was compared directly against the control group, and the trial was small. Discuss the protocol, positioning, fatigue management, and your eligibility with your neurologist or physiotherapist. Diagnostic Detectives Network provides independent expert second opinions.

Source Information

Original article title: Effects of the powerball® system on muscle strength, coordination, fatigue, functionality and quality of life in people with multiple sclerosis. A randomized clinical trial.

Authors: Blázquez-Fernández A, López-Hazas-Jiménez G, Fernández-Vázquez D, Navarro-López V, Fernández-González P, Marcos-Antón S, Molina-Rueda F, Cano-de-la-Cuerda R.

Publication details: Journal of NeuroEngineering and Rehabilitation (2024), volume 21, article 33. DOI: 10.1186/s12984-024-01325-w. Published as open access under a Creative Commons Attribution 4.0 International License.

Trial registration: NCT05895734.

Affiliations: Rey Juan Carlos University and associated institutions in Madrid, Spain.

This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and does not replace advice from your neurologist, physiotherapist, or other qualified healthcare professional.