Under and over rehabilitation tool

Under & Over is a new hand and arm rehabilitation tool, and home-based training programme, for people with MS. It consists of a grid, two coloured laces and a book of instructions.

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The tool has been designed to be fun, creative and challenging. The training programme is made up of a variety of patterns, ranging in style and complexity, that a person with MS should try to complete at home each day. People using the tool will be actively encouraged to create and share new patterns, which makes Under & Over a creative and interactive tool.

From our design-led research process, the activity of threading and pulling combines multiple motor movements into a well-defined repetitive task. We believe that a controlled upper limb activity that engages patients to complete it every day could potentially maintain and improve their upper limb function.

We conducted research into how people with MS with an EDSS of 6 and over, enjoyed completing this activity over time and how it impacted their arm and hand function.

While we were unable to demonstrate an effect of the Under & Over tool on upper limb function in all groups as measured by the cardboard 9 Hole Peg test, there was a meaningful improvement in fatigue as measured by MFIS across all groups and on the physical subscale of the MSIS-29 for those in the Daily Under & Over group. This indicates some responsiveness to the intervention or due to participation in the study.

Future remote intervention studies could benefit from incorporating adaptive engagement strategies, such as personalised reminders and participant-tailored activity adjustments, to enhance adherence and capture a broader spectrum of patient experiences.

Project outputs:

In March 2024, an academic paper was published in the Multiple Sclerosis and Related Disorders Journal, “Under & Over: A randomised controlled study to develop an upper limb rehabilitation tool for people with Multiple Sclerosis". The paper describes the results of the study.

In March 2023 the research team presented study results to the study participants in a series of online meetings.

The study team shared these results with health care professionals, health researchers, charities and companies through a series of presentations throughout 2022 and 2023.

An academic poster was presented at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS 2023) conference, “Under and Over: Findings from a remote study in people with Multiple Sclerosis” describing initial study results.

This tool is part of the #Thinkhand campaign, which aims to raise awareness of the importance of hand and arm function for people with MS. You can find out more about #Thinkhand on the Barts-MS Research Blog: ms-res.org