Telerehabilitation for Neurological Disability with Remotely Supervised Transcranial Direct Current Stimulation (RS-tDCS)

Objective: To demonstrate the feasibility of delivering telerehabilitation paired with transcranial direct current stimulation (tDCS) to patients at home. Background: Effective rehabilitation for cognitive and motor recovery requires multiple training sessions for optimal benefit. tDCS is an emerging noninvasive brain stimulation technique that may be used to improve rehabilitative outcomes and reduce symptom burden across a variety of CNS disorders. The burden of time and travel is often a barrier for patients to attend outpatient rehabilitation. A telerehabilitation protocol was developed to remotely supervise patients in real time via videoconference to complete at-home training exercises paired with tDCS treatment (RS-tDCS). Design/Methods: Feasibility and compliance rates were compared across RS-tDCS in patients according to age, level of neurological disability, and cognitive and motor functioning. We also tested when patients could independently place the tDCS headset and operate the device without supervision, in order to enable extended treatment regimens. Results: To date, our program has delivered n=4,031 RS-tDCS sessions to a total of n=239 patients, ranging in age from 18 to 71 years, with conditions including multiple sclerosis (MS), Parkinson’s disease, and other CNS disorders. RS-tDCS was safe and well-tolerated without serious adverse events. Procedures were feasible for patients with advanced neurologic impairment (e.g., MS EDSS scores up to 8.0), moderate cognitive impairment (SDMT z scores ≤-3.0) and limited upper extremity function. Completion rates for at-home training averaged 95.6%, 92.4%, 91.1% for 5, 10 and 20 training sessions, respectively, and individual cases have completed up to 60 sessions. In the subsample studied (n=50), independent tDCS headset placement and device operation was achieved after an average of 4 RS-tDCS sessions. Conclusions: Telerehabilitation with tDCS is feasible for at-home delivery, improves training compliance and completion when compared to outpatient visits, and is feasible for a variety of patients with neurological-related disability. Disclosure: Dr. Lee has nothing to disclose. Dr. Ro has nothing to disclose. Dr. Lustberg has nothing to disclose. Dr. Shaw has nothing to disclose. Dr. Khan has nothing to disclose. Dr. Best has nothing to disclose. Dr. Malik has nothing to disclose. Dr. Links has nothing to disclose. Dr. George has nothing to disclose. Dr. Datta has nothing to disclose. Dr. Bikson has nothing to disclose. Dr. Sherman has nothing to disclose. Dr. Krupp has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Everyday Health, Gerson Lehman, Novartis, RedHill Biopharma, Roche, Shire, and Sanofi-Aventis. Dr. Krupp has received royalty, license fees, or contractual rights payments from Biogen, Reata Pharma, AbbVie Pharmaceuticals, Amicus Therapeutics, SA Inventions, Finkhar Health, Janssen Pharmaceuticals, Eisai, IPSOS, Octapharma, Atara Biotherapeutics, Merck, Research Tech, and ERT Inc. Dr. Krupp has received research support from Biogen and Novartis.Dr. Charvet has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen - reimbursed travel. Dr. Charvet holds stock and/or stock options in Johnson & Johnson. Dr. Charvet has received research support from Biogen.