Online Keyboard Tapping Assessment Accurately Evaluates MS Disease Severity

computer typing
computer typing
The BRAIN test is limited by its ability to only assess upper limb function.

The BRadykinesia Akinesia INcoordination (BRAIN) test is a reliable online keyboard-tapping assessment tool to identify disability and disease severity related to multiple sclerosis (MS) remotely, according to study findings published in the Journal of Neurology.

In this study, investigators calculated akinesia times (AT; mean dwell time on each key), kinesia scores (KS; number of key taps in 30 seconds), and incoordination scores (IS; variance of traveling time between keys) using the BRAIN test in a total of 39 patients with MS. Following assessment, these scores were correlated against pyramidal and cerebellar functional system scores, Expanded Disability Status Scale (EDSS) scores, and the 9-hole peg test.

The EDSS scores were found to correlate with AT (r =0.464, P =.003), KS (r =-0.594, P <.001), and IS (r =0.423, P =.007). In addition, there was a significant correlation of 9-hole peg test (r =0.926, P <.001) and pyramidal scores (r =-0.517, P <.001) with KS.

Cerebellar scores also correlated with AT (r =0.567, P <.001), KS (r =-0.665, P <.001), and IS (r =0.546, P =.007). The investigators found that KS could be used to determine the absence or presence of cerebellar and pyramidal dysfunction with an area under the curve of 0.829 (P <.001) and 0.840 (P <.001).

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The BRAIN test evaluates upper limb function only, which limits the overall ability of the tool to assess other important indicators for disability and MS disease severity. In this study, the investigators did not prospectively examine changes in BRAIN scores with EDSS over the long-term, further limiting the overall findings.

Administering BRAIN tests online “raises the possibility of using it in clinical trials for assessing disability in patients from their own home” and may also reduce the need for repeated hospital visits.


Shribman S, Hasan H, Hadavi S, Giovannoni G, Noyce AJ. The BRAIN test: a keyboard-tapping test to assess disability and clinical features of multiple sclerosis [published online December 4, 2017]. J Neurol. doi:10.1007/s00415-017-8690-x