MS-Specific Cognitive Rehabilitation Tool Shows Promise in Pilot Study

A multiple sclerosis (MS)-specific computerized cognitive rehabilitation (CR) program led to significant improvements in mental skills among MS patients participating in a recent pilot study.

These findings suggest that those with MS, and likely other disorders, might gain the greatest benefits from tailored cognitive tests that are specifically adapted to the features of their medical condition, according to the researchers.

The study, “Enhancing cognitive rehabilitation in multiple sclerosis with a disease-specific tool,” was published in the journal Disability and Rehabilitation: Assistive Technology.

Nerve damage in MS — which leads to muscle spasms, walking difficulties, and other hallmark features of the neurodegenerative disorder — also tends to cause cognitive problems. These occur frequently, with estimates indicating that such cognitive difficulties might affect 40–70% of MS patients.

Cognitive impairment affects attention, memory, and executive function, which is a set of mental skills that include the ability to exercise self-control, and to plan and make decisions. People living with such impairments can experience difficulty learning new things and may even lose some visual-spatial skills.

Although computerized tools exist to provide cognitive rehabilitation, research on their effectiveness has yielded conflicting results.

Researchers from the University of Bologna, in Italy, and their colleagues hypothesized that this was due to the non-specific nature of available tools. Such tools, they argued, are broadly targeted at cognitive disability in general, whereas cognitive impairment in a given disorder, such as MS, has specific features that must be addressed.

To put these concepts into practice, the investigators developed a computerized tool, called MS-rehab, that focuses on the cognitive features that are most relevant to people with MS.

MS-rehab allows users to grow familiar with exercises by practicing easier versions of them. Rehabilitation exercises included in the program simulate real-life situations to help patients develop strategies for managing them as they arise. These exercises are then followed by a neuropsychological evaluation, carried out by a psychologist. Further interventions can then be prepared by a patient’s healthcare team, as needed.

As part of the program, MS-rehab also creates a cognitive profile of each user. That profile enables healthcare providers to track changes in the various tasks in order to best tailor each session to suit a patient’s needs.

Now, the team tested MS-rehab in a small study of eight MS patients. The tool was evaluated for its impact on patients’ cognitive abilities, and assessed for any potential side effects the rehabilitation program might cause. Additionally, the researchers asked participants to provide feedback on the tool’s usability.

Participants were adults (ages 18–72) and scored no more than four on the Expanded Disability Status Scale, indicating mild to significant disability, but with the patient still self-sufficient.

The eight individuals underwent a psychological evaluation that included the Beck Depression Inventory – II (BDI-II), the State-Trait Anxiety Inventory (STAI-Y1 and STAI-Y2) scales, the Fatigue Severity Scale, and the Multiple Sclerosis Quality of Life-54 questionnaire (MSQOL-54).

A cognitive neuropsychological evaluation also was performed using the Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV). This scale measures verbal comprehension, working memory, perceptual reasoning, and processing speed.

All of these tests were carried out at the beginning and end of the study.

The rehabilitation program took place over three weeks, and participants engaged in three, 40-minute individual sessions per week. All patients performed the same exercises, with the difficulty varying based on individual performance.

By the study’s end, the participants’ WAIS-IV scores had improved significantly across all indices within that scale. BDI-II scores fell from an average of 15.6 to 10.8, indicating lower levels of depression.

Other changes were not deemed significant, although the researchers did note an improvement in the volunteers’ overall mental status, as measured by the MSQOL-54.

All of the participants expressed enthusiasm for MS-rehab, and a willingness to continue using it in the future. While providing feedback, they also suggested a series of improvements for the tool, including making the text larger, making all images in the program more widely familiar (not all patients recognized certain images), and adapting the interface — currently optimized for a 10-inch display — to fit larger screens.

Finally, the investigators compared MS-rehab to other available CR tools, such as Rehacom, Happy Neuron Pro, and CogniFit, some of which have already been used in MS patients.

While MS-rehab lacks some features, such as multiple language support and 3D graphics, it distinguished itself by providing other functionalities, including realistic exercises geared toward everyday tasks, and dynamically accessing stored test results during the rehabilitation process.

The research team now hopes to confirm these findings in a larger study.

“As a future work, an extensive clinical study to validate the CR effectiveness of MS-rehab is planned. In addition, we want to fully incorporate in the system a promising reinforcement learning based mechanism to automatically adapt exercise difficulty to the actual performance of patients in the rehabilitation,” they wrote.