Although physical rehabilitation is very common, cognitive rehabilitation for Multiple Sclerosis is not yet applied to all cases in which it would be necessary. Cognitive impairment is common in people with multiple sclerosis (MS) and can affect several cognitive domains. Approximately 40% to 70% of people with multiple sclerosis experience some degree of cognitive impairment.
What cognitive functions should be included in cognitive rehabilitation in Multiple Sclerosis?
Multiple sclerosis affects various cognitive functions, depending on factors such as duration and course of the disease, and the burden of brain lesions.
The most commonly affected functions, and therefore should be included in the cognitive rehabilitation in multiple sclerosis are:
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Processing speed:
- Processing speed is the most commonly affected cognitive function, with approximately 20% to 50% of patients experiencing a slowing in this domain.
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Attention:
- Between 20% and 50% of MS patients present difficulties to maintain attention in tasks with the presence of distractors.
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Memory:
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Memory problems affect between 20% and 60% of patients. Episodic memory and working memory are the most frequently affected.
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Executive functions:
- Between 15% and 30% of people with MS have difficulties with executive functions.
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Language:
- Language difficulties such as anomia are seen in approximately 20% to 30% of patients.
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Visuospatial skills:
- Problems with perception and management of space, such as difficulties in judging distances or interpreting maps, are less common, affecting between 10% and 20% of people with MS.
Activities for cognitive rehabilitation in Multiple Sclerosis
The treatment of Multiple Sclerosis should have a multi- or transdisciplinary approach. Although motor skills such as balance or gait should be worked on in physiotherapy, it would also be necessary to include :
- Speech and language therapy
- Occupational therapy or ergotherapy
- Neuropsychology or cognitive rehabilitation
In order to design a treatment plan for cognitive rehabilitation in multiple sclerosis, you can install a professional cognitive rehabilitation software that offers a large number and variety of activities.
The same type of activities may not be used for a person with dementia as with someone with multiple sclerosis. Often, people with multiple sclerosis are relatively young, who are still working or want to re-enter the workforce, and who need demanding activities with difficult levels.
Example of a session for cognitive rehabilitation in Multiple Sclerosis
Processing speed
In this activity, the patient will have to touch, as quickly as possible, only the boxes of the category indicated.
Divided attention
To train divided attention, the patient will have to touch the shapes in the middle lane if they match in color with the left, and those of the right lane if they match in shape with the left. This way, processing speed and the ability to pay attention to several stimuli simultaneously are trained.
Working memory
To work on auditory working memory, the patient will listen to a series of words that he/she will later will have to remember and choose among some images.
Executive functions
The goal of this activity is to choose the fastest route in a public transport network. It can be used to train planning, decision making and working memory.
Language
In order to train naming, an image is shown and the patient will have to name it and choose the letters that make it up.
Visuospatial skills
The patient has to copy exactly a board with the pieces provided.
Likewise, to prevent falls due to the presence of distractors or to work on divided divided attention by combining physical and cognitive activities, dual tasks can be used.
While performing a cognitive activity with Rehametrics, motor components or even walking can be included, in order to make cognitive rehabilitation in Multiple Sclerosis more ecological and and that the results can be transferred to real life.
