Multiple Sclerosis - A Practical Guide to Rehabilitation - 29

A Practical Guide to Rehabilitation
in
A PRACTICAL GUIDE TO IDIOPATHIC

MULTIPLE SCLEROSIS

* Forgetting to take medications or taking
medicines incorrectly
* Disorganization when approaching or carrying
out a task
* Distractibility or inattention (visual or auditory)
* Difficulty assembling things
* Delay in thought processing
* Delay in responding (verbal or physical)
* Difficulty planning, sequencing, and carrying
out activities or schedules
* Difficulty problem solving
* Getting easily overwhelmed
* Poor reading comprehension
* Difficulty with mathematical calculations
* Difficulty expressing thoughts and ideas
* Difficulty answering questions directly
* Asking for the same information over and over
* Poor interpersonal skills
* Difficulty learning new tasks
* Lack of awareness of problems
* Unexplained failure to succeed
When considering cognitive evaluation, it is
important to be mindful of possible comorbid or
independent deficits in motor, sensory,
coordination, vision, and hearing capabilities. For
example, visual impairment occurs frequently in
MS, and hearing impairments (though usually
not severe) may be present.83 Clinicians should be
aware that functional performance below the level
of a patient's ability, as shown on testing, may
suggest aggravating factors such as fatigue, mood
disturbance, or pain. Cognitive fatigue (decline in
cognitive performance over a single testing
session) is now an accepted reality in people with
MS.84,85 Recognition and documentation of this
finding may help patients maximize function or
obtain workplace accommodations.

TREATMENT TO MAINTAIN OR
IMPROVE COGNITION IN MS
To date, no medications have consistently shown
efficacy for treatment of cognitive changes in MS,
although research continues.86,87 However,
neuropsychological and cognitive rehabilitation
strategies show promise.

Neuropsychological rehabilitation is concerned
with mitigating the cognitive, emotional,
psychosocial, and behavioral deficits caused by
damage in the brain.88 Cognitive rehabilitation is
the process of improving or supplementing
cognitive skills needed for activities of daily living,
with treatment approaches that may be restorative
or compensatory in nature. An increasing body of
literature supports the use of neuropsychological
and cognitive rehabilitation in patients with MS.
For example, a 2014 Cochrane review of 20
studies found that neuropsychological
rehabilitation improved cognitive symptoms.89
Cognitive training was associated with
improvements in memory span and working
memory, and cognitive training combined with
other neuropsychological methods was associated
with improvements in attention, immediate verbal
memory, and delayed memory.90 Other recent
studies have shown benefits of various cognitive
rehabilitation strategies in patients with MS,
including retrieval practice for memory-impaired
patients,90,91 a modified Story Memory
Technique,92 and a computer-assisted intervention
focused on memory, attention, and
problem-solving skills.93 A variety of
compensatory strategies employed for cognitive
challenges in MS are summarized in Table 12
(page 30).
For a patient with MS, a typical cognitive
rehabilitation session might include reviewing
what has happened since the previous session,
outlining goals for the current session, practicing
cognitive exercises, developing and/or practicing
compensatory strategies, self-evaluating
performance, reviewing the session, discussing
homework, and formulating a to-do list.
Cognitive rehabilitation strategies need to be
specific to the patient's goals, as well as realistic
and applicable to day-to-day life. Having a means
for accountability-for tracking if or how a given
strategy is used-is key, as is establishing a
timeline for when the strategy will be
implemented, and for how long.94

Selected Aspects of Cognition in Multiple Sclerosis

29



Multiple Sclerosis - A Practical Guide to Rehabilitation

Table of Contents for the Digital Edition of Multiple Sclerosis - A Practical Guide to Rehabilitation

Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 1
Multiple Sclerosis - A Practical Guide to Rehabilitation - 2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 3
Multiple Sclerosis - A Practical Guide to Rehabilitation - 4
Multiple Sclerosis - A Practical Guide to Rehabilitation - 5
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Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover3
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover4
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