Effectiveness of cognitive rehabilitation for people with multiple sclerosis: a meta-synthesis of patient perspectives

While previous randomised controlled trials and meta-analyses offer only limited evidence for the effectiveness of cognitive rehabilitation, qualitative studies examining patient perspectives report more positive outcomes. This meta-synthesis of qualitative studies examined patient perspectives of cognitive rehabilitation for memory, attention, and executive function problems in people with multiple sclerosis. Using set eligibility criteria, we screened electronic databases, reference lists, and academic networks for relevant papers. Seven papers (195 participants) were selected. Two independent researchers conducted quality appraisals of papers. Data analysis, guided by the thematic synthesis approach, yielded six main themes. These suggested that patients benefitted from the group environment in rehabilitation. Cognitive rehabilitation facilitated the participants’ reflection and awareness of their cognitive deficits, and was associated with increased knowledge and understanding of their illness. Increased strategy use was reported and associated with improvements in cognitive functioning and greater confidence and perseverance. Participants reported emotional and social improvements, and felt more optimistic. Overall, these changes had a positive impact on participants’ quality of life. This synthesis of qualitative studies indicates that people with multiple sclerosis who experience cognitive deficits benefit from cognitive rehabilitation programmes. This finding must, however, be viewed in light of the limitations of this meta-synthesis. The meta-synthesis was registered in the PROSPERO database under CRD42017040148.     

The effectiveness of memory rehabilitation following neurological disabilities: A qualitative inquiry of patient perspectives

The evidence for the effectiveness of memory rehabilitation following neurological conditions, mainly studied through quantitative methodologies, has been equivocal. This study aimed to examine feedback from participants who had been through a randomised controlled trial (RCT) comparing two types of memory rehabilitation with a self-help control. It was envisaged that this information would offer a detailed understanding of patient experience of going through a trial and the perceived effects of having attended group sessions. Through 31 in-depth interviews, data collected were thematically analysed. The seven themes identified highlighted improvements in insight and awareness of memory problems and their neurological conditions, knowledge and skills about using memory aids; and as a consequence, improvements in cognitive functions, mood, and confidence, assertiveness and control over their condition. Participants also reported an altered perspective of life that helped them deal with their problems, and the therapeutic effects of attending group sessions. While these improvements were mainly reported in the intervention groups, even those in the control group reported some benefits. This study highlights that it is both feasible and advantageous to embed qualitative research within the traditional RCT methodology to arrive at a more nuanced understanding of patient experiences and intervention outcomes.     

The role of reading on the health and well-being of people with neurological conditions: a systematic review

Objectives: Little research has been conducted that investigates the benefits of reading for people with neurological conditions despite its age old use to improve well-being. The aim of this study was to identify and review the evidence of the effect of ‘lone’ reading, reading aloud and shared reading groups on the health and well-being of people with neurological conditions in clinical and long-term care settings.Methods: A literature search was conducted incorporating a systematic search of electronic databases, internet searching, ‘snowballing’ technique from references of relevant studies and consultation with clinicians and academics in the field.Results: Twelve studies (five quantitative, three qualitative and four mixed methods) met the criteria for inclusion in the review. No randomised controlled trials were identified. Significant heterogeneity in the results of the quantitative studies precluded statistical data synthesis. Thematic analysis and synthesis was applied to the three qualitative studies and the qualitative data of the mixed-method studies. All but one of the quantitative studies reported that the reading interventions had a positive effect. The evidence from the qualitative studies demonstrated multiple positive effects of shared reading groups.Conclusions: The effect of ‘lone’ reading, reading aloud and shared reading groups on the health and well-being of people with neurological conditions is currently an under-researched area. Although this review reports encouraging results of positive effects, the results should be viewed with caution due to the lack of randomisation, the small numbers of participants involved, and the limited and heterogeneous evidence base.     

The NeuroPage system for children and adolescents with neurological deficits

Objective: Several studies have demonstrated the effectiveness of a paging system, NeuroPage, in helping survivors of brain injury compensate for everyday memory and planning problems. This study examines the effectiveness of the paging system in the sub-group of 12 children and adolescents with neurological deficits who took part in a larger study.

Methods: Twelve participants aged 8–17 years took part in a randomized controlled crossover trial in which their completion of everyday goals was monitored prior to and during use of the NeuroPage system, where participants were sent reminder messages regarding tasks they should complete.

Results: All 12 young people showed significant improvements in carrying out everyday tasks between the baseline and treatment phases.

Conclusions: The NeuroPage system can be successfully used by children and adolescents with neurological deficits and can alleviate some of the everyday difficulties caused by their memory and planning difficulties.     

Cognitive rehabilitation two and one-half years post right temporal lobectomy

Abstract

A 45-year old radiologist, who underwent a right temporal lobectomy to remove a tumor, sought treatment for difficulties with attention/scanning, sustained concentration, leisure reading, driving, and self-monitoring in social situations. A neuropsychological evaluation conducted 2.5 years postsurgery revealed impaired visual-spatial memory, inefficiency in general visual scanning, a mild left-sided neglect, and diminished social perception. The patient subsequently underwent a 4-month cognitive retraining program, which was tailored to his specific neuropsychological deficits. At the termination of treatment, improvements were observed on follow-up neuropsychological data, behavioral observations made by the patient's wife, and efficiency on work-related tasks. This case illustrates the ecological validity of cognitive rehabilitation procedures and emphasizes the need to tailor the procedures to specific cognitive deficits revealed on neuropsychological testing.     

Neurocognitive rehabilitation for schizophrenia

A critical review of randomized, controlled trials of extended programs of neurocognitive rehabilitation for the cognitive deficits characteristic of schizophrenia conducted between the years 2000 to 2002 was completed. Over the past several years, two models of cognitive rehabilitation have emerged. In one model, labeled “cognitive remediation,” cognitive deficits are treated directly through repeated practice and acquisition of compensatory strategies on cognitive exercises designed to engage underfunctioning brain systems. In a second model, labeled “cognitive adaptation,” neurocognitive deficits are addressed through modification of the patients’ environment to allow patients to bypass their deficits. Results revealed that a range of cognitive remediation strategies varying widely along dimensions of duration, intensity, method, target of behavioral intervention, and clinical status of participants produced improvements on measures of working memory, emotion perception, and executive function distinct from those trained during remediation. No effects were evident in secondary verbal or nonverbal memory. Results of two pilot studies using functional magnetic resonance imaging to assess changes in task-evoked brain activation have revealed that these interventions may produce changes in several functionally relevant neural systems in a subset of patients. Results from studies of standardized cognitive adaptation interventions have indicated that these treatments can produce improvements in symptoms, psychosocial status, and relapse rates. A variety of approaches for future research are also discussed.     

Memory outcomes following cognitive interventions in children with neurological deficits: A review with a focus on under-studied populations

Given the primary role of memory in children's learning and well-being, the aim of this review was to examine the outcomes of memory remediation interventions in children with neurological deficits as a function of the affected memory system and intervention method. Fifty-seven studies that evaluated the outcome of memory interventions in children were identified. Thirty-four studies met the inclusion criteria, and were included in a systematic review. Diverse rehabilitation methods for improving explicit and implicit memory in children were reviewed. The analysis indicates that teaching restoration strategies may improve, and result in the generalisation of, semantic memory and working memory performance in children older than 7 years with mild to moderate memory deficits. Factors such as longer protocols, emotional support, and personal feedback contribute to intervention efficacy. In addition, the use of compensation aids seems to be highly effective in prospective memory tasks. Finally, the review unveiled a lack of studies with young children and the absence of group interventions. These findings point to the importance of future evidence-based intervention protocols in these areas.     

Cognitive rehabilitation in multiple sclerosis: a review of the literature

Introduction

Cognitive impairment is now well-known in multiple sclerosis (MS). However, few rehabilitation interventions are proposed or really efficient.

Objectives

To present a review of cognitive rehabilitation intervention research conducted in people with multiple sclerosis (MS), regarding different findings about episodic memory, working memory, attention and executive function disorders in MS.

Data sources

A search of Medline (yield 20 papers) and of PsychInfo (yield 1 article), using combinations of the following terms: cognitive rehabilitation, multiple sclerosis, cognitive therapy, neuropsychological rehabilitation, in the title or in the abstract, from 1960 to March 2010, excluding animal studies.

Results

Episodic memory rehabilitation studies appear to be promising. Programs on working memory, attention and executive functions are in the very early phases.

Conclusions

Results are encouraging and allow specific recommendations for future research about: (1) inclusion criteria, often not defined, (2) a specific baseline adapted to the program of rehabilitation, (3) a control measure regarding program efficiency and (4) a role for the psychologist (presence and advice during the program).     

Decision-making,cognition, and aphasia: developing a foundation for future discussions and inquiry

Background: Making a decision is a cognitive task that requires the use of cognitive functions such as attention, memory, language, and executive function. Researchers have found people with cognitive deficits perform worse than healthy controls on experimental measures of decision-making. Researchers have also shown that persons with aphasia (PWA) may have deficits in the cognitive functions implicated in rational decision-making.

Aims: In this paper, we will discuss the cognitive processes associated with decision-making by examining decision-making abilities in populations with cognitive deficits. Then we will discuss cognitive functions within the dual-process theory of decision-making, and describe the way(s) in which these processes may be impaired in PWA. We will also present a theoretical model of cognitive processes involved in decision-making and discuss the potential clinical implications of cognitive impairments on decision-making in PWA.

Main contribution: This paper provides a theoretical foundation to support future discussions and investigations of decision-making in PWA.

Conclusions: Making a rational decision may be more challenging for PWA, given the possibility of concomitant cognitive impairments. Future research is needed to validate or refute the theoretical synthesis presented in this paper. This could be accomplished through a variety of qualitative, quantitative, and mixed-methods research studies.     

Memory rehabilitation for the working memory of patients with multiple sclerosis (MS)

Objective: The main cognitive impairments in multiple sclerosis (MS) affect the working memory, processing speed, and performances that are in close interaction with one another. Cognitive problems in MS are influenced to a lesser degree by disease recovery medications or treatments,but cognitive rehabilitation is considered one of the promising methods for cure. There is evidence regarding the effectiveness of cognitive rehabilitation for MS patients in various stages of the disease. Since the impairment in working memory is one of the main MS deficits, a particular training that affects this cognitive domain can be of a great value. This study aims to determine the effectiveness of memory rehabilitation on the working memory performance of MS patients.

Method: Sixty MS patients with cognitive impairment and similar in terms of demographic characteristics, duration of disease, neurological problems, and mental health were randomly assigned to three groups: namely, experimental, placebo, and control. Patients’ cognitive evaluation incorporated baseline assessments immediately post-intervention and 5 weeks post-intervention. The experimental group received a cognitive rehabilitation program in one-hour sessions on a weekly basis for 8 weeks. The placebo group received relaxation techniques on a weekly basis; the control group received no intervention.

Results: The results of this study showed that the cognitive rehabilitation program had a positive effect on the working memory performance of patients with MS in the experimental group. These results were achieved in immediate evaluation (post-test) and follow-up 5 weeks after intervention. There was no significant difference in working memory performance between the placebo group and the control group.

Conclusions: According to the study, there is evidence for the effectiveness of a memory rehabilitation program for the working memory of patients with MS. Cognitive rehabilitation can improve working memory disorders and have a positive effect on the working memory performance of these patients.     

Divergences of perspective between people with aphasia and their family caregivers

Background: Studies of the relation between family caregivers and care-receivers have identified large divergences between their perspectives. It has been suggested that these divergences may adversely affect the care relationship. However, there has been little research examining the source of these divergences.

Aims: The reported mixed-method study aimed to examine the relationship between people with aphasia and their family caregivers in order to identify the sources of observed divergences of perspective.

Methods & Procedures: A total of 20 people with aphasia and their main family caregivers, living in the UK, completed an adapted version of the Interpersonal Perception Method questionnaire, which yielded both rating data and qualitative data. Participants rated themselves, each other, and how they thought the other would rate them, on issues regarding communication ability and identity.

Outcomes & Results: As expected on the basis of existing research, divergences clustered around the provision of communication support and issues of confidence, independence, embarrassment, and overprotection. A qualitative analysis of the participants' talk during the rating task suggested that a source of these discrepancies is in the conflicting demands which characterise the care relationship, specifically, caregivers' desire to support independence on the one hand but feeling compelled to be protective on the other hand. In response to these demands, caregivers try to create the impression that the disability has less impact than it has, and that they are more in control than they feel they are.

Conclusions: We conclude by suggesting that some divergences of perspective may not be adverse overall, but rather may be a result of caregivers' creative adaptations to seemingly irreconcilable demands.     

Semantic anomaly judgement in individuals with probable Alzheimer's disease

Background: Research has shown that individuals with probable Alzheimer's disease (PrAD) show impaired semantic knowledge of nouns. More specifically, while they demonstrate preserved superordinate category information, information regarding specific semantic attributes associated with subordinates appears to be disrupted. Results of some recent studies suggest that PrAD participants may also be impaired in processing semantic information associated with verbs. Aims: Provided that a parallel exists between PrAD participants' noun and verb impairment, it is plausible that the semantic deficits observed in the breakdown of their noun lexicon may also exist in their knowledge of verb‐related information. This experiment examined PrAD participants' knowledge of the semantic restrictions associated with the complements of verbs. Methods & Procedures: Fourteen PrAD participants were asked to judge the semantic plausibility of 44 auditorily presented sentences. To examine their knowledge of the selection restriction of verbs, each verb was paired with two plausible complements that fully met the restriction, an implausible complement that violated the specific attributes required but belonged to the correct semantic category, and an implausible complement that violated the semantic category requirement. Outcomes & Results: Results showed that PrAD participants' errors were primarily on anomalous sentences that contained implausible complements that belonged to the correct semantic category. Conclusions: This finding confirms our hypothesis and suggests that a parallel pattern exists in PrAD participants' breakdown in noun and verb knowledge.     

Cognitive rehabilitation and cognitive training for mild dementia

Cognitive deficits caused by dementing illnesses are chronic and progressive problems, which should be tackled both by biological and non‐biological approaches. Among the various techniques of non‐biological approaches (cognitive rehabilitation), centered is cognitive training intervention for individuals with dementia. Cognitive training is further divided into two different types of setting: group and individualized. Among group training techniques, the reality orientation training and day care/day services are known to have evidence‐based efficacy. Individually tailored cognitive training aims to directly and explicitly improve cognitive functioning of people with dementia specifically in the early stages. Increasing evidence demonstrates the efficacy of various individualized training programs for dementia, including Alzheimer's disease (AD). Specifically, three techniques, known as spaced retrieval, dual cognitive support and procedural memory training, have shown promise in their ability to enhance learning in people with dementia. In addition, recent studies have suggested that a combination of pharmacotherapy and cognitive training may benefit individuals with AD. Cognitive training appears to be particularly effective for people with mild memory impairment who are on cholinergic treatment. It is now widely accepted that the theoretical framework of ‘errorless learning’ is also a guiding principle in the realm of cognitive training for people with dementia. Although the effect of factors, namely effort (effortful vs effortless) and stimulus features (perceptual vs conceptual), has not been fully determined, error elimination during learning sessions is essential for favorable outcomes.     

Everyday memory measures in multiple sclerosis: a systematic review

ABSTRACT

Everyday memory is one of the most affected cognitive functions in multiple sclerosis (MS). Assessing everyday memory problems is crucial for monitoring the impact of memory deficits on individuals’ day-to-day lives and evaluating the effectiveness of interventions that aim to improve cognitive functions. The aim of this systematic review was to identify the research literature on everyday memory measures used with people with MS, describe the types of measures used, and summarise their psychometric properties. Empirical studies of cognitive function in MS using standardised everyday memory measures were included. Online databases (MEDLINE, PsycINFO, PsycARTICLES, Embase) and Google Scholar were searched. Forty-four studies met the inclusion criteria. A total of 12 measures were identified, with varied uses and administration methods. The majority of papers did not report any psychometric properties for MS populations. The few papers that did, reported that the measures have good reliability and appear to have good face, concurrent, and ecological validity, but these need to be evaluated further. This review presents researchers and clinicians with an overview of the various everyday memory measures used in studies with people with MS, to help them choose the appropriate measure for their evaluations.     

A comparison of client and therapist goals for people with aphasia: A qualitative exploratory study

Background: A considerable body of literature attests to the efficacy of client and therapist collaborative goal setting to achieving optimal rehabilitation outcomes. Collaborative goal setting and shared decision making relies on good communication, thus potentially disadvantaging people with aphasia.

Aims: This study aims to identify the similarities and differences between client goals and therapist goals in rehabilitation for people with aphasia and to explore reasons why any differences occur.

Methods & Procedures: Three speech-language pathologists and four people with aphasia participated in in-depth semi-structured interviews to identify rehabilitation goals. All the interviews were transcribed and analysed using qualitative content analysis.

Outcomes & Results: Results indicated both matching and mismatching of goals between the clients and the speech-language pathologists. Matched goals tended to focus on communication outcomes. Mismatched goals were those associated with the client's desire to return to previously valued activities. Reasons for the mismatching included: impaired communication made collaboration on goal setting difficult, the service-delivery approach, the goal was perceived to be outside the speech-language pathologist's scope of practice, and the goal was not considered to be appropriate within the confines of the rehabilitative situation.

Conclusions: This study highlights the need for speech-language pathologists to understand their clients' goals and how these can be incorporated into rehabilitation. A re-examination of some professional beliefs was highlighted. Future research may lead to educational resources that enable better collaborative goal setting between therapist and client so that outcomes of rehabilitation are optimised.     

Executive skills and their functional implications: Approaches to rehabilitation after childhood TBI

Background: It is widely acknowledged that children recover differently from adults following traumatic brain injury. The impact of neurological injury in the context of developing skills and changing expectations of behaviour requires a developmental approach to rehabilitation that considers children's abilities across home, school and community environments.

Methods: This article aims to provide an overview of the impact of executive deficits on everyday functioning and to review information about intervention strategies that support long term development of skills.

Results and conclusions: While individual disciplines are not directly referred to in this paper, input from a comprehensive and co-ordinated interdisciplinary team is crucial to understanding and reducing the impact of executive deficits on functional performance.