Rehabilitación cognitiva en esclerosis múltiple

Cognitive rehabilitation in multiple sclerosis


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By: Soraya Vázquez Caro, psychologist at ADEMBI (Esclerosis Múltiple Euskadi)

Our association has been offering the neuropsychology service since February 2006, given the need for it in people with multiple sclerosis, since it is estimated that the % of cognitive impairment is above 60%.

Normally when they start, they are given a neuropsychological evaluation, which is usually repeated every few years, as a follow-up, or in the event that there has been an evident worsening, or they request a report for some procedure, such as incapacity for work. The NeuronUP program is widely used in neuropsychology sessions, both in paper and digital activities. Some of them also take cards to do at home.

NeuronUP also gives us the advantage of being able to see, before starting each session, what exercises you have done in previous sessions, when was the last time you have done a specific exercise, to be able to select a specific function to work on, to compare results in the same activity, to give them feedback.

We also use it on a very large touchscreen computer, which allows them to use it without the need to operate the mouse, given the motor and fine motor skills, grip, tremor, etc. Likewise, it makes the task easier for all those who have visual impairments; which are many, due to the size of the screen, and because the instructions and others are also provided at audio level; not only in writing.

Our experience with NeuronUP

Starting out

As for the trajectory of this tool in our association, we began to use it almost when it began to be created and distributed, when I believe that only Aita Menni had acquired it. It would be approximately in September 2012. In fact, in one of the photos on the platform’s website, a user appears next to me who then started using it, and who continues to do so today.

At that time, we met on numerous occasions, to see how the platform was working, what suggestions we had, in terms of improvement, adaptations, the needs that we were seeing when we started to apply it with our users, and the multiple sclerosis collective in the different associations of the Spanish territory. For example, in March 2014 we met in Madrid and in July of the same year in Barcelona.

Study with NeuronUP

And a study was also carried out with NeuronUP from the end of 2014 to mid-2015, entitled “Observational study to explore the effectiveness of a computer-based cognitive rehabilitation program in multiple sclerosis, either in person or at a distance”. The results were presented at various conferences; at the Spanish Society of Neurology(SEN), in November 2016 and at RIMS, in May 2017

Two study groups: face-to-face and distance therapy

In this study, the rehabilitation intervention was carried out with the NeuronUP platform. There were two groups; one of them in person, and the other at a distance; telerehabilitation. Both groups were comparable in terms of the functions to be worked on, the exercises to be performed, the duration of the sessions, the frequency of these, and the months of treatment. As well as the follow-up carried out, the feedback administered, the previous and subsequent evaluations, the first sessions of explanation of the project and handling of the application, as well as the pertinent resolution of doubts or possible difficulties that arose.

As for the follow-up and feedback of all the subjects who participated in the study, even though they had not requested help themselves, the neuropsychologist contacted them by telephone to provide them with feedback and motivation, as well as to resolve possible doubts. And every 10 days, approximately, they were also sent an e-mail.

The sessions lasted 30 minutes each, with a weekly frequency, and throughout 3 months; therefore they added up to a total of 12 sessions. There were 46 patients; 24 in the face-to-face group and 22 from their homes. And the neuropsychologist guided the program in an individualized way.

Cognitive functions being worked

The functions to work on were: orientation, attention (processing speed, sustained, selective, alternating and hemineglective attention), language (comprehension, repetition, expression, naming, vocabulary, fluency, discrimination, reading and writing), memory (semantic, episodic and procedural), visoconstructive praxias, gnosis (visual and body schema), visospatial skills (spatial relationship, spatial visualization), executive functions (working memory, cognitive flexibility, planning, reasoning, decision making), as well as instrumental activities of daily life.

It was also proposed to work on compensatory functions, i.e. not only those that are affected, but also to compensate with some that are more preserved.

To be able to extract variables of effectiveness, and to be able to make a comparison, the time the subject was connected and whether or not he or she carried out the session could be obtained from the application. In the results themselves, we had the following parameters: the phases completed, the number of screens made, broken down into passed and failed, the average time spent per screen, and the user feedback; their assessment of the execution, in order to check whether it is in line with the objective performance, and thus be able to verify whether it presents anosognosia; and they are not aware of their limitations and even if this is the case, try to make them aware of them, showing them the real results and their subjective assessment.

Objectives of the study

The objectives of the study were to evaluate the feasibility of this program, both in person and at a distance, as well as its efficiency.

A patient satisfaction questionnaire and a professional satisfaction questionnaire were administered retrospectively.

Results of the study

The results showed that there were no statistically significant differences, and that they rated the activities as very good and that the levels of difficulty were adjusted to their cognitive impairment.

Conclusions of the study

And as for the conclusions, we can say that NeuronUP allows assistance to a greater number of users, that both groups have found it comfortable to use, and that they find the main benefits in terms of coordination, concentration, motivation or stimulation and memory.

Likewise, the association uses other technologies for cognitive rehabilitation, such as virtual reality glasses.

Therefore, we can show our satisfaction with the tool. Moreover, we also use it in our residence, where people have a greater deterioration, both physical and cognitive.

By: Soraya Vázquez Caro, psychologist at ADEMBI (Esclerosis Múltiple Euskadi)

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