The most complete cognitive exercise for people with multiple sclerosis

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By: Juan Portillo Rivas, health psychologist at ACODEM

Next December 18th, the National Multiple Sclerosis Day is celebrated as every year, which is why our friends from NeuronUP have invited us to participate in this blog. Bearing in mind the eminently practical and functional philosophy of the platform, it seemed to us that instead of sharing with you information that you can perfectly consult on our website of the Cordoba Multiple Sclerosis Association (http://www.alcavia.net/acodem/), it would be more useful, practical and enjoyable to use an activity of the platform to make a brief and simple review of aspects related to cognitive impairment associated with MS.

Some preliminary considerations:

Not all people diagnosed with MS end up with impairment or cognitive alterations. According to Fisher (2001), cognitive impairment affects 40-60% of people with MS.
The main characteristic of cognitive impairment in MS is its heterogeneity and variability among subjects, so it is risky to raise profiles of cognitive impairment in MS.
Nevertheless, according to Cummings and Benson (1984) it could be said that there is a profile of cognitive alterations associated with MS, characterized by the presence of problems of processing speed, attention and concentration, memory and executive functions.

Based on this profile, I propose an activity with which we can work in a single exercise all these functions.

Activity: “Find the missing numbers”

The specific activity is “Find the missing numbers”. Most of you who use the platform will know it; for those who don’t, it consists of searching for a series of missing numbers in a given sequence.

Customizing the activity

We are making the following personalizations to the activity:
- Sequence from 1 to 50.
- There are 5 numbers missing.
- Between 4 and 7 minutes, depending on each subject.
- The missing numbers are not written until they are all found.
- Objective of the session: 3 good exercises in a row or 4 good alternates.
- Always try to start with a baseline that is adjusted to the situation of the subject, and manipulate variables depending on the results.
- Never be too easy or too difficult.
- Mark a result objective at the beginning of the session.

To work processing speed

The variable to manipulate is the time limit to perform the exercise. In fact, any activity or exercise, for whatever function, to which we place a time limit, becomes an exercise for the processing speed.

To work memory:

- contrary to the original exercise, the boxes with the empty numbers are not eliminated one by one when they are found but the subject has to “keep in memory” all the numbers until he finds the last one, which is when he writes them all.
- I gradually manipulate the quantity to remember of missing numbers.

To work on sustained attention and concentration

I personalize the:

- Length of the sequence of numbers.
- Number of exercises.
- Pause between exercises

To work executive functions

Specifically flexibility, planning and working memory, the exercise requires the active participation of the therapist and continuous interaction, because the subject will have to communicate each time they find a number, since at that moment the search sequence changes (flexibility).

The subject begins to search from 1 in an ascending manner; when he finds the first number, he says it aloud, and the search sequence changes to descending from the 50 until he finds the next one. At that moment you will have to manipulate the information of the numbers you have saved to avoid starting the search again from 1 or 50 (working memory) so as not to waste time.

Functional exercise

You can work many things with just one exercise, which on the one hand makes it more functional (rarely in our day to day we put into play a single cognitive function) and on the other hand, results in economy of time.

I hope you find it useful. Surely it can be improved in many ways. Use your imagination to get the most complete cognitive exercise for people with multiple sclerosis.