Are Home Based Interventions Effective to Increase Executive Functions of Individuals

with Multiple Sclerosis?

Lauren Hoppe, OTS and Emily Matthews, OTS
Contact Information: OT15.lauren.hoppe@nv.touro.edu; OT15.emily.matthews@nv.touro.edu
An estimated 400,000 people in the United States have been
diagnosed with Multiple Sclerosis (MS), a progressive disease
causing demyelination of the neurons in the central nervous
system. Areas affected by multiple sclerosis include; motor
function, visual systems, sensory functions and cognition. In
fact, an estimated 50-75% of people diagnosed with MS are
thought to have cognitive deficits secondary to the disease and
while numerous studies have been conducted to address
psychological and physical deficits of the disease, there has
been little evidence-based interventions developed to help
combat cognitive deficits.
Introduction
Review Process
Focused question in a PIO format related to occupational
therapy was used.
Focused question and rationale were approved by instructor.
Four databases were searched using the key search terms
listed below.
The comprehensive literature search chart was completed and
submitted for review each week for a total of 7 weeks.
Each article was reviewed using a critical review form (CRF)
and submitted via Blackboard for instructor approval.
The course instructor reviewed the comprehensive literature
search each week and gave feedback.
Atotal of 204 articles were found. Articles were excluded
according to the below-mentioned exclusion criteria. Nine
articles were included in the final evidence table.
Evidence table was submitted for review.
Instructor reviewed the evidence table.
CAT worksheet was completed and submitted for review.
Participants with a diagnosis of multiple sclerosis (MS),
articles from 2004-2014, executive functioning impairments,
cognitive deficits and community interventions.
Summary of Key Findings

Computer-aided retraining of memory and attention is not
an effective intervention to support the efficacy of
specific memory and attention retraining in multiple
sclerosis for individuals with cognitive impairments.
Computer based training programs specifically made for
impaired attention abilities yields adaptive neural
plasticity of the associated neural network. When CR is
tailored to one specific cognitive domain, significant and
more effective results can be found.
Exercise may have therapeutic potential for
neuropsychiatric symptoms such as depression, fatigue
and cognitive impairment in MS Computer based
interventions that also included translation of skills into
everyday life showed a decrease in cognitive deficits.
Group therapy sessions focusing on story memory
techniques showed no long term effects.
Computer based intervention programs focusing on
memory tasks did show significant improvement in
memory tasks and only patients with low brain atrophy
benefited from the treatment.
Using a PDAsignificantly improved participants
functional performance and satisfaction with functional
performance in everyday life tasks.
Participants who improved their physical fitness
demonstrated improvement in psychomotor speed, visual
speed, working memory, executive function, and divided
attention.
Beier, M., Bombardier, C. H., Hartoonian, N., Motl, R. W., &
Kraft, G. H. (2014). Improved Physical Fitness Correlates
With Improved Cognition in Multiple Sclerosis. Archives of
Physical Medicine and Rehabilitation.
Briken, S., Gold, S. M., Patra, S., Vettorazzi, E., Harbs, D.,
Tallner, A., Schulz, K., & Heesen, C. (2013). Effects of
exercise on fitness and cognition in progressive MS: a
randomized, controlled pilot trial. Multiple Sclerosis
Journal, 0(0) 19.DOI: 10.1177/1352458513.
Other References available upon request
Bottom Line for OT Practice Contd
Selected References
Exclusion Criteria
Participants with a diagnosis other than MS, interventions
taking place in the clinic, non-English articles and
pharmacological interventions.
Categories
Patient/Client
Population
Multiple Sclerosis, MS, Cognitive impairment


Intervention Computer based, home based, community,
exercise, group interventions, physical fitness,
assistive technology


Outcomes Treatment outcome, activities of daily living,
ADL, cognition, attention, memory,
compensatory strategies, learning, fluency







Level of
Evidence
Study Design/Methodology of Selected
Articles
Number
of
Articles
Selected
I Systematic reviews, meta-analysis,
randomized controlled trials
7
II Two groups, nonrandomized studies (e.g.,
cohort, case-control)
0

III One group, nonrandomized (e.g., before
and after, pretest, and posttest)
2
IV Descriptive studies that include analysis of
outcomes (single subject design, case
series)

0
V Case reports and expert opinion, which
include narrative literature reviews and
consensus statements

0
Other Qualitative Studies 0



TOTAL
9



Inclusion Criteria
Search Terms
Levels of Evidence
The use of isolated computer assisted memory and attention retraining
in MS patients are no better than non-specific interventions improving
these functions.
Patients with MS that have attention deficits should be given
computer assisted cognitive rehab in one specific domain to increase
executive functioning skills.
Occupational therapy practitioners may use physical exercise adjunct
with other interventions to increase cognition in patients who suffer
from MS.
Teaching compensatory strategies with the use of a Personal Digital
Assessment (PDA) has been found to be a successful intervention for
accommodating cognitive impairments related to MS.
Healthcare delivery and policy:
More research and resources are needed for home-based interventions
for patients with MS to address executive functioning impairments.
Refinement, revision, and advancement of factual knowledge or
theory:
Supplementary research needs to be performed with larger sample
sizes and additional randomized controlled trials to determine the
level of effectiveness of home interventions on cognition for MS
patients.
Bottom Line for OT Practice
The clinical and community-based practice of OT:
Occupational therapists can create memory programs within
community or group setting to provide strategies for
improving the patients cognitive ability and overall health
and well being. Within group session patients benefit from
the psychosocial aspect group interventions.
Clinical importance suggests that occupational therapists
can design compensatory strategies to manage patients
cognitive deficits to increase function in day to day living to
learn and retain information more easily.
Interventions should be used with clients reporting
significant cognitive deficits and may not be the most
beneficial for those with mild cognitive deficits

Touro University Nevada
Retrieved from: www.brain-train.co.il-