Home and Community Based Cognitive Rehabilitation for People with Multiple Sclerosis: A Preliminary Study

Background: Up to 70% of individuals diagnosed with Multiple Sclerosis experience cognitive impairments and decreased function (Chiaravalloti, & DeLuca, 2008; Stuifbergen, Becker, Perez, Morison, Kullberg, & Todd, 2012), impacting relationships, work, functional independence, and quality of life. There has been a growing body of research on the efficacy of Cognitive Rehabilitation Therapy (CRT) delivered in a clinic setting (MS Society, 2015). Further, there are studies supporting the role of cognitive reserve in protecting against cognitive decline (Sumowski et al, 2013).  There has been little attention to the importance of CRT in the individual’s own home and community as a vehicle for building cognitive reserve and addressing specific cognitive and functional issues, in a way that is highly individualized and relevant to each person served. The MS Society awarded a grant to fund this project to construct a home and community based CRT model specifically tailored to the unique needs of people with MS.

Objectives: The goal of this presentation is to review the evolving model of home and community based Cognitive Rehabilitation Therapy for individuals with MS and to identify the core tools, resources, strategies and approaches that are specifically designed to meet the unique needs of people with MS.

Methods: Fifteen individuals with MS were assessed to determine their cognitive skills, functional abilities, and interest in the program.  Ten individuals were selected to participate in a 26 session home and community based CRT program.  CRT services occur in each participant’s own home and community to provide education, relevant skills training and strategy development, and to ensure in vivo application of skills and strategies to promote generalization and confidence. Assessments, including the MSNQ, Snyder Hope Scale, Mayo-Portland Inventory 4, Inventory of Environmental Factors, were conducted prior to the delivery of services, and at the conclusion of the program.

Results: As this project has not yet concluded at the time of this submission, a formal analysis of the data has not been conducted. Preliminary results are showing improvements in life satisfaction, hopefulness and function.

Conclusions: This model for home and community based services for people with MS is still under construction at this time.  The project will conclude in the spring and it is expected that some techniques and practices will emerge that will inform the future delivery of home and community based CRT. Preliminary findings will be presented.