Adaptation of the Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) Program for Individuals with Multiple Sclerosis: A preliminary analysis

Background: The Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) program was developed to provide a compensatory approach to the cognitive rehabilitation of individuals with traumatic brain injury (TBI).  The CogSMART program has been successful at improving cognitive and psychosocial outcomes in this group.  The cognitive dysfunction present in those with multiple sclerosis (MS) is comparable to that observed in those with TBI and thus a similar intervention may be beneficial.

Objectives: The goal of the present project was to adapt the CogSMART program for use with those with MS and conduct a program evaluation of the adaptation to determine efficacy.

Methods: Permission was obtained from Elizabeth Twamley (CogSMART developer) to adapt the program.  Session content was modified by two Neuropsychologists with expertise in MS to reflect the cognitive and physical symptoms of the disease (e.g. impact of fatigue, interaction between physical and cognitive symptoms, modification of exercises to accommodate physical limitations).  A program evaluation component was designed to reflect variables relevant to those with MS.  Pre-intervention and post-intervention assessment sessions included evaluation of objective cognition (i.e. prospective memory, processing speed, learning/memory), subjective cognition, mood, fatigue and quality of life.  Five people with MS completed the inaugural CogSMART group sessions.  All were either self-referred or referred to Ricci and Associates by a physician (e.g. MS Neurologist).  Each 2-hour intervention session took place on 10 consecutive evenings.

Results: The program content was developed and implemented.  Data is being compiled.  Results reported will include reliable change index (RCI) analyses evaluating any change between pre-intervention and post-intervention on measures of objective cognition (i.e. processing speed, verbal learning, visual learning).  Paired sample t-tests will evaluate change in subjective cognition, mood, fatigue and quality of life variables.

Conclusions: To date there are no published data available on the feasibility and efficacy of the CogSMART program in an MS sample.  Although the MS cognitive rehabilitation literature is growing, particularly with regard to remediation approaches, the current program will provide much needed information on the efficacy of a broader-based and compensatory approach to MS rehabilitation.