Pilot Study: Cognitive Rehabilitation Via Telehealth Yields Impressive Outcomes

Background: Cognitive impairment is a debilitating symptom in people with MS that often results in difficulty with memory, attention, executive function, processing speed, and word finding. The COVID-19 pandemic led to outpatient clinic closures with limited operations. Due to these challenges presented by COVID-19, cognitive rehabilitation was provided by Speech Language Pathologist (SLP) to address cognitive impairment via telehealth (TH), a mode of providing skilled therapy which our clinic had not considered prior.

Objectives: 1) Determine if cognitive rehabilitation provided via TH was effective for treating cognitive dysfunction in people with MS. 2) Describe the benefits realized by patients and staff on providing cognitive rehabilitation via TH services.

Methods: Patients with MS and receiving care at the outpatient facility were screened to determine the appropriateness for TH. This included having the appropriate equipment (laptop/desktop with audio/camera capabilities), ability to independently utilize his/her computer, and if they present with mild to moderate cognitive deficits (determined from chart review and telephone screen). At initial TH SLP evaluation, patients provided medical history and completed the Behavior Rating Inventory of Executive Functions for Adults (BRIEF-A). Each patient received cognitive therapy for 8 to 10 weeks via TH, that targeted memory, attention, word finding, and executive functions. One patient participated in a hybrid model which included services provided both in person and via TH. Patients completed BRIEF-A at discharge for comparison.

Results: After completion of 8 to 10 therapy sessions, pre and post BRIEF-A scores were calculated. Overall percent change for all indexes ranged from 0% to 34% from pre to post BRIEF-A scores. Specifically, percent change ranged from 5% to 26% between those who indicated perception of deficits (score greater than 65) from initial evaluation to discharge (to scores below 65). The largest percent change in Global Executive Composite (GEC) and Behavioral Regulation Index (BRI) scores was seen in the patient receiving the hybrid model.

Conclusions: Improvement was seen in all 10 patients in varying degrees. Telehealth can be an effective model for providing cognitive rehabilitation for people with MS depending on the severity and/or perception of deficits. This mode may not be as effective for patients that have more mild cognitive deficits and/or decreased perception of deficits, which is similar to what is observed with in person therapy. Patients who have deficits in the following indexes: Shift, Emotional Control, Initiate, Working Memory, Plan/Organize, Task Monitor, and Organization of Materials (scores greater than 65) can improve significantly when given strategies and therapeutic tasks via TH. A hybrid model can also be effective for improving cognitive function depending on the severity of the deficits.