Much of the effort in treating multiple sclerosis is focused on therapy and rehabilitation, since there is no cure and science still hasn’t determined an exact cause for the autoimmune reaction leading to the disease. Many therapies are created to help manage symptoms and try to slow the progression of the disease.
However, rehabilitation efforts can help control the damage already done so that patients can cope with what has already been lost based on damage to the central nervous system. With cognitive rehabilitation, the mental issues that arise from lesions on the brain and nerve damage becomes less of a problem, especially since there are ways to help the brain adjust, as well as means of working around permanent damage.
What is cognitive rehabilitation?
Cognitive rehabilitation is a very specialized field with great variability in how it is implemented, based on the needs of the patient. But the main focus of the treatment is to help with two separate factors: restoration of cognitive abilities and compensation for those that have been compromised.
The rehabilitation effort assists individuals with multiple sclerosis with several functionalities based in cognitive abilities, including but not limited to:
- Effective communication with others
- Task completion, including making efforts more efficient and accurate
- Organization skills
- Overcoming impairments with scheduling
- Memory retention specialization
Of course, tons of methods have been tested in the treatment of MS to improve cognitive abilities. However, some stand out as more effective than others.
The modified story memory technique
One of the most effective methods used for cognitive rehabilitation in multiple sclerosis is the modified Story Memory Technique (mSMT). For this treatment, the patient attends 10 sessions with a therapist, who utilizes some very specific strategies to help improve verbal and memory skills.
The method has been proven extremely effective in multiple studies, one of which showed through brain imaging an increase in brain activity, specifically in regions related to memory and learning. In fact, it has been so successful that mSMT is now considered a “practice standard”, meaning it is recommended to patients based on quality and effectiveness.
Practice guideline rehabilitation treatments
Practice guideline treatments are those that show promise but haven’t had extensive studies performed to prove the effectiveness and, therefore, can’t be considered practice standards. For MS cognitive rehabilitation, there are two other treatments that achieve this level of promise.
Attention Processing Training (APT) has shown improved attention and memory retention, while RehaCom has proven effective with several general cognitive abilities. With greater research and more extensive trials, these encouraging factors could be elevated to practice standard levels based on their efficacy.
Neuroplasticity and cognitive rehabilitation
One reason that cognitive rehabilitation can be effective in treating multiple sclerosis is that the brain has a special ability known as neuroplasticity. This is the practice of reorganizing functionality.
However, when stimulated properly, the brain can compensate by “moving” certain processes to healthy connections, as well as creating new connections. This is called axonal sprouting, in which some of the undamaged axons will grow new nerve cells. In some cases, these new cells will reconnect with the neurons who lost links based on damage or complete destruction due to MS. Other times, those newly formed nerve cells will connect with other undamaged cells to create a new pathway, through which the original functionality can “redirect”.
With cognitive rehabilitation, not only is the brain stimulated in new ways; it also assists in training the brain to “reorganize” so that those newly formed connections can learn to process the functions formerly handled through the severed and damaged neural pathways.
Additional cognitive rehabilitation efforts
Not all rehabilitation efforts for multiple sclerosis patients involve restoration. Some are about compensation and teach individuals how to compensate for the abilities that have been lost. Because cognitive impairment is so common in MS, especially as the disease progresses and more damage is caused, it’s essential to have coping mechanisms that help improve quality of life. Some of these efforts involve:
- Identifying when during the day their alertness is peaked so that they can plan to handle activities that are very brain intensive during those periods for the greatest effectiveness
- Discovering what sorts of activities patients enjoy, since these stimulate the pleasure center of the brain, which leads to improvement in resiliency of the parts of the brain damaged by MS; and teaching patients how to partake in these activities, despite disabilities and impairments
- Helping patients to engage in activities that stimulate learning areas of the brain, such as card games, reading, and completing puzzles
- Working on attention span and focus so that patients can concentrate on a single task and perform it with efficiency, blocking out any distractions that could interrupt the process and cause exertion of more energy and effort
- Practicing memory retention tricks and finding the best way to keep track of tasks and activities that have to be completed, whether with alarms and electronic device reminders or a need to carry a simple daily organizer and pen to record lists
A number of rehabilitation practices are available for multiple sclerosis patients, including physical therapy to help restore mobility and retain what bodily functions remain. But one of the most important types of rehabilitation to assist with daily life is for cognitive impairment.
In addition, finding coping mechanisms to compensate for issues that can’t be resolved other ways can improve life significantly for patients suffering from the impairment. With multiple tools and therapies available, there is an option for each individual that can make it worth the effort.