Integrated Cognitive and Neuromotor Rehabilitation in Multiple Sclerosis: A Pragmatic Study

Abstract

Background: Few studies examined the effects of combined motor and cognitive rehabilitation in patients with multiple sclerosis (MS). The present prospective, multicenter, observational study aimed to determine the efficacy of an integrated cognitive and neuromotor rehabilitation program versus a traditional neuromotor training on walking, balance, cognition and emotional functioning in MS patients. Methods: Sixty three MS patients were selected and assigned either to the Integrated Treatment Group (ITG; n = 32), receiving neuropsychological treatment (performed by ERICA software and paper-pencil tasks) complemented by conventional neuromotor rehabilitation, or to the Motor Treatment Group (n = 31) receiving neuromotor rehabilitation only. The intervention included two 60-min sessions per week for 24 weeks. At baseline and at end of the training all patients underwent a wide-range neuropsychological, psychological/emotional, and motor assessment. Results: At baseline the two groups did not differ for demographic, neuropsychological, psychological/emotional, and motor features significantly. After rehabilitation, only ITG group significantly (p-corrected for False Discovery Rate) improved on test tapping spatial memory, attention and cognitive flexibility, as well as on scales assessing depression and motor performance (balance and gait). A regression analysis showed that neuropsychological and motor improvement was not related to improvements in fatigue and depression. Conclusion: The present study demonstrated positive effects in emotional, motor, and cognitive aspects in MS patients who received an integrated cognitive and neuromotor training. Overall, results are supportive of interventions combining motor and cognitive training for MS.

Keywords: brain plasticity; cognitive motor interference; cognitive rehabilitation; multiple sclerosis; neuromotor rehabilitation.

FIGURE 1

Flowchart illustrating patient selection and study design.

FIGURE 2

Comparisons of Delta (Post Test–Pre Test) scores for Italian Version Rao’s Brief Repeatable Battery (BRB) between the two groups (^∗significantly different between groups; p-corrected for False Discovery Rate, Mann–Whitney U-test). Positive values indicate an improvement in performance; negative values indicate a worsening in performance. All bars mean standard error. SRT-LTS, Selective Reminding Test-Long Term Storage; SRT-CLTR, Selective Reminding Test-Consistent Long Term Retrieval; SRT-D, Selective Reminding Test-Delayed; SPART, Spatial Recall Test; SPART-D, Spatial Recall Test-Delayed; WLG, Word List Generation; SDMT, Symbol Digit Modalities Test; PASAT-3, Paced Auditory Serial Addition Test-3 seconds; PASAT-2, Paced Auditory Serial Addition Test-2 seconds.

FIGURE 3

Comparisons of Delta (Post Test–Pre Test) scores for neuropsychological tests between the two groups (^∗significantly different between groups; p-corrected for False Discovery Rate; Mann-Whitney U-test). Positive values indicate an improvement in performance; negative values indicate a worsening in performance. For the Stroop test time, positive values indicate a worsening in performance; negative values indicate an improvement in performance. All bars mean standard error. SS, Spatial Span; FVS, Forward Verbal Span; BVS, Backward Verbal Span; STT, Stroop Test Time; STE, Stroop Test Error; PF, Phonological fluency; FAB, Frontal Assessment Battery; RM, Raven’s Matrices.

FIGURE 4

Comparisons of Delta (Post Test–Pre Test) scores for motor scales between the two groups (^∗significantly different between groups; p-corrected for False Discovery Rate; Mann–Whitney U-test). Positive values indicate an improvement in performance; negative values indicate a worsening in performance. All bars mean standard error.

FIGURE 5

Comparisons of Delta (Post Test–Pre Test) scores for psychological scale between the two groups (^∗significantly different between groups; ^∗p-corrected for False Discovery Rate; Mann–Whitney U-test). Positive values indicate increased scores; negative values indicate reduced scores. All bars mean standard error. FSS, Fatigue Severity Scale; BDI-II, Beck Depression Inventory-II; STAI-Y, State-Trait Anxiety Inventory.