https://orcid.org/0000-0002-2845-3904
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Abstract
Purpose
Computerised rehabilitation programs can be used to address cognitive deficits typically caused by multiple sclerosis (MS). However, there are still doubts on their effectiveness, due to mixed results obtained in clinical trials. The objective of this paper is to improve cognitive rehabilitation (CR) practices in MS, by presenting and assessing a MS-specific cognitive rehabilitation software.
Methods
We conducted a detailed analysis of how CR is carried out in practice in MS rehabilitation centres. From the analysis, we elicited a reference CR process, and identified the essential features a software supporting the process should have. We designed and implemented MS-rehab, a novel MS-specific computerised rehabilitation system having the identified features. We experimented MS-rehab in a pilot study involving eight MS patients. To highlight the improvement with respect to the state of the art, we compared MS-rehab with available professional tools selected using well defined criteria.
Results
This paper has three main contributions: (1) the identification of a set of essential features a computerised tool for CR in MS should provide; (2) MS-rehab, a novel CR system designed for MS therapists and patients, which embodies innovative MS specific features; (3) the assessment of MS-rehab efficacy in a pilot study with MS patients.
Conclusions
The availability of a MS-specific CR system like MS-rehab fosters the design of more rigorous clinical studies on the effectiveness of computerised rehabilitation in MS. MS-rehab demonstrated its potential and innovativeness as a tool for cognitive rehabilitation in MS.
Computerized tools for cognitive rehabilitation (CR) in multiple sclerosis (MS) can be improved by a set of MS-specific features.
The availability of advanced home-based cognitive rehabilitation mechanisms is fundamental for supporting standardized cognitive rehabilitation protocols in MS.
A MS-specific CR system has given promising results in a pilot study involving MS patients.
Hardly do state-of-the-art professional tools include all the required MS specific features.
IMPLICATIONS FOR REHABILITATION
Acknowledgements
We would like to thank Dr. Debora Castellano, Dr. Federica Pinardi, Dr. Francesca Rizzi, Dr. Fabio Bellomi, Dr. Beatrice Goretti, Dr. Federica Lato, Dr. Enrico Montanari and Dr. Livia Ludovico for their help in the analysis of the MS cognitive rehabilitation process and cognitive profiles; Dr. Elena Maria Bressan, Dr. Daniele Baschieri, Dr. Margherita Donnici, and Dr. Bartolomeo Lombardi for the contribution given to the developement of MS-rehab with their master thesis. We also thank the Laboratory of Cognitive Psychology of the Department of Medicine and Surgery of the University of Parma, and Prof. Olimpia Pino and Dr. Ciro Urselli for their contribution to the pilot study.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes
1 The patient performance in expressed in a scale from 0% to 100%, and is calculated with a function that combines the number of correct, wrong, and missed answers with the exercise execution time. In this paper, we do not elaborate more on this concept, explained in [Citation55] in detail.
2 We also experimented with promising results another adaptive difficulty variation mechanism based on Reinforcement Learning [Citation55].
5 As the T-test is generally considered robust to violations of normality and homogeneity of variance, performing Wilcoxon test might be too conservative. Indeed, it reduces the chance of type-I errors but, at the same time, increases the chance of type-II errors.
6 See also the SCHUHFRIED Web page: https://www.schuhfried.com/vienna-test-system.