The application of Strategy-based Training to Enhance Memory (STEM) in multiple sclerosis: A pilot RCT

ABSTRACT

New learning and memory (NLM) impairments are common in multiple sclerosis (MS), negatively impacting daily life. Few studies seek to remediate these deficits to improve everyday functioning. Self-generation, spaced learning and retrieval practice have been shown to improve NLM in healthy persons and have been incorporated into an 8-session treatment protocol, Strategy-based Training to Enhance Memory (STEM). STEM teaches participants about each of the techniques, how to apply them in daily life and provides practice. Participants are taught to restructure a memory-demanding situation to optimize self-generation, spaced learning and retrieval practice. This pilot double-blind, placebo-controlled, randomized clinical trial (RCT) tested the efficacy of STEM in 20 learning-impaired participants with clinically definite MS (9 treatment, 11 control). Significant treatment effects were noted on self-report measures of daily functioning (primary outcome). Objective neuropsychological testing approached significance, showing a medium-large effect on verbal NLM. Results suggest that STEM may improve everyday functioning in individuals with MS. A full-scale RCT is warranted to validate findings in a larger sample so that findings may be generalized to the broader MS community.

KEYWORDS:

• Cognitive rehabilitation
• Cognitive functions
• Daily life activities
• Multiple sclerosis
• Disease course

Acknowledgements

Nancy D. Chiaravalloti, PhD designed the study, obtained external funding and led the implementation of the study. She led data analysis and prepared the initial draft of the manuscript. Nancy B. Moore, M.A. ran the day to day data collection and procedures. In addition, she proofread and edited the manuscript and provided information for the methodology section. Erica Weber, PhD was involved in data analysis and interpretation. She also edited the manuscript and contributed to the writing. John DeLuca, PhD was similarly involved in data analysis and interpretation. He also edited the manuscript and contributed to the writing.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The authors would like to acknowledge grant support from the National Multiple Sclerosis Society (pilot grant # PP1952) to N. Chiaravalloti and Kessler Foundation. The funding agency did not have a role in: study design; collection, analysis, and interpretation of data; the writing of the report; and the decision to submit the article for publication.