Support for RehaCom's use with Multiple Sclerosis

Multiple Sclerosis can often cause cognitive difficulties with memory, concentration, verbal fluency and executive functions such as planning. Up to 50% of those with MS can be affected. RehaCom can be helpful with this condition and ideally it’s use should be guided by a competent therapist embracing both restitution and compensation strategies for rehabilitation.  

Of course RehaCom represents a restitution approach and depends on the brain’s natural ability to plasticity.   Prosperini et al (see reference) recently reviewed the literature relating to functional and structural brain plasticity and we noticed a couple of mentions of RehaCom in their review.

Cerasa and colleagues [1] performed a randomised, double-blind, controlled trial in which 26 patients with MS were allocated to receive a 6-week computer-aided training (1-hour sessions, twice per week) either with

  • the RehaCom package, or with
  • a simple visuomotor coordination task (serving as the control group). 

Before and after the intervention, both groups were clinically examined and scanned to obtain task-related fMRI data (visual PASAT). Performance at Stroop test improved only in the active group using RehaCom, which also showed increased activation of brain areas subserving refreshing phonological stimuli and short-term information storage, that is, the right posterior cerebellar lobule and left superior parietal lobule.

Filippi and colleagues [2] used functional and structural MRI to investigate brain changes after a 12-week computer-assisted training with RehaCom. Twenty patients with MS were randomly allocated either to the active group (n = 10) or to the control group, which did not undergo any intervention (n = 10). 

Before and after the 12-week study period, both groups were assessed by a complete neuropsychological evaluation and scanned to map changes in WM and GM structures and to obtain task-related fMRI (Stroop test) and RS-fMRI data. The active group showed a clinical improvement in some tests of attention, information processing, and executive functions, an increased activation of posterior cingulated cortex and/or precuneus and dorso-lateral prefrontal cortex (bilaterally) during the task-related fMRI, and increased RS-FC of the anterior cingulated cortex (salience processing), left dorsolateral prefrontal cortex (executive function), right inferior parietal lobule, posterior cingulated cortex, and/or precuneus (default-mode network). Neither WM nor GM microarchitecture, assessed with DTI and voxel-based morphometry, was impacted by the rehabilitation. The authors concluded that rehabilitation of attention, information processing speed, and executive function enhance recruitment of brain networks subserving the trained functions.

Bonavita and colleagues [3] performed a nonrandomised parallel-group trial in which 18 patients were trained using the RehaCom package (active group) and 14 patients were submitted to newspaper reading and content referring for 8 consecutive weeks. 

Both groups underwent an extensive neuropsychological evaluation and RS-fMRI study at entry and at the end of follow-up. Several neuropsychological tests of information processing speed and verbal and visual sustained memory improved in the active, but not in the control, group after the 8-week study period. Likewise, increased RS-FC in the posterior cingulated cortex and inferior parietal cortex bilaterally (subserving the default-mode network) was found in the active group.

RehaCom is software designed in Germany by Hasomed GmbH led by neuropsychologists and computer scientists to be used as a tool to help the therapist in cognitive rehabilitation.  It is used in 95% of German clinical facilities dealing with cognition issues but is relatively new to the UK.  One of things we know is that for training to be effective it takes quite a commitment - training needs to be frequent and relatively intensive over a few months.  The good news is that the software is designed to allow a therapist to supervise a user working at home on their own computer. It's not necessary to be in a hospital to use it.  Contact us to learn more.  For UK and Ireland we can provide a demo copy allowing full exploration of RehaCom and the associated Screening Modules.

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438192/#B36

References

[1] Cerasa A., Gioia M. C., Valentino P., et al. Computer-assisted cognitive rehabilitation of attention deficits for multiple sclerosis: a randomized trial with fMRI correlates. Neurorehabilitation and Neural Repair. 2013;27(4):284–295. doi: 10.1177/1545968312465194.

[2] Filippi M., Riccitelli G., Mattioli F., et al. Multiple sclerosis: effects of cognitive rehabilitation on structural and functional MR imaging measures—an explorative study. Radiology. 2012;262(3):932–940. doi: 10.1148/radiol.11111299.

[3] Bonavita S., Sacco R., Corte M. D., et al. Computer-aided cognitive rehabilitation improves cognitive performances and induces brain functional connectivity changes in relapsing remitting multiple sclerosis patients: an exploratory study. Journal of Neurology. 2015;262(1):91–100. doi: 10.1007/s00415-014-7528-z.