Computer-based brain training at home can improve cognition in patients with multiple sclerosis (MS), a new trial shows. A ‘tele-rehabilitation’ approach offers easy access to treatment for disabled patients, and could improve treatment for many diseases.

Multiple sclerosis causes a gradual decline in neurologic function and is well established as a cause of physical disability, but up to 70% of patients also develop cognitive impairment. Options for treating this impairment are limited, and disability can make access to therapy difficult.

“Traditional cognitive rehabilitation typically requires clinic visits spanning weeks or months, but people with multiple sclerosis face many obstacles to reach the clinic,” explain Leigh Charvet and Michael Shaw from the New York University School of Medicine in the United States. “The travel presents a barrier to patients most in need of cognitive remediation.”

Previous work has suggested that computer-based cognitive training benefits patients with MS. Charvet and colleagues had previously seen success in a smallscale test of their tele-rehabilitation approach: a variety of auditory and visual exercises designed to improve speed and accuracy of information processing. The training is done at home with remote monitoring and supervision. The new trial tested the same approach more rigorously.

The trial involved 135 patients with MS and mild to moderate neurologic disability. Participants were selected at random to either use the computer-based cognitive training program for 12 weeks, or to play normal computer games over the same period. People who did the cognitive training program improved more on tests of cognitive function over the trial period than people who played games, even though those who played games spent longer doing so.

The outcome reinforces the fact that cognitive training helps people with MS, and validates the tele-rehabilitation approach, which enables all patients to benefit regardless of their ability to attend clinics. Charvet and Shaw say that the approach could be used to target specific cognitive impairments early, and that it could be applied more widely.

“Our methodology is not confined to reaching people with MS,” says Charvet. “The remote protocols we have developed are widely applicable across disorders associated with cognitive impairment.”

The team’s next steps are to determine the optimal amount of training and how to maintain the improvement beyond 12 weeks. Ultimately, they hope to develop the approach so it can be personalized to provide each individual with maximal benefit.

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