Multiple sclerosis treatment with NeuronUP

Soraya Vázquez Caro, psychologist at ADEMBI, describes in this article her experience in the treatment of multiple sclerosis with NeuronUP.

Work of the Multiple Sclerosis Association

Our association has been offering the neuropsychology service since February 2006, given the need for it in people with multiple sclerosis, since it is estimated that the % of cognitive impairment is above 60%.

Normally when they start, they are given a neuropsychological evaluation, which is usually repeated every few years, as a follow-up, or in the event that there has been an evident worsening, or they request a report for some procedure, such as incapacity for work. The NeuronUP program for multiple sclerosis treatment is widely used in neuropsychology sessions, both in paper and digital activities. Some of them also take worksheets to do at home.

NeuronUP also gives us the advantage of being able to see, before starting each session, what exercises have been done in previous sessions, when was the last time a specific exercise has been done, to be able to select a specific function to work on, to compare results in the same activity and to give them feedback.

We also use it on a very large touchscreen computer, which allows them to use it without the need to operate the mouse, given the motor and fine motor skills, grip, tremor, etc. Likewise, it makes the task easier for all those who have visual impairments; which are many, due to the size of the screen, and because the instructions and others are also provided at audio level; not only written.

Our experience with NeuronUP in the treatment of multiple sclerosis

Next, the psychologist talks about her experience with NeuronUP in multiple sclerosis treatment.

Starting out

As for the trajectory of this tool in our association, we began to use it almost when it was created and distributed. It would be approximately in September 2012.

At that time, we met on numerous occasions, to see how the platform was working, what suggestions we had, in terms of improvement, adaptations, the needs that we were seeing when we started to apply it with our patients, and for the treatment of the multiple sclerosis collective in the different associations of the territory.

Study to evaluate the efficacy of NeuronUP in the treatment of multiple sclerosis

A study was also carried out with NeuronUP from the end of 2014 to mid-2015, entitled “Observational study to explore the effectiveness of a computer-based cognitive rehabilitation program in multiple sclerosis, either in person or at a distance”. And, which aimed to evaluate the efficacy of NeuronUP in multiple sclerosis treatment.

The results were presented at various conferences; at the Spanish Society of Neurology (SEN), in November 2016 and at RIMS, in May 2017.

Two study groups: face-to-face and remote therapy

In this study, the treatment of multiple sclerosis was carried out with NeuronUP. There were two groups; one of them in person, and the other at a distance; telerehabilitation. Both groups were comparable in terms of the functions to be worked on, the exercises to be performed, the duration of the sessions, the frequency of these, and the months of treatment. As well as the follow-up carried out, the feedback administered, the previous and subsequent evaluations, the first sessions of explanation of the project and handling of the program, as well as the pertinent resolution of doubts or possible difficulties that arose.

As for the follow-up and feedback of all the subjects who participated in the study, even though they had not requested help themselves, the neuropsychologist contacted them by phone to provide them with feedback and motivation, as well as to answer possible doubts. And every 10 days, approximately, they were also sent an email.

The multiple sclerosis treatment sessions lasted 30 minutes each, with a weekly frequency, and throughout 3 months; therefore they added up to a total of 12 sessions. There were 46 patients; 24 in the face-to-face group and 22 from their homes. The neuropsychologist guided the program in an individualized way.

Cognitive functions being worked

The functions to work on were:

Orientation
Attention (processing speed, sustained attention, selective, alternating and hemineglect)
Language (comprehension, repetition, expression, naming, vocabulary, fluency, discrimination, reading and writing)
Memory (semantic, episodic and procedural)
Visoconstructive praxis
Gnosis (visual and body schema)
Visuospatial skills (spatial relationship, spatial visualization)
Executive functions (working memory, flexibility, planning, reasoning, decision making)
Instrumental activities of daily life

It was also proposed to work on compensatory functions, i.e. not only those that are affected, but also to compensate with some that are more preserved.

In order to be able to extract variables of effectiveness in multiple sclerosis treatment, and to be able to make a comparison, the time the subject was connected and whether or not he or she carried out the session could be obtained from the app.

In the results themselves, we had the following parameters: the phases completed, the number of screens made, broken down into passed and failed, the average time spent per screen, and the patient feedback; their feedback of the execution, in order to check whether it is in line with the objective performance, and thus be able to verify whether it presents anosognosia; and they are not aware of their limitations and even if this is the case, try to make them aware of them, showing them the real results and their subjective assessment.

Objectives of the study

The objectives of the study were to evaluate the feasibility of this program, both in person and in remote, as well as its efficacy in the treatment of multiple sclerosis.

A patient satisfaction questionnaire and a professional satisfaction questionnaire were administered retrospectively.

Results

The results showed that there were no statistically significant differences between face-to-face and distance modalities. They rated the activities as very good and the difficulty levels matched their cognitive impairment.

Conclusions on the efficacy of NeuronUP in multiple sclerosis treatment

NeuronUP makes it possible to extend support to a larger number of patients. In addition, both groups found it comfortable to use. The main benefits found were related to coordination, concentration, motivation, stimulation and memory.

Therefore, we are satisfied with the tool for the treatment of multiple sclerosis. Moreover, we use it in our nursing home, where people are more physically and cognitively impaired.

Work of the Multiple Sclerosis Association