ACODEM health psychologist Juan Portillo Rivas proposes a NeuronUP activity to work on the cognitive alterations associated with people with multiple sclerosis.

Taking into account the eminently practical and functional philosophy of NeuronUP, we have found it useful, practical and enjoyable to use an activity of the platform to make a brief and simple review of aspects related to cognitive impairment associated with multiple sclerosis (MS). If you are interested in more theoretical information about this disease, I encourage you to consult our website of the Asociación Cordobesa de Esclerosis Múltiple (Multiple Sclerosis Association of Cordoba).

Some preliminary considerations

• Not all people diagnosed with MS end up suffering cognitive impairment or alterations. According to Fisher (2001), cognitive impairment affects between 40 and 60% of people with MS.

• The main characteristic of cognitive impairment in MS is its heterogeneity and variability among subjects, so it is risky to propose profiles of cognitive deficits in MS.

• Even so, according to Cummings and Benson (1984), we could speak of a profile of cognitive alterations associated with MS, characterized by the presence of problems of processing speed, attention and concentration, memory and executive functions.

Based on this profile, I propose an activity with which we can work on all these functions in a single exercise.

The most comprehensive cognitive exercise for people with multiple sclerosis: Find the missing numbers.

The specific activity is Find the missing numbers. Most of you who use the platform will know it; for those who don’t, we explain it to you.

What does it consist of?

It consists of finding a series of missing numbers in a given sequence.

Personalization of the activity

The basic exercise on which I am doing manipulations is this one

• Sequence from 1 to 50,
• 5 numbers missing,
• between 4 and 7 minutes, depending on each subject,
• missing numbers are not written until all are found,
• goal of the session: 3 good exercises in a row or 4 alternating good ones,
• always try to start with a baseline that is adjusted to the subject’s situation, and manipulate variables according to the results,
• never make it excessively easy or excessively difficult,
• set a target result at the beginning of the session.

Working different executive functions

Below, we explain how we use this exercise for people with multiple sclerosis to work on the following executive functions.

To work on processing speed

The variable to manipulate is the time limit to perform the exercise. In fact, any activity or exercise, for whatever function, to which we place a time limit, becomes an exercise for processing speed.

To work on memory

Contrary to the original exercise, the boxes with the empty numbers are not cancelled one by one when they are found, but the subject has to “keep in memory” all the numbers until he finds the last one, which is when he writes them all down.

I gradually manipulate the amount of missing numbers to be recoded.

To work on sustained attention and concentration

I manipulate the:

• Length of the sequence of numbers,
• number of exercises,
• pause between exercises.

To work on executive functions

Specifically, flexibility, planning and working memory, the exercise requires the active participation of the therapist and continuous interaction, because the subject must communicate each time he/she finds a number, since at that moment the search sequence changes (flexibility).

The subject starts searching from 1 in an ascending way; when he finds the first number, he “sings” it out loud, and the search sequence changes to descending from 50 until he finds the next one. At that moment, he/she should manipulate the information of the numbers stored to avoid starting the search again from 1 or 50 (working memory) in order not to lose time.

Conclusion

You can work on many things with a single exercise, which, on the one hand, makes it more functional (rarely in our day to day we put into play a single cognitive function) and on the other hand, results in economy of time.

I hope you find it useful. Surely it can be improved in many ways. Put your imagination to get the most complete cognitive exercise for people with multiple sclerosis.