Attention/Working Memory Rehabilitation in Multiple Sclerosis: A Pilot Project Using Cogmed Working Memory Training
Condition: Multiple Sclerosis
MeSH terms: Multiple Sclerosis; Sclerosis
Study type: Interventional

Summary: 
      Patients diagnosed with any type of multiple sclerosis (MS) who show objective evidence of
      attention problems will be randomized to standard medical care (treatment as usual) or
      attention training, which will be completed at their home using a commercially available
      attention training task (Cogmed Working Memory Training - CWMT) for 5 weeks. Patients will
      undergo cognitive testing before and after intervention and at 6 months follow up.
    

Detailed description: 
      MS patients who meet the inclusion criteria of the study showing deficits on at least 2 of 3
      attention/working measures who will then be randomized to either a treatment group (cognitive
      rehabilitation training) or a control group (standard clinical care). Patients must show mild
      to moderate-severe impairment on 2 out of 3 test measures of processing speed and sustained
      attention to be included in the study. Participants will undergo cognitive testing (Minimal
      Assessment of Cognitive Function in MS [MACFIMS] performed at Dr. Morrow's cognitive clinic
      at Parkwood Hospital) at pre- and post-treatment, and also at 6-months follow-up.
      Participants will also fill out non-cognitive measures in the form of questionnaires
      regarding quality of life (QoL), self-efficacy, stress, and copying strategies at both pre
      and post treatment. In addition, the intervention group will undergo attention training using
      CWMT for 5 days per week (30-45 minutes daily) for 5 weeks. They will complete this training
      by themselves in their home. The assigned Cogmed coach will set up the Cogmed program for the
      duration of the trail on the training group participant's computers. The study will not be
      able to continue to pay for the Cogmed program after the 5 week training sessions.
      Participants are welcome to purchase the software themselves after the entire study has ended
      if they would like at: http://www.cogmed.com/. The CWMT (Cogmed) method consists of 25
      training sessions done online. Each participant assigned to the training group will complete
      eight exercises for five weeks with five sessions every week. The Cogmed program uses an
      adaptive training approach in which the difficulty level of the training is adjusted in real
      time (trial by trial basis) based on the trainee's performance. Each session consists of a
      selection of various tasks that target the different aspects of attention/working memory.
      Specifically, each session will involve training on visuospatial working memory tasks (e.g.,
      remembering the position of objects in a 4 x 4 Grid) as well as verbal working memory tasks
      (e.g., remembering phonemes, letters, or digits). Given that adults will be involved in this
      study, Cogmed QM will be used, a version of the CWMT program adapted for adults. Participants
      will engage in weekly discussions over the phone for about 1 hour with an assigned Cogmed
      coach who will provide support and encouragement over the 5 weeks. Additional calls will be
      made if the Cogmed coaches see the participant is not completing their online training. Each
      participant will be assigned a Cogmed qualified coach who is responsible for providing
      structure, motivation, and feedback on training progress in order to optimize training gains.
      Before Cogmed training begins, each participant in the training group will be visited once by
      their respective Cogmed coach who will ensure that participants' daily Cogmed sessions will
      be conducted in a space in their home that is conducive to attention training (e.g., little
      clutter, private area of the home) and ensure consistency between participants. During
      training, each participant's performance will be tracked online and will be reviewed by the
      participant and his/her coach in weekly telephone meetings throughout the five week period.
      The participant's performance will be tracked online on the Cogmed platform. The Cogmed
      coaches set up the program for the participants and assign them a username. The Cogmed
      coaches can track the individual's performance and see who has completed the training based
      on their username. No Internet Protocol (IP) information will be collected. At the end of
      training, the coach will summarize the training by telephone with the participant.
    

Intervention name(s): Cogmed Working Memory Training (CWMT)
Intervention type(s): Behavioral
Intervention description(s): The CWMT (Cogmed) method consists of 25 training sessions done online. Each participant assigned to the training group will complete eight exercises for five weeks with five sessions every week. Each session consists of a selection of various tasks that target the different aspects of attention/working memory. Participants will engage in weekly discussions over the phone for about 1 hour with an assigned Cogmed coach who will provide support and encouragement over the 5 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment