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Name: Lauren Hoppe and Emily Matthews

Date: 9/30/14

Focus Question: Are home based interventions effective to increase executive functions of individuals with Multiple Sclerosis?

Rationale for inclusion/exclusion criteria applied to determine which articles should be included in the evidence table: 9
articles were found that matched the inclusion and exclusion criteria and answered the focus question. Inclusion criteria: participants
with a diagnosis of multiple sclerosis (MS), articles from 2004- 2014, executive functioning impairments, cognitive deficits and
community interventions. Exclusion criteria included: participants with a diagnosis other than MS, interventions taking place in the
clinic, pharmacological interventions,

Author/
Year

Study Objectives

Level/Design/
Subjects

Intervention and
Outcome Measures

Results

Study
Limitations

Implications for OT

Carr, S.,
das Nair,
R.,
Schwartz,
A., &
Lincoln,
N. (2014).

To evaluate the
feasibility and
effectiveness of a
group memory
rehabilitation
program
focusing on
compensation
and restitution
strategies for
participants with
MS.

Level I

One control group


and one treatment
group

48 participants
were chosen from a
register of patients
who attended
Central Surry
Health MS clinics,
were more than 12
months since
diagnosis, able to
speak and
understand English
and able to attend
the treatment
session where the
outpatient
information was
given and who had
reported memory
difficulties due to
MS.

The treatment group


received group
interventions that
lasted 1.5 hours and
consisted of homework
over a 10 period week.
The program included
one introductory
session, three sessions
on attention training,
three sessions on
internal memory
strategies, two sessions
on external memory
aids and one session to
bring everything
together. Treatment
sessions were
delivered by an
assistant psychologist
based entirely off a
manual. The control
group was placed on a
waiting list and
received no treatment
from the researchers.
They were offered
treatment when the
study had concluded.
Outcome Measures:
Guys Neurological

The groups were


comparable at
baseline. At
independent
samples MannWhitney U-tests
were utilized to
compare groups.
There was no
significant
difference
between the EMQ
self-report at four
or eight months.
There was a
significant
difference in
mood at eight
months on the
GHQ but not on
any other
measures.

Small sample
size was a
limiting factor.
Also, the
outcomes did not
include a
standardized test
of memory
which would
have indicated
whether there
were changes in
underlying
memory issues,
memory was
also not limited
to individuals
with memory
difficulties on
formal testing
and therefore the
perception of the
memory
problems may
have been
related to mood,
there was also
co-treatment bias
since the control

Clinical and
community-based
practice of OT: The
study showed clinical
significance in that
majority of
participants in the
intervention group
believed the program
facilitated reflection of
their own memory
difficulties, offered them
the opportunity to learn
from others experiences
and gave them a set of
tools or strategies that
they could use to seal
with the memory
difficulties. Creating
memory programs
within community
setting can not only
provide strategies for
improving the patients
cognitive ability but
patients also seem to
benefit from the
psychosocial aspect
group interventions.
Program development:

Disability Scale
(GNDS) measures 12
impairments due to
MS, Everyday
Memory Questionnaire
(EMQ-28) measures
self-reported memory
difficulties, the general
Health Questionnaire
28 (GHQ-28) measures
psychological wellbeing, and the Multiple
Sclerosis Impact Scale
(MSIS-29) measures
physical and
psychological impact
of MS.

group and
treatment group
was allowed to
continue with
other treatments
such as (OT and
physiotherapy).

The at home portion of


the intervention was not
monitored in terms of
completion. This could
impact the clients
memory rehabilitation.
OTs should encourage
clients to participate in
home programs, if
given, so that the client
can gain the most
benefit from the
program and implement
what they learn in group
therapy into real life
situations.
Societal needs:
Memory deficits is a
common problem for
people with MS. Group
intervention is cost
effective, and allows
clients to interact with
other people going
through the same things
which may have
psychosocial benefits.
Healthcare delivery and
health policy:

More resources
available for homebased interventions for
patient with MS to
address cognitive
function.
Education and Training
of OT student:
OT students should be
aware and educated on
how to run group
interventions as well as
familiar with evidencebased memory
rehabilitation
interventions.
Refinement, revision
and advancement of
factual knowledge or
theory:
This study could be
improved by using a
larger population size,
keeping track of at
homework done by the
participants and using a
standardized test for
memory deficits instead
of relying on self-

reported memory issues.

Author/

Study Objectives

Level/Design/
Subjects

Intervention and
Outcome Measures

Results

Study
Limitations

Implications for OT

To assess the
feasibility and
effects of a
computer-assisted
cognitive rehab
intervention for
memory, attention
and problem
solving for a
person with MS.
The purpose of
this study is to
refine and test a
novel computerassisted cognitive
rehabilitation
intervention,
MAPSS-MS
(memory, attention
and problem
solving).

Level I

The intervention
consisted of two
components; eight a
weekly 2 hour group
sessions focused on
building efficacy for
the use of
compensatory
strategies, and a
computer based
cognitive training
program. The
computer program
enables participants to
engage in practice
sessions a minimum of
45 minutes three times
a week. Translation of
skills practiced to
everyday issues was
the focus of the group
sessions.

The scores
across time
periods and
between groups
revealed the
intervention
group had more
gains over time
than the control
group and the
intervention
group change
scores were
higher in the
CVLT-Total
(performance
measure for
learning and
memory), the
Strategy
Subscale of the
Multifactorial
Memory
Questionnaire

Limitations
included using a
multi component
intervention for
this group and that
it cannot be
determined if
change in the
outcomes came
from one more
than the other. The
study used a
convenience
sample, potential
selection bias and
treatment
contamination
may have
occurred. The
study also
included a
perceived or selfreported moderate
level of cognitive
deficits rather
than an objective
performance

Clinical and
community-based
practice of OT:
Clinical importance
suggests that
occupational
therapists can design
compensatory
strategies to manage
patients cognitive
deficits and with these
strategies evidence
has shown increased
function in day to day
living and participants
were able to learn and
retain information
more easily.

Year
Stuifberge
n, A.,
Becker,
H., Perez,
F.,
Morison,
J.,
Kullberg,
V., &
Todd, A.
(2012)

One control group


and one treatment
group.

A total of 60
participants were
included in this
study.

Inclusion criteria
comprised 18-60
years old, able to
understand and
comply with the
protocol, be able to
read and write in
English, visual acuity
with correction
sufficient to work on
a computer screen,

Outcome measures:

Program development:
Evidence from this
article show that
through teaching the use
of compensatory
strategies, retraining

clinically definite
MS for at least 6
months that was
documented by a
physician and stable
disease status at time
of entry.
Participants were 24
to 60 years old and
89% were white,
66% were married
and 79% were not
employed. On
average the sample
population held a
mild to moderate
memory deficit based
off of the EDSS scale
scores.

CVLT-Total, MMQStrategy, CVLT,


Neuropsychological
Screening
Questionnaire
(MSNQ), Multiple
Sclerosis Self-Efficacy
Scale (MSSE-Control)
Strategy Subscale of
Multifactoral (MMQStrategy), Minimal
Assessment of
Cognitive function in
MS (MACFIMS).

(the self-report
of the frequency
of use of
compensatory
memory
strategies), for
the six
neuropsychologi
cal performance
tests, the two
self-reported
compensatory
strategies, and
measure of
neuropsychologi
cal performance
(MSNQ). This
indicates scores
changed
significantly
over the 5 month
protocol for both
groups. The
evidence from
the MAPS-SS
intervention
provided initial
evidence that it
can help people

measure of
cognitive
impairment based
off of a
neuropsychologic
al test.

skills and
environmental/lifestyle
support that clients may
demonstrate an
increased use of
compensatory strategies,
improved performance
of neurological tests and
develop greater selfefficacy. Specific
compensatory strategies
or retraining skills were
not addressed within the
study; therefore the
occupational therapists
should develop clientcentered programs to
meet the individual
needs of the client.
Societal needs:
Results gained
throughout the study did
not last the test of time;
therefore practitioners
building efficacy and
skills for the strategies
given are a key
component of the group
component intervention.
Healthcare delivery and

with MS develop
compensatory
strategies. Verbal
memory and
compensatory
strategies were
the only two
interaction
effects with
significance. The
MAPSS-SS
group had
greater selfefficacy and
more frequent
use of
compensatory
strategies and
improved
performance on
neuropsychologi
cal tests.

health policy:
More resources are
needed for home-based
interventions for patient
with MS to address
cognitive function.
Education and training
of OT students:
For use of the specific
MAPSS-SS group
intervention requires
education and training.
However, developing
compensatory strategies,
retraining skills and
environmental/lifestyle
support is well within
the scope of
occupational therapy
and occupational
therapists have the skill
sets to create a client
centered skills plan. Use
of home intervention
should be utilized to
ensure skills are
generalizable to real life
situations.

Author/

Study Objectives

Level/Design/
Subjects

Intervention and
Outcome Measures

Results

Study
Limitations

Implications for OT

This RCT was


done to established
techniques to
improve learning
and memory
performance in
MS participants
with learning
disabilities.

Level I

Participants took part


in 8 week therapeutic
session, two per
week for 45 minutes
for 4 weeks.

There were no
statistical
significance
between the
control and
experimental
group in overall
intelligence, word
fluency, auditory
attention, working
memory,
information
processing
abilities, mental
flexibility, new
learning, memory
abilities,
depression, state
anxiety or train
anxiety.

Limitations
included a
selection bias,
small sample size,
and the population
did not include
severe cognitive
symptoms.

Clinical and
community-based
practice of OT

Year
Chiaravall
oti, N. D.,
Deluca, J.,
Moore, N.
B., &
Ricker, J.
H (2005)

One randomized
control group and
one intervention
group.
There were 29
participants with
clinically definite
MS were included in
the study. 17 had
relapsing-remitting
MS, 4 had primary
progressive MS and
7 had secondary
progressive MS.
There was a wide
range of physical
deficits measured by
Ambulation Index
with an average of
2.86 + or -2.66 and
wide range of length
of time since
diagnosis of MS (12432 months). All

The control group was


taught the story
memory technique
(SMT) and were taught
two interrelated skills;
the use of visualization
(imagery) to facilitate
new learning and
utilize context to learn
new information
(story). Session 1-4
focus on imagery. The
first session began
with the participant
being asked to read
story containing highly
visualized scenes and
were instructed to use
visualization to help
remember parts of the
story. After 100

Immediately
following
treatment the
experimental
group showed an
increase in

Long term effects


were not sustained
through intervention.
Although directly
following the
intervention the
participants who
demonstrated the most
gain where those with
moderate to severe
memory deficits.
Clinicians should look
into other strategies
that provide long term
effects or develop a
strategy for continued
practice after
termination of
intervention to
increase long term

participants were
determined to have
impaired verbal new
learning. There were
no significant
differences between
control and
experimental group
in terms of age,
education,
ambulation index, or
estimated pre-morbid
verbal IQ,
handedness or
gender.

seconds of exposure to
the story the
participants were asked
to recite the bolded
words from the study.
Cued recall was then
tested by presenting
the patient with the
contextual cues and
asking them to recall
story details. The same
story was then used
with the same
procedure to help
participants learn
visualization for the
next 4 sessions.
Sessions 5-8 worked
on creating context aid
new learning. During
this session the
participants were given
a list of words instead
of a story. The subject
was instructed on
incorporating the list
of words into their own
story and instructed to
visualize the story to
aid memory. Free
recall and recognition

learning abilities
and number of
words learned as
compared to the
control group. At
11 weeks post
intervention any
treatment gains
noted in the
experimental
group on the
HVLT-R total
learning scales
from baseline to
follow up were
not maintained,
with the
moderately severe
group showing
greater benefit
from cognitive
intervention.

effects.
Program development:
Due to lack of gains
seen within the
treatment group
practitioners should not
solely rely on this form
of intervention to aid in
clients memory deficits.
Societal needs:
Compensatory strategies
will allow those with
cognitive deficits adjust
to daily life and keep
them engaged in their
daily roles and within
the community.
Healthcare delivery and
health policy:
More resources are
needed for home-based
interventions for patient
with MS to address
cognitive function.
Education and training
of OT students:

questions followed.
The non-control group
met the same amount
of time but engaged
the group in nontraining oriented tasks
such as reading the
story and asking
questions with no
instruction on
visualization or context
aid.

Outcome Areas:
Attention,
concentration,
memory, language
comprehension
Outcome Measures
Used: Digit Span,
Animal Fluency,
Oral Trail Making,
controlled oral word
association,
vocabulary subtest,
block design subtest,
the paced Auditory
Serial Addition Test,
Letter Numbering

Students should
familiarize themselves
with different
compensatory strategies
used to help combat
different aspects of
executive functioning.

Sequencing, Symbol
Digit Modalities,
Hopkins Verbal
Learning Test, State
Trial Anxiety
Inventory, Beck
Depression
Inventory, Memory
Questioning
Function
Questionnaire

Author/

Study Objectives

Level/Design/
Subjects

Intervention and
Outcome Measures

The purpose of
this study was to
explore homebased cognitive
training programs
for memory and
working memory
functions in
relapsingremitting MS
patients. The
study researched
efficacy of

Level I

Intervention:

Year
Hildebran
dt, H.,
Lanz, M.,
Hahn, H.
K.,
Hoffmann,
E.,
Schwarze,
B.,
Schwende
mann, G.,
& Kraus,
J. A.
(2007).

One control group


and one
intervention group.
42 participants with
relapsing-remitting
MS who were
diagnosed using the
McDonald criteria.
17 patients agreed to
participate in
treatment group after

Results

Intervention and
control group
Control group was
did not differ in
provided a CD with
the Verbal IQ,
memory and
Performance IQ,
rehabilitation tasks.
central or whole
These patients were
brain atrophy,
required to train for 6 EDDs score or
weeks, at least 5
any neurological
days a week for 30
test or clinical
minutes a day.
scales at first
Evaluation of
assessment.
treatment effects was Ambulatory,

Study
Limitations

Implications for OT

Limitations: no
placebo group,
motivation of
participants
because they had
to do intervention
on their own and
not all of them
complied, using
self- rating
questionnaires,
control group was
larger than
treatment group,

Clinical and
community-based
practice of OT
Only participants with
low brain atrophy
benefited from the
intervention and
therefore it should be
used with clients
reporting significant
cognitive deficits and
may not be the most

memory and
working memory
training in
relapsingremitting MS
patients,
controlling for
brain atrophy at
the beginning of
the study. This
study applies to
our research
question because
our research
question is
focused on
finding home
based
interventions for
patients with MS
that focus on
executive
function.

being randomly
assigned and 25 were
control patients. Avg.
age of treatment
group was 42.4 and
36.5 years for the
control group.
Similarities in the
groups in all relevant
aspects except for
age being
significantly higher
in the treatment
group. Gender was
not specified.
Enrollment in the
study started 4 weeks
after discontinuation
of treatment with
methylprednisolone.
Exclusion criteria
included those
scoring higher than a
7.0 on Expanded
Disability Status
Scale, a current or
past medical illness
or psychiatric
disorder according to
the Diagnostic and
Statistical Manual of
Mental Disorder.

carried out about two


weeks after the end
of the training
period. No treatment
was given to the
control group, but
they were assessed at
the same time.
The software
required the person
to look at a list and
memorize it with no
time pressure.
Calculations were
then presented which
had to be added or
subtracted, this task
only allotted 9
seconds. Subjects
then had to decide
whether the
calculation presented
next was larger,
smaller or the same
as the prior on. After
9 calculations the
participant was asked
to input the word list

no follow ups
depression or
after initial
health related
treatment.
quality of life
were unaffected.
Verbal memory
performance was
increased in the
control group.
Only patients
with low brain
atrophy profited
from the
intervention.

beneficial for those


with mild cognitive
deficits.
Program development:
Evidence revealed
positive effects on
memory and working
memory but none of
these were statistically
significant from the
control group. Authors
concluded that treatment
partly improved and
partly counteracted
function loss. This
program should not be
used for those with
significant cognitive
deficits and the clinician
should weigh the
benefits to determine if
the patient will benefit
from treatment.
Societal needs:
More resources are
needed for home-based
interventions for patient
with MS to address
cognitive function.

given at the start of


the program. The list
had to be reproduced
and the participant
was given two
chances, if they
failed they were
given a new list to
memorize.
Outcome Measures:
Motor performance,
verbal memory,
working memory,
cognitive flexibility,
brain atrophy,
depression, and
quality of life.
Clinical investigation
was used with a
number of tests (nine
hole peg test, timed
walk test)
Neurological
investigation was
also performed
WAIS, performance
IQ was scored using

Healthcare delivery and


health policy:
More resources
available for homebased interventions for
patient with MS to
address cognitive
function.
Education and training
of OT students
Occupational therapy
students should be
familiar with the
different aspects of
executive function and
know differences
between the subtypes to
properly develop an
intervention plan for
their clients.

the Block design and


Picture completion
tests, verbal
assessment, German
translation of the
California Verbal
learning Test,
PASAT, MRI

Author/

Study Objectives

Level/Design/
Subjects

Intervention and
Outcome Measures

Results

Study
Limitations

Implications for OT

The purpose of the


study is to
determine the
impact of
computer assisted
cognitive
rehabilitation (CR)
to improve or
restore impaired
attention functions
in relapsing
remitting (RR) MS

Level I

The experimental
group met 2 times a
week for one hour
sessions for 6
consecutive weeks.
Cognitive training was
performed using the
RehaCom software.
Sessions consisted of
computer assisted
training of several
information processing

For the clinical


and
neuropsychologic
al findings, the
experimental
group performed
better than the
control group in
all
attention/executiv
e functions tests,
but significantly

Small sample
sizes and the
study only used

Clinical and
community-based
practice of OT:

Year
Cerasa, A.,
Gioia, M.
C.,
Valentino,
P., Nistic,
R.,
Chiriaco,
C.,
Pirritano,
D.,Tomaiu
olo, F.,
Mangone,

One experimental
group and one
control group
Using a double
blind randomized
control study, the
researchers
enrolled 12 MS
patients who

participants that
only had the
relapsing
remitting MS and
not the other types
of MS.

Patients with MS that


have attention deficits
should be given
computer assisted CR
in one specific domain
to increase executive
functioning skills.

G.,Trotta,
M.,
Talarico,
T., Bilotti,
G. &
Quattrone,
A. (2013).
ComputerAssisted
Cognitive
Rehabilitat
ion of
Attention
Deficits
for
Multiple
Sclerosis
A
Randomiz
ed Trial
With
fMRI
Correlate.
Neuroreha
bilitation
and
neural
repair,
27(4),
284-295.

patients with
predominant
attention deficits.
This study applies
to our research
question because
the computer
assisted cognitive
rehabilitation is
performed in a
home community
and it is
hypothesized to
increase attention
which is an
executive function.

underwent a CR
program
(experimental
group) and 11 age
gender- matched
MS patients that
were a part of a
placebo
intervention
(control group). A
fMRI was used to
record the
execution of a
cognitive task
broadly used for
assessing attention
abilities in MS
patients. Participants
were recruited at the
department of
Neurology,
University Magna
Graecia of
Catanzaro. All
patients had RR MS
and had no evidence
of a severe cognitive
impairment, (1) had
either predominant
deficits in either

and attention ability


tasks. The study
treatment was on
divided attention,
attention and
concentration and
vigilance. For the
divided attention part,
the participant was
required to stimulate a
train driver and had to
carefully watch out for
distractions such as
crossing animals and
train speed with
increasing difficulty.
For the attention and
concentration part, a
target is shown and
presented with a series
of pictures in a matrix.
The participant had to
recognize the target
and select form the
matrix with increasing
difficulty. For the
vigilance part, the
participant was trained
to sustain his/ her
attention for a long
period of time by
providing response

significant results
were only found
in the ST (P<.007,
d=.88) There were
no noticeable
benefits in mood
status, but the
experimental
group showed an
almost significant
improvement in
anxiety scores
after cognitive
rehabilitation
(STAI-Y2;
P=.056), with a
large effect size
(d=.84). For the
fMRI data, the
experimental
group
demonstrated an
increased activity
in the right
posterior lobule
and the left
superior parietal
lobule with
respect to the
control group
during the
execution of the

This intervention
should be client
centered and tailored
to patients individual
needs
Program development:
Occupational therapist
should be able to
determine deficits in
cognitive abilities in
patients with MS
through standardized
cognitive assessments.
Addressing cognition
should be a part of all
practice settings.
Societal needs:
With the increase in the
aging population and
with individuals with
MS, occupational
therapy practitioners
should consider
maximizing the use of
computer assisted
cognitive rehabilitation
interventions. This will
help alleviate attention

attention and/or
information
processing speed,
working memory
and/or executive
function,(2) had no
additional
impairment in other
cognitive domains
(i.e.- language,
verbal, spatial
memory), (3) no
clinical relapses and
steroid treatment for
at least one month
proper to study entry,
(4)no concomitant
therapy with
antidepressants or
psychoactive drugs,
(5)must have optimal
visual acuity and
(6)no psychiatric
problems.

times limited to
various items. The
participant had to
control a conveyor belt
and to pick objects that
differed from the
sample in one or more
details. The control
group was exposed to
computerized tests,
consisting of 12
individual 1 hour
sessions over a two
week period (2
sessions per week).
The control group was
given vasomotor
coordination task using
an in house software
in their homes. The
participants had to
respond fast and
accurately to the
appearance of a target
(numbers 2-4-6-8) on
the screen by pushing
the matching number
on the keyboard. The
level of difficulty
increased as the
participant became
more proficient at their

PVSAT task. The


detected over
activity during the
retest phase of the
experimental
group was
positively
correlated with the
improvement of
ST. Depression
was also greater in
the control than in
the experimental
group.

In conclusion,
computer-based
training programs
specifically made
for impaired
attention abilities
yields adaptive
neural plasticity of
the associated
neural network.
When CR is
tailored to 1
specific cognitive
domain,
significant and

deficits in patients with


MS so they can increase
their participation in
daily activities and
reduce patient
dependence.
Healthcare delivery and
health policy:
More resources are
needed for home-based
interventions for patient
with MS to address
cognitive function.
Education and training
of OT students

Students should be
exposed to cognitive
rehabilitation
interventions to help
clients with MS that
are experiencing
attention deficits. This
specialized training
should continue to be
required to provide an
excellent service
delivery to patients

current level. At the


end of 6 weeks of
training both groups
were given a blind
evaluation. They were
instructed to perform a
cognitive paced visual
serial addition test
(PVSAT) for 6 minutes
so the researchers
could get fMRI data.
The participants were
required to add up
visually presented
single digits and add
each digit to the one
immediately after it.
The participants all
completed a 10 minute
practice session to
practice to PVSAT
until they could
perform with ease and
accuracy.
Outcome measures:
Selective reminding
test (SRT)
Spatial Recall Test
(SPART)

more effective
results can be
found.

with MS.

SDMT
Word list
generalization
PASAT
ST and Trial Making
Test form A-B
Mini- mental state
exam
Beck depression
inventory
State- trait anxiety
inventory Y1 and Y2
(STAI Y1 and STAI
Y2)

Author/

Study Objectives

Level/Design/
Subjects

Intervention and
Outcome Measures

Results

Study
Limitations

Implications for OT

To determine
whether there is an
association
between
improvements in
objective measures
of physical fitness
and performance
on cognitive tests
in individuals with

Level 3

Participants were
measured for strength
(isokinetic
dynamometer), aerobic
fitness (bicycle
ergometer) and
cognition (Paced
Auditory Serial
Addition Test
[PASAT], Trail Making

Yes, results were


statistically
significant
between the
physically
improved group
versus the
physically not
improved group,
for the 12 week

The researchers
from this study
analyzed another
studys results
and did not
perform the
interventions
with the actual
patients. The

Clinical and
community-based
practice of OT:

Year
Beier, M.,
Bombardi
er, C. H.,
Hartoonia
n, N.,
Motl, R.
W., &
Kraft, G.
H.

Design
They analyzed data
from a previously
published RCT
examining the
effects of telephone
phone counseling

Occupational therapy
practitioners may use
physical exercise
judiciously to increase
cognition in patients

(2014).
Improved
Physical
Fitness
Correlate
s With
Improved
Cognition
in
Multiple
Sclerosis.
Archives
of
physical
medicine
and
rehabilita
tion.

multiple sclerosis.
This study applies
to our research
question because
physical fitness is
performed in the
home community
and cognition falls
under the realm of
executive
functioning.

on health
promotion in
people with MS.
The researchers
created a
physically
improved group
and a not
physically
improved group
from the
availability of preand postintervention data of
endurance or
muscle strength
and improvement
of cognition
functioning within
the group as a
whole. 88
community
dwelling
individuals with
clinically
confirmed MS who
wanted help with
exercise as part of a
previously

Test [TMT] at baseline


and 12 weeks later.
Change in fitness was
calculated by
subtracting each
participant's baseline
score from outcome
score and then
transforming the
difference to a Z score
Outcome measures:
Pace Auditory Serial
Addition Test (PASAT)
Trail Making Test
TMT- A
Trail Making Test
-TMT-B.

comparisons.
TMT-B (P=.05)
and TMT-BA
(P=.02). The
physically
improved group
demonstrated
better
performance
(decrease time to
completion) at
follow up on both
TMT-B and TMTBA.

physically
improved and
physically not
improved groups
could
have other
unknown
characteristics or
experiences that
biased
them toward the
increased
improvement in
cognitive
functioning
Also, other
variables that
improve with
exercise, such as
mood, may also
mediate
improved
cognition.
Furthermore, the
exercise
behaviors that
subjects adopted

who suffer from MS.


Findings demonstrate
that there is minimal
risk. Program to
physical exercise in this
population group.
Therefore it may be
useful for patients who
find physical exercise
meaningful.
Program development:
Physical fitness should
be used in conjunction
with other occupational
therapy services for
encouraging more
independence in
participation of
occupations and
meaningful activities.
Societal needs:
The link of physical
exercise to increase
cognition of individuals
with MS shows to value
of physical fitness
therapeutic effect. This
information will help
with the advocacy of

published health
promotion trial.

were selfdetermined, not


quantified and
not standardized,
making
replication of the
study unlikely.

getting individuals
involved in more daily
exercise to increase their
cognition and reduce
their dependence on
other resources with will
reduce costs.
Healthcare delivery and
health policy:
More resources are
needed for home-based
interventions for patient
with MS to address
cognitive function.
Education and training
of OT students

It is important that OT
programs stress to the
students the
importance of
physical activity on
health and wellbeing
and its potential
positive effects on
client factors to
promote participation
in everyday activities

of patients.
Author/

Study Objectives

Level/Design/
Subjects

Intervention and
Outcome Measures

Results

Study
Limitations

Implications for OT

The purpose of the


study is to
investigate the
potential of
standardized
exercise as a
therapeutic
intervention to
help with
cognition for
progressive MS.
This study applies
to our research
question because
exercise can be
done in the
community and
exercise is shown
to be
neuroprotective in
rodents and
therefore might
help with
cognition in
humans.

Level I

The researchers of the


study performed the
intervention under the
supervision of a
licensed
physiotherapist. Each
participants training
schedule was based off
of their individual
results from the
bicycle ergometer
performance test that
was used to test
aerobic levels. The
participants then were
trained on one of the
four modalities (First
Degree Fitness E-920
Upper body arm
ergometer, the Ergofit
3000 bicycle
ergometer the
Waterrower or the
control group)
depending on which
group they were
chosen to be a part of

The results
showed that
cognitive
functioning at
baseline and 12
weeks differed
based on the level
of fitness. There
was a nonsignificant change
for TMT-B.
Significant results
were seen for the
TMT-BA and
TMT-A. The
significant
interaction
involving TMT-A
is more likely
attributed to
regression to the
mean rather than
the change in
cognition
associated with
change in fitness.

The study only


tested aerobic
physical
exercise.
Studying more
types of physical
exercise
including
anaerobic,
flexibility and
stability would
have made the
study more
comprehensive
of physical
exercise.

Clinical and
community-based
practice of OT: The

Year
Briken,
S., Gold,
S. M.,
Patra, S.,
Vettorazz
i, E.,
Harbs,
D.,
Tallner,
A., ... &
Heesen,
C.
(2013).
Effects of
exercise
on fitness
and
cognition
in
progressi
ve MS: a
randomiz
ed,
controlle

The study was


designed as a
randomized control
trial of three
different exercise
training
tools (rowing, arm
ergometry and
bicycle ergometry)
and a waitlist
control group with
progressive MS
patients with
moderate disability.
Training programs
comprised of 23
sessions per week
for 810 weeks of
standardized
exercise.
The training
program was

implications for practice


may include
incorporating more
physical fitness into
occupational therapy
interventions for
individuals with MS to
help with improvements
in cognition so they can
participate in
meaningful activities.
Program development:
Practitioners that have
an interest in exercise
fitness and/or executive
functioning may find
special training in this
area beneficial, but
current evidence does
not specify that it should
be a necessary
component for treating
cognition in patients

d pilot
trial.
Multiple
Sclerosis
Journal,0
(0) 1
9.DOI:
10.1177/1
35245851
3507358

geared to the
individual level of
fitness of the
participants, as
determined by
standard ergometry
at baseline. The
feasibility measure
of the study was
the of subjects
completing the
trial.

through the
randomization process.
All training sessions
were performed at the
Department of
Physiotherapy,
University Medical
Center HamburgEppendorf. The length
of the training session
steadily increased from
15 to 45 minutes. This
increase came from
every training session
in which targeted
performance and
training interval were
met. All increases were
based on a predefined
plan. The participants
performance, as well
as their subjective
work load ratings
(BORG Scale) was
recorded during each
training session.
Outcome Measures:
Symbol Digit
Modalities Test was
used to measure speed.
Verbal Learning and

with MS.
Societal needs:
The link of physical
exercise to increase
cognition of individuals
with MS shows to value
of physical fitness
therapeutic effect. This
information will help
with the advocacy of
getting individuals
involved in more daily
exercise to increase their
cognition and reduce
their dependence on
other resources with will
reduce costs
Healthcare delivery and
health policy:
The results are
preliminary and there is
a lack of evidence
regarding physical
exercise to improve
cognition in individuals
with MS. Further
research is warranted
and health policies

Memory Test was used


to evaluate declarative
memory and learning
abilities. Test Battery
Attention was used to
test executive function
and Regensberg Verbal
Fluency Test was used
to test verbal fluency.

Author/

Education and training


of OT students

OT students should
know general exercise
techniques for
multiple practice
settings and be
encouraged to pursue
continuing education
in physical exercise if
there is a special
interest.

Study Objectives

Level/Design/
Subjects

Intervention and
Outcome Measures

Results

Study
Limitations

Implications for OT

The purpose of the


study was to
examine the
relationship
between the use of
a PDA (Personal
Digital Assistant)
and individuals
with MS who have

Level 3

Intervention phase was


conducted during 4
home visits. On the
first training visit the
COPM and the
CHART-R were
administered and the
participant was given a
PDA and shown how

The results
indicated that a
significant change
did not occur in
pre and post
treatment scores
for the COPM,
however for post
treatment

The same
individuals who
scored the
assessments also
administered the
trainings which
could have
potentially

Clinical and
community-based
practice of OT: The

Year
Gentry, T.,
Wallace,
J.,
Kvarfordt,
C., &
Lynch, K.
B. (2008).
Personal
digital

should not be changed.

The study was a


quasi-experimental
design that had a
pretreatment,
training period and
post training period

study concluded that


home based OT training
intervention was
successful to teach to
people with cognitive
impairment related to

assistants
as
cognitive
aids for
individual
s with
severe
traumatic
brain
injury: A
communit
y-based
trial.
Brain
Injury,
22(1), 1924

cognitive
impairments
related to
functional tasks.
This study relates
to our research
question because
PDAs can be used
in the home and
they can
potentially help
with cognitive
impairments
related to
functional task
which is under the
realm of executive
functioning.

Volunteers were
recruited from the
community and
demonstrated
cognitive
impairments
associated with MS.
They needed to score
28 or lower on the
RBMT-E profile
scale or 75 or lower
on the CHART-R
cognitive subscale.
Also participants had
to rate their cognitive
difficulty as their
most or 2nd most
cognitive difficulty.
Also they had to
have functional
hearing, vision, and
dexterity to
manipulate PDA.

to enter data and


transfer information
using the USB cord..
The investigator
loaded the Palm
desktop software onto
the participants home
computer and showed
him/her how to enter
alarm and calendar
entries using the Palm
software. The next day,
the investigator,
returned for a 60 min
visit in which the
calendar and alarm
features were reviewed
and participate was
taught how to use the
to do list and
contacts. Participants
were encouraged to
transfer information
such as appointments,
medication schedules
and other items from
their paper based
notebooks. During
week 11, the
investigator returned
for a 60 min visit and
participant was showed

satisfaction and
performance
scores were higher
at the end of post
treatment than the
initial assessment
scores. For the
CHART-R
measures of
functional
performance,
results indicated
significant
changes in the
social, cognitive
and mobility
subscales.
However the
occupational and
physical subscales
did not show a
significant
change. For the
RBMT-E
assessment, no
significant change
was found
between the
pretest and
posttest. The
results were
statistically

created a scoring
bias. Also, the
study sample
was not
randomized or
fully
representative of
the MS
population. The

MS how to use a PDA.


Those improvements

sample consisted
of people who
were living in a
community

Program development:

with intact
hearing, vision
and dexterity.
Results should
be used
cautiously to
apply to the MS
population.

were not the result of


remediation but from
the training of an
occupational therapist in
the utilization of a PDA
as a compensatory
assistive technology.

OT practitioners that
have an interest in
assistive technology
should find special
training in this area
useful. Current evidence
supports the use of
PDAs to improve
cognitive impairments
in individuals with MS.
OT practitioners should
implement the use of
PDAs to help with
cognition with
individuals with MS
who are open to learn
how to use this
technology.

investigator previously
taught skills on the
PDA and was trained
on any new features.
During week 12, the
investigator returned
for a 90 min visit in
which the participant
could ask questions
related to using the
PDA were addressed,
the PDA was inspected
for entries posted by
participant and
assessment measure
were administered
again.
Outcome measures:
Canadian Occupational
Profile
Measure(COPM),Crai
g Handicap
Assessment and Rating
Technique Revised
(CHART-R),
Rivermead Behavioral
Memory Test
Extended(RBMT-E)

significant due to
its use of applying
the Huyn-Feldt
correction.

Societal needs:
With more affordable
prices for PDAs,
patients with MS can
improve functional
performance and be
more independent in
daily activities. This will
improve their wellbeing and make them
more productive in
society.
Healthcare delivery and
health policy:
More resources
available for homebased interventions for
patient with MS to
address cognitive
function.
Education and training
of OT students

OT students should be
aware of general
assistive technology
applications for
multiple practice
settings and be

encouraged to pursue
continuing education
in assistive technology
if there is a special
interest