Adaptive vs. non-adaptive cognitive training by means of a personalized App: a randomized trial in people with multiple sclerosisReport as inadecuate

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Journal of NeuroEngineering and Rehabilitation

, 13:88

First Online: 04 October 2016Received: 30 March 2016Accepted: 17 September 2016


BackgroundCognitive impairment is common in multiple sclerosis MS, but the definition of the best cognitive rehabilitation tools and features is still an open issue among researchers. The aims of the present study were to evaluate the effectiveness of COGNI-TRAcK a customized application software delivering personalized working memory-based exercises on cognitively impaired people with MS and to investigate the effects of an adaptive vs. a non-adaptive cognitive training administered by means of COGNI-TRAcK.

MethodsTwenty eight patients 20 women, age 47.5 ± 9.3 years, Expanded Disability Status Scale score 3.8 ± 1.9 were randomized in two homogeneous groups, both performing a 8-week home-based cognitive rehabilitation treatment by means of COGNI-TRAcK. The study group ADAPT-gr underwent an adaptive training given by the automatic adjustment of tasks difficulty to the subjects’ performance, whilst the control group CONST-gr was trained at constant difficulty levels. Before and after the treatment, patients’ cognitive status was assessed using a gold standard neuropsychological evaluation. Moreover, the mostly affected cognitive domains in MS i.e., attention, concentration and information processing speed were also assessed 6 months after the end of the treatment.

ResultsThe analysis of variance showed a significant Group*Time interaction in six out of ten tests of the cognitive evaluation. Post-hoc analysis revealed a significant improvement between the performances before and after the intervention only in the ADAPT-gr in tests evaluating verbal memory acquisition p <0.05 and delayed recall p = 0.001, verbal fluency p = 0.01, sustained attention, concentration and information processing speed p < 0.01. This last effect was maintained also after 6 months p < 0.05.

ConclusionsWe concluded that COGNI-TRAcK represents a suitable tool to administer a personalized training to cognitively impaired subjects and that an adaptive working load is a crucial feature determining the effectiveness of cognitive treatment, allowing transfer effects to several cognitive domains and long-term maintenance of results.

KeywordsApplication software Cognitive rehabilitation Adaptive working load Personalized treatment Multiple sclerosis AbbreviationsADAPT-grAdaptive training group

ANOVAAnalysis of variance

BRB-NTRao’s Brief Repeatable Battery of Neuropsychological Tests

CICognitive impairment

CONST-grConstant training group

CRCognitive rehabilitation

DMDDisease-modifying drugs

Dual-Nback task-dual- N-back task

EDSSExpanded disability status scale

MSMultiple sclerosis

Oper-Nback task-Operation- N-back task

PASATPaced auditory serial addition test

PwMSPeople with multiple sclerosis


SDStandard deviation

SDMTSymbol digit modalities test

SPSecondary progressive

SPART10-36 Spatial Recall Test

SPART-DSpatial recall test-Delayed

SRT-CLTRSelective reminding test-Consistent long term retrieval

SRT-LTSSelective reminding test-Long term storage

SRT-DSelective reminding test-Delayed

VS-WM taskVisuospatial working memory task

WCSTWisconsin card sorting test

WLGWord list generation

WMWorking memory

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Author: Ludovico Pedullà - Giampaolo Brichetto - Andrea Tacchino - Claudio Vassallo - Paola Zaratin - Mario Alberto Battaglia - La



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