Cognition dysfunction can be a prominent issue in a number of patients with multiple sclerosis. Occupational therapy can help.

Cognition dysfunction can affect people in many ways throughout their daily lives. Common areas of cognitive dysfunction for people with MS include slower processing speeds, decreased ability to multitask, decreased memory, lower attention span, difficulty planning out tasks, and word finding difficulty. All of these can affect one’s safety and independence as well as make it challenging for family to help care for their loved ones. Taking action to address cognitive dysfunction is an important way for patients and caregivers to help decrease the effects of MS. An occupational therapist (OT) is trained to perform tests to evaluate what areas of cognition are being affected. Then, cognitive rehab can occur where the individual and the OT work on strategies to address dysfunction. OTs look at what is called functional cognition which means assessing how an individuals’ thinking and processing skills are affected within their everyday lives. How are someone's daily and meaningful activities affected by their cognitive dysfunction? By looking at these difficulties, we can come up with ways to adjust habits, and adapt or reinvent how tasks are completed which will treat the corresponding cognitive dysfunction.

The goal of OT services is to improve awareness into individualized impairments and assist with ways to be as independent as possible. Cognitive rehab with an OT can take two different approaches. First, an OT can perform activities of daily living (ADL) training to address the deficits which is supplemented with varied feedback strategies. Giving feedback during tasks, working on multiple approaches until the “right” approach is determined then mastered and setting individualized goals to improve cognitive independence are what skilled sessions with an OT would include. Second, an OT can also prescribe to patients a series of self-directed tasks to perform at home to increase cognitive abilities.

The important part is linking those skills from the self-directed tasks into everyday tasks. What an OT providing cognitive rehab can achieve is almost limitless with skilled sessions and a home program being performed. Other professionals can also be involved in cognitive rehab. Speech language pathologists also work on cognitive function. They look at the deficits based on how the individual communicates, versus an OT that looks at them functionally. A psychologist may perform a longer battery of tests to evaluate cognition. A social worker can also assist with outside referrals for therapists and neuropsychologic testing. There is a great article by Rosalind Kalb et. al. titled, “Recommendations for cognitive screening and management in multiple sclerosis care.” It explains that early and ongoing cognitive assessments and personalized treatments are supported by much evidence.

Many of the cognitive screens they suggest in the article are being used by OT at IMSMP. Many neurologists will refer patients with MS for a baseline cognitive screening or test battery. This does not mean all patients will have cognitive decline due to MS. The screen allows your medical team to assess changes. Repeating testing over time would give your MS care team insight as well as the ability to give early support and treatment. Cognitive rehab would be a strategy to keep people as independent in their daily lives as possible. The occupational therapist at the IMSMP will be offering these services in our new Wellness Center opening in 2021.