Neuropsychological Rehabilitation Research Articles

Cognıtıve functıons in idiopathic intracranial hypertensıon.

Cognitive problems in idiopathic intracranial hypertension (IIH) is generally overlooked in the presence of disabling headache and threat to visual function. The aim of this study was to search for cognitive deficits in patients with IIH using neuropsychologic tests in addition to P300 potential recordings to assess cognition related brain activity. Fifty IIH patients were examined using Montreal Cognitive Assessment Test, Stroop Test and Visual Aural Digit Span Test to measure different domains of cognition at the time of diagnosis. P300 potentials were recorded by using an oddball paradigm. Hospital Anxiety and Depression Scalewas used to determine anxiety and depression. Quality of life (QoL) was assessed by SF-36. The results were compared with fifty healthy controls with matching age, gender and body mass index. Neuropsychologic tests revealed wide cognitive impairment including attention, working memory, executive function, naming, language, delayed recall and orientation in IIH patients. In addition, quality of life was affected in the sub-parameters of general health perceptions, emotional role functioning, vitality, mental health and bodily pain. P300 potential latencies were long and the amplitudes were reduced indicating deficits in attention and working memory. Anxiety scores were high, and health-related QoL was low mainly involving vitality, emotional and mental health. Cognitive dysfunction was not correlated with the levels of anxiety and the correlation with headache severity was mild. A multidomain cognitive decline mainly involving attention and working memory was recorded in IIH patients. It was not correlated with anxiety and only a mild correlation with headache severity was present which may indicate a casual relationship between raised intracranial pressure and cognitive deficits. Screening is important as neuropsychological rehabilitation might be relevant in these patients.

Socratic guided feedback therapy after acquired brain injury: A multicenter randomized controlled trial to evaluate effects on self-awareness

ABSTRACT Impaired self-awareness after acquired brain injury (ABI) challenges neuropsychological rehabilitation. The current study aimed to compare the effects of Socratic Guided Feedback therapy to usual care in a multicenter randomized controlled trial with 64 participants with reduced self-awareness after ABI. The objectives were to study the effects on (1) self-awareness and (2) motivation for and participation in therapy, mood, quality of life, and social participation. Patients were recruited from rehabilitation centres in The Netherlands and Belgium. They were 50.8 (±16) years old and 2.7 months (±1.8) post-injury at baseline. Session duration ranged from 20–60 minutes and the number of sessions ranged from 1 to 162 sessions. Self-awareness increased over time in both groups. Between 9 and 12 months after baseline measurement, self-awareness (Patient Competency Rating Scale discrepancy score between patient and significant other) improved in the experimental group and deteriorated in care as usual. No significant differences were found on secondary outcome measures. In conclusion, Socratic Guided Feedback therapy is as effective as care as usual but provides a structure for therapists. We recommend further investigation of the added value of Socratic Guided Feedback therapy in later follow-up measurements, group therapy settings, and on other outcome domains such as caregiver burden.

A neuropsychological rehabilitation service delivery model for South African adults with acquired brain injury (RSDM-SA).

In low- and- middle- income countries (LMICs) such as South Africa, a high number of Acquired Brain Injuries (ABIs) and a lack of accessibility to healthcare lead to many survivors of brain injury not receiving the level of healthcare and rehabilitation required. Further, in LMICs life-saving or acute care is prioritized with an inadequate focus on the lifelong effects of ABI. This study used Program Theory to develop a Rehabilitation Service Delivery Model for South African Adults with Acquired Brain Injury (RSDM-SA) that caters for the unique nuances of a resource-constrained and culturally diverse context. The RSDM-SA has four interdependent levels, namely (i) Integration of Relevant Aspects of Explanatory Frameworks (ii) South African Contextual Influences on the Model (iii) Systemic Role players Necessary for the Model and (iv) Evidence-Based Guidelines in a Holistic Rehabilitation Process. The Model is a valuable resource in guiding future research endeavors and its contribution lies in the Model's focus on quality, accessibility, relevance, and efficiency, all of which are needed in healthcare internationally.

Lost Self to Present Self: A Case Report of Narrative Therapy for a Woman with Acquired Brain Injury

BACKGROUND: Psychotherapy for people with acquired brain injury (ABI) is considered to be an important component of a holistic neuropsychological rehabilitation approach. This helps in making sense of the loss of the sense of self they experience. Gender, premorbid personality, and socio-cultural discourses guide this process of understanding. Narrative formulation takes these considerations into account and, thus, can be used for formulating therapeutic plans.
 AIM: To present a case report which highlights the use of narrative case formulation to understand the psychological, social, and cultural factors forming the dominant discourse of a woman with ABI.
 METHODS: Ms. VA, a 43-year-old female, presented herself with a diagnosis of hypoxic ischemic encephalopathy with small chronic infarcts with gliosis in the bilateral cerebellar hemisphere, myoclonic seizures, mild cognitive impairment, depression, generalized dystonia, and bronchial asthma. Along with neuropsychological rehabilitation and cognitive retraining, 25 sessions of psychotherapy using narrative formulation were performed.
 RESULTS: Following the therapy, microgains such as a developing strong therapeutic relationship, accommodating vulnerability in her narrative, and finding moments of independence and assertion within the constraints of ABI were observed. Acceptance of her current predicament vis-à-vis her lost self and finding meaning in her new self were facilitated.
 CONCLUSION: There is paucity of research detailing psychotherapeutic management of ABI, especially in India. Psychotherapy, particularly using narrative formulation, can be helpful in understanding the intersections of gender role and expectations, premorbid personality and ABI, and aiding the post-ABI rehabilitation and adjustment. Future work in this area can explore the socio-cultural aspects that play an important role in the therapy process.

NEUROPSYCHOLOGICAL CONSEQUENCES OF COVID-19: CURRENT APPROACH AND CLINICAL RECOMMENDATIONS

Nearly two years into the pandemic, a large body of data has emerged on how COVID-19-positive patients function with the viral infection. It is now known that the virus targets the central nervous system(CNS). As a result, in addition to the expected common health complaints, patients display cognitive and emotional problems. Cognitive deficits should be expected particularly in patients who have arrived at an intensive care unit as a result of respiratory failure, in patients suffering from comorbid neurodegenerative diseases and respiratory conditions, as well as in the elderly. However, these may also occur in patients with moderate to mild symptoms as well as in those of a younger age. The cognitive impairment has an unknown profile. Given the hypothesised hippocampal vulnerability to the SARS-CoV-2 virus, one might expect particular difficulties with memory, attention, information processing, and executive functions. With varying neuropsycho- logical and emotional problems, convalescents in trying to return to their social, family and professional life require professional psychological assistance. The role of neuropsychologists is here crucial. Indeed, many patients will require a detailed, multifaceted neuropsychological diagnosis that will form the basis for subsequent neuropsychological rehabilitation. An early detection of neuropsychological manifestations could modify the risk of subsequent irreversible impairment and further neurocognitive decline.

Neuropsychology of Spinocerebellar Ataxia Type 2, a Case Study in Stage I Disease

Currently, the evaluation of cognitive disorders in Spinocerebellar Ataxia Type 2 is of great interest, given that the identification of its neuropsychological characteristics allows for a deeper understanding of the disease. However, its approach from the field of study of neuropsychology, based on the integration of the cognitive, affective and behavioral state, is insufficient. The objective of study is characterized from a neuropsychological point of view, a series of cases with Spinocerebellar Ataxia Type 2 in stage I. A multiple case study was carried out with four patients with diagnosis of Spinocerebellar Ataxia Type 2 in stage I genetically confirmed and intentionally chosen. Psychological and neurocognitive tests were applied to evaluate the cognitive, affective and behavioral spheres. Patients with SCA2 stage I presented cognitive impairment in the neuropsychological examination, only one of the subjects showed normal global cognitive functioning, although in the evaluation by specific domains he evidenced various cognitive deficits. Anxiety and depression at pathological levels were not identified in the patients. They showed satisfaction and self-actualization with their lifestyles. The neuropsychological characterization of the cases studied with SCA2 in stage I contributed to a greater understanding of the disease. The identified deficits speak in favor of carrying out a neuropsychological evaluation from the initial stages, to project more effective neuropsychological rehabilitation strategies, which is of interest to the scientific community in the field of Neurosciences.

Verbal Fluency Disorders in Ischemic Stroke Patients Undergoing Neuropsychological Rehabilitation

Introduction: Studying verbal processes is an important aspect of a neuropsychological assessment and therapy of post-brain infarct patients.

Нейропсихологическая коррекция в дополнительном образовании – эффективное средство работы с детьми с ОВЗ

The article presents the author's view on the application of neuropsychological correction in additional education. In recent decades, a lot of children have demonstrated delays and distortions of psychorechological development, lack of formation of arbitrary self-regulation, dysgraphy, etc. Together, this leads to emotional, personal and cognitive unpreparedness for learning and adequate adaptation to society. The priority participation of neuropsychology —the science of the formation of the brain organization of human mental processes in solving a wide range of dysontogenetic problems is primarily due to the depressing realities of development processes in the modern child population. Never before have we encountered such an abundance of negative phenomena as are observed today. Neuropsychological analysis of the problems of deviant development, which has been actively developing in our country since the early 1980s, immediately proved to be the most reliable and productive. This is natural, since it is based on a powerful methodological and scientific-practical base developed in general neuropsychology, neuropsychology of childhood, the theory of neuropsychological rehabilitation. [1]

A game changer Joint Design Journey of PREMS and PROMS in the HOSMARTAI virtual coach study

Background: HosmartAI, “Hospital Smart development based on AI” (H2020, GA.101016834), stands for effective and efficient healthcare system transformation creating a common open integration platform offering multifaceted lasting functionalities (e.g. Marketplace, Co-creation space, Benchmarking tool) to healthcare stakeholders. This platform will allow the collection and analysis of highly relevant datasets to support decision-making. For validating the concept and AI platform, the project includes 8 Lighthouse Pilots, between them, a complementary system aimed to support older adults in their homes or in clinical centres to perform training, prevention and rehabilitation activities. In this sense, appropriate quality measures and methods are fundamental for a continuous improvement of care services. However, the use of PREMs in a continuous and systematic way portrays a recent and still scarcely implemented approach. 
 Objective: This case study presents the process that led to the participatory definition of the productivity, efficiency and quality measures for the HosmartAI virtual assistant for a continuity of care in neuropsychological rehabilitation and elderly care.
 Methods: The HOSMARTAI co-creation methodology focused on exploring the care journey through two initial cycles involving 24 participants to empathize, define collaboratively user requirements and ideate the solution use paths. In the process was included the selection and adjustment of the most valuable assessment indicators with a double goal to validate the approach in a pilot study and of value for the different parts (patients, therapists, healthcare services managers).
 Results/Discussion: The process contributes to meet the end-users’ demands. Firstly, the co-creation process allowed deepening the understanding of the context, the health system and the challenges perceived by people in the primary-user condition, to identify significant concepts of interest for the response, and to reach an appropriate direction, taking into account the patients key points of interest. It was the base to define collaboratively an assessment protocol for the proposed system to address the commented challenges, with a key focus on the Patient Reported Experience which data has the potential to narrow the gap between the therapists’ and patients’ views and help tailor treatment plans to meet the patients’ preferences and needs. The resulting assessment protocol ensure a combination of suitable set of PROMs and PREMs, where PREMs capture in detail the patients’ experience perception with the technology and the service(s) offered through it. From the key considerations, ensuring a soft evaluation approach including data collected throughout seamless interactions with the service interfaces (tablet and social robot) at appropriate moments of the interventions that are complemented with easy to answer questionnaires and semi-structured interviews, ensuring an assessment approach to the patient so natural, intuitive and pleasant as possible.
 Conclusions: This work contributes to the solution development, validation and standardisation, enabling the delivery of high quality care from the perspective of the different stakeholders with a special focus on the end-users. This research continues collecting lessons learnt from the process, such as the need to adopt a flexible co-design framework with stakeholders (including primary and secondary users) and open to regular adjustment/revision of PREMs and PROMs on these highly changing contexts.

Features of Neuropsychological Support of Patients with Impaired Consciousness at the Early Stage of Rehabilitation: a Narrative Review

INTRODUCTION. In the neuropsychological support of patients with impaired consciousness at an early stage of rehabilitation, methodological and practical problems arise related to the choice and procedure for using methods of neuropsychological diagnostics and neuropsychological rehabilitation. To develop methods of working with such patients, it is necessary to address the concepts of the structure of consciousness and the content of consciousness.
 RESULTS. The article presents a review of the literature devoted to the problem of the work of a neuropsychologist with patients with impaired consciousness. In the reviewed literature, attention is drawn to the insufficient development of the neuropsychological content of the concept of “consciousness”; methodological and procedural limitations that arise when a neuropsychologist works with patients with disorders of consciousness of varying degrees of severity; the possibilities of conducting and limiting psychostimulotherapy and sensory stimulation in domestic and foreign approaches are discussed.
 CONCLUSION. The analysis of publications on the topic of accompanying patients with impaired consciousness reflects the presence of a number of unresolved issues. At the present stage of development of neuropsychological work with patients with impaired consciousness, there is no single approved and detailed protocol regulating the conduct of neuropsychological diagnostics and neurorehabilitation with them. The problem is at the stage of solution and requires further research.

Engaging carers in neuropsychological rehabilitation for brain cancer survivors: The “I’m aware: Patients And Carers Together” (ImPACT) program

BackgroundCognitive impairment is a common late effect in child and adult brain cancer survivors (BCS). Still, there is a dearth of research aimed at therapeutic interventions and no standard treatment options for most BCS. ObjectiveTo describe 1) a novel neuropsychological rehabilitation program for BCS – the “I'm aware: Patients And Carers Together” (ImPACT) program, and 2) two studies that aim to assess the feasibility of the ImPACT program in child and adult BCS, respectively. The program adapts the holistic neuropsychological approach pioneered by Leonard Diller and Yehuda Ben-Yishay to an outpatient setting. MethodsTwo feasibility studies are described: 1) A single-armed study with 15 child BCS (10–17 years) (ImPACT Child); and 2) a randomized waitlist-controlled trial with 26 adult BCS (>17 years) (ImPACT Adult). In both studies, patients will undergo an 8-week program together with a cohabiting carer. Primary outcomes (i.e., cognitive and neurobehavioral symptoms), and secondary outcomes (i.e., behavioral and psychological symptoms, e.g., quality of life, fatigue) will be assessed at four time points: pre-, mid-, and post intervention, and 8 weeks follow-up. Adult waitlist controls will be assessed at equivalent time points and will be included in the intervention group after all study assessments. Semi-structured interviews will be conducted at follow-up. Expected outcomesResults will provide feasibility data in support of future larger scale trials. DiscussionThe findings could potentially improve the management of cognitive impairment in BCS and transform available services. The program can be delivered in-person or remotely and harnesses existing resources in patients' lives.

Long COVID neuropsychological follow-up: Is cognitive rehabilitation relevant?

Duration of neuropsychological disorders caused by long COVID, and the variables that impact outcomes, are still largely unknown. To describe the cognitive profile of patients with long COVID post-participation in a neuropsychological rehabilitation program and subsequent reassessment and identify the factors that influence recovery. 208 patients (mean age of 48.8 y.o.), mostly female, were reevaluated 25 months after their first COVID infection and 17 months after their initial evaluation. Patients underwent subjective assessment, Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS), Phonemic Verbal Fluency and Clock Drawing Tests (NEUPSILIN) for executive functions, Hospital Anxiety and Depression Scale (HADS) and WHOQol-Bref. We noted a discrete improvement of neuropsychological symptoms 25 months after the acute stage of COVID-19; nonetheless, performance was not within the normative parameters of standardized neuropsychological testing. These results negatively impact QoL and corroborate patients' subjective assessments of cognitive issues experienced in daily life. Improvement was seen in those who participated in psychoeducational neuropsychological rehabilitation, had higher levels of education, and lower depression scores on the HADS. Our data reveal the persistence of long-term cognitive and neuropsychiatric disorders in patients with long COVID. Neuropsychological rehabilitation is shown to be important, whether in-person or online.

A narrative review of the use of a cutting-edge virtual reality rehabilitation technology in neurological and neuropsychological rehabilitation.

Virtual reality (VR) interventions have been increasingly used in the rehabilitation of a wide range of neurological and neuropsychological dysfunctions. Findings of previous reviews showed positive and promising effects of VR-based interventions. However, they summarized findings on VR-based intervention carried out through different VR systems and tasks. We carried out a narrative review with the aim of qualitatively synthesising the results of previous studies that used specific VR systems, i.e. the Khymeia -Virtual Reality Rehabilitation System, for treatment purposes. We searched the literature in various databases (i.e. EMBASE, Web of Science, SCOPUS, PubMed and PubMed Central) for studies published until November 23, 2023. 30 studies were selected. The VRRS was used for neuromotor rehabilitation only in 13 studies, for cognitive rehabilitation in 11 studies, and for both neuromotor and cognitive rehabilitation in six studies. The study design was heterogeneous including 15 randomised controlled trials. After discussing each study according to the type of rehabilitation we concluded that the use and efficacy of VRRS rehabilitative intervention for increasing the neurological and neuropsychological functioning of patients are promising but more evidence is needed to make a comparison with conventional treatment. Future studies should also include long-term follow-up as well as cost-effectiveness analysis.

Neuropsychological Rehabilitation Improves Memory and Action Naming in Patients With Post-COVID-19 Syndrome.

Post-COVID-19 syndrome (PCS-19) is a condition characterized by both physical and cognitive alterations in patients who have overcome COVID-19. Despite the high incidence of this disorder and the inconveniences it produces to those affected, there are few studies investigating the efficacy of cognitive stimulation in these patients. The aim of this study was to compare two groups of patients with PCS-19. One of them was treated with neuropsychological intervention for 6 months, whereas the other did not receive treatment. Both groups shared similar clinical characteristics and cognitive profiles. The study included 15 participants. Eight (seven women and one man, with a mean age of 50.13 years) made up the experimental group and received neuropsychological rehabilitation sessions once a week with the aim of recovering or compensating for their impaired functions. The control group consisted of seven patients (six women and one man, with a mean age of 52.86 years) who did not undergo neuropsychological rehabilitation sessions. The neuropsychological assessment protocol included tests for all cognitive domains. In comparison with the assessment prior to the neuropsychological intervention, significant differences were found in the experimental group both in verbal memory and in the action naming task. As for the control group, improvements in action fluency performance were observed. Neither group showed significant improvement in pre- versus posttest Stroop scores. However, the control group did perform higher than the treatment group in the final assessment. Despite the small sample size, our results suggest that patients with PCS-19 may benefit from neuropsychological rehabilitation, as it may help them to improve several cognitive functions that do not recover spontaneously.

Speech Development of Children with ASD: A Neuropsychological Approach

Effective identification, support, and development of children’s abilities is a priority task of the education system in Russia. This demands deeper research based on the use of modern diagnostic technologies and neuropsychological tools, especially in what concerns children with impaired development, such as autism spectrum disorders (ASD). Neuropsychological rehabilitation of children with ASD remains a poorly understood yet critical problem. Here, we explore common neuropsychological tools employed in Russia for diagnostics and therapy of ASD in childhood. The prospects of these methods to study the speech characteristics of such children were substantiated. The study is based on a survey of 20 parents of 20 children aged 4–6 years who attend the “WE ARE TOGETHER” Special Kindergarten for Children with Autism Spectrum Disorders at Kazan Federal University (Russia). The speech characteristics of the children, starting from an early age, were thoroughly investigated during the experiment with the help of neuropsychological tools. The latter included game tasks to test social, cognitive, motor, neurodynamic, and regulatory skills, as well as the analysis of the transcripts of the interviews with both children and their parents. The results obtained facilitate the introduction of the neuropsychological approach to diagnose speech disorders in preschool children with ASD, and it can be further improved by experts in the rehabilitation and education of children exhibiting ASD symptoms.

Neuropsychological assessment and rehabilitation: an experience report at the ILCN - Instituto Luso Cubano de Neurologia in Porto, Portugal

This experience report aims to describe a period of observational/ethnographic activity in Neuropsychology, carried out at the ILCN - Instituto Luso Cubano de Neurologia, in the city of Porto, Portugal. This study presents the unit's assessment and rehabilitation models, drawing parallels with the assessment and therapeutic models in Brazil; a characterization of the Institute is carried out, with a profile of the patients and the functions performed by the multi-professional team. The theoretical concepts referenced by the neurosciences will also be described, as will the procedures and instruments used in the follow-ups, the aim of which was to qualify the treatments in order to promote the development and functionality of the users in the face of the difficulties they face on a daily basis, variables which have a direct impact on the establishment of their autonomy and quality of life. To illustrate the activities carried out, two case studies were selected which were monitored by the team from the renowned institute

COVID19 and cognitive impairment ‐ A follow‐up study with cognitive and neuroimaging evaluation of the Clinical Hospital of São Paulo

AbstractBackgroundPost‐COVID19 syndrome is characterized by signs and symptoms that occur within 3 months of the onset of COVID19 and last for at least 2 months. Cognitive impairment has frequently been associated with COVID19 with descriptions of attentional, executive, memory, and language disorders. Moreover, some morphological and metabolic changes have been described in MRI and FDG PET‐CT, respectively. There is no formal treatment for this condition.MethodWe selected patients less than 65 years of age with COVID19 at least 3 or more months of symptoms and no more than 6 months, no relevant structural brain lesions, no record of neurodegenerative disease. A cross‐over design study was performed with neuropsychological rehabilitation. They were evaluated 3 times by a neurologist (0, 3, and 6 months) with specific cognitive battery tests and questionnaires and then by a neuropsychologist for evaluation and training. Finally, most patients underwent neuroimaging with cranial MRI and FDG PET CT or MRI.Result44 patients performed the first baseline evaluation, 34 matched inclusion criteria and were referred to neuropsychological rehabilitation. 20 underwent functional and structural neuroimaging. This sample had a mean age of 44 (SD8.9) years, 61% of females, 16.1 (SD5.1) years of education, 17.6% of hypertension, 2.9% diabetes, 11.8% dyslipidemia and 23.5% obesity. Cognitive evaluation depicted that 90.6% had memory complaints; MMSE of 27.7 (SD1.8); delayed recall of 8.68 (SD1.6) out 10 in the brief cognitive screening battery; semantic verbal fluency of 18.24 (SD5.1); lexical fluency of 31.7 (SD11.7); forward digit span 6.62 (SD0.7); backward digit span 4.82 (SD 1.3); clock drawing test of 9.12 (SD1.6) and Boston naming test‐15 of 14.06 (SD1.5). 46.9% reported more than 5 points on the depression scale and 41.2% somnolence on the Epworth scale. 60% had abnormal findings (hypometabolism) in brain FDG PET, 16% with frontotemporal involvement, 33% basal ganglia, 8% frontoparietal, 41% cerebellum, 8% parietal only, 8% frontalmedial, and 25% temporal. Some (33%) had mixed patterns.Conclusionpost‐COVID19 syndrome and cognitive impairment are relatively common and we need prospective studies in low and middle‐income countries to understand the cognitive profile, structural and metabolic patterns in neuroimage, and the role of neuropsychological rehabilitation.

Post COVID‐19 cognitive rehabilitation effects on depressive symptoms

AbstractBackgroundMore than 600 million people have been infected by Covid‐19 since the beginning of the pandemic. Common cognitive and psychological symptoms in these patients are memory impairment, attention difficulties, anxiety and depression, and neuropsychological rehabilitation is a possible strategy to improve them. In addition, some studies have shown a decrease in depressive symptoms after starting a cognitive rehabilitation program, although this was not the main objective of rehabilitation.MethodFive patients underwent mood assessment, more specifically, depressive symptoms. For this, the Patient Health Questionnaire‐9 (PHQ‐9) was used. The application was made immediately before and after the cognitive rehabilitation intervention, lasting 20 weekly sessions of about one hour of activity.ResultThe evaluation was performed on five patients with a mean age of 52.5 years (Table 1). These presented measures that indicated the presence of depressive symptoms at the beginning of the study. After 20 sessions of cognitive rehabilitation it was not possible to observe an objective change in depressive symptoms. This can be explained by the reduced number of individuals in the sample, which may have impaired the statistical calculation. But it was observed a clinical improvement of depressive symptoms was observed in 60% of patients and 40% remained stable (Table 2). Clinical improvement was also noted in patients, who reported that they were feeling better and that they resumed activities that they have previously avoided or that they were finding it easier, in addition to perceiving their own evolution throughout the treatment, increasing their sense of self‐efficacy and feeling more hopeful.ConclusionFinally, it is noted that cognitive rehabilitation is a possible strategy to improve not only cognitive impairment, but also the clinical manifestations of depressive symptoms in post‐Covid‐19 patients.

Neurovisual rehabilitation in multiple sclerosis: Why a close integration of low-vision rehabilitation and neuropsychological rehabilitation may be effective for visual complaints

Objective The quality of life of people with multiple sclerosis (MS) is often affected by visual complaints. A previous study suggested that visual complaints are not likely to be related to specific visual functions, but by a global decline of cognitive and visual functioning. In this study, we further explore this hypothesis, by investigating the relation between visual functions and global cognitive functioning, aiming to provide recommendations for rehabilitation for visual complaints. Design Cross-sectional study. Setting A rehabilitation centre for partially sighted and blind people and a MS centre at a university hospital. Participants 102 people with MS. Main measure Correlations between assessments of visual functions (acuity, contrast sensitivity, visual field, smooth pursuit and saccades) and composite scores of a neuropsychological assessment (tests with a visual component and without a visual component). Results All composite scores correlated with visual acuity, contrast sensitivity and the sensitivity of the monocular field, but not with smooth pursuit and saccades. Similar patterns were found in various subgroups. Results showed that visual functions that related to visual complaints correlated with a diffuse decline of global cognitive functioning and that visual and cognitive functioning may decline concurrently in people with MS. Conclusions Visual complaints may occur as a result of a diffuse decline of the integrity of a cerebral network involved in vision and cognition. People with MS with visual complaints may benefit from neurovisual rehabilitation, in which low-vision rehabilitation and neuropsychological rehabilitation are closely intertwined.

80 Looking Beyond Visual Functioning in the Rehabilitation of Visual Complaints in People with Multiple Sclerosis: Integrating Low Vision and Neuropsychological Rehabilitation

Objective:The objective of the present study is to expand our understanding of visual complaints in people with multiple sclerosis (MS) with the aim of exploring potential rehabilitation approaches for treating visual complaints. Visual complaints are increasingly recognized as a core manifestation of MS. Up to 90% of people with MS report all kinds of visual complaints, such as blurry vision, double vision, being blinded by bright light, a reduced visual field and having trouble with depth perception. Since intact vision is quintessential to many activities of daily life, such as reading or car driving, these complaints affect independent participation to a great extent. The complaints cannot be fully explained by optical neuritis (a common symptom of MS) or other treatable visual or ophthalmological disorders. Moreover, there are no rehabilitation programs available for visual complaints in people with MS. However, the complaints are not yet understood well enough to develop effective rehabilitation strategies to reduce the impact of the visual complaints.Participants and Methods:Visual complaints were assessed using the Screening Visual Complaints questionnaire. 68 people with MS with visual complaints, and 37 with hardly any visual complaints received a standard visual function assessment and a neuropsychological assessment. Correlations between the visual complaints, visual functions and cognitive functions were calculated. In addition, correlations were calculated between several visual functions and a composite score of the neuropsychological assessment.Results:Only some specific visual measures related to visual complaints, with small to moderate effect sizes. While most specific cognitive functions did not show correlations, measures indicative of overall cognitive capacity in people with MS (such as motor speed) consistently correlated with different kinds of visual complaints. Additionally, visual functions that related to visual complaints also correlated with the composite score for cognitive functioning.Conclusions:Our study serendipitously showed that in developing or composing effective rehabilitation strategies for visual complaints, we should look beyond a person’s visual functioning: first, the overall cognitive capacity should be taken into account. Second, visual functioning and cognitive functioning are closely related. These results indicate that visual complaints may be a result of a general decline of the visual and/or cognitive system as one. When treating these complaints, low vision rehabilitation and neuropsychological rehabilitation strategies may be combined. Strategies should not focus on specific visual or cognitive functions, but at making the visual world more easily accessible, or more easily visible, to reduce the impact on the visual system and cognitive capacity. Strategies could range from applying more contrast in the environment to psycho-education. Future research should focus on developing rehabilitation programs and assessing their effectiveness in people with MS or with other types of non-acquired brain injuries.