A Conceptual Approach to Comprehensive Interdisciplinary Cognitive Rehabilitation: A description using the TIDieR-Rehab Framework

Cognitive impairment is highly prevalent in people with progressive multiple sclerosis. Computerized cognitive training techniques have demonstrated some success at targeting core cognitive processes but are criticized for lack of transfer to real-world tasks. Research in physical rehabilitation has demonstrated the efficacy of high volume, moderate intensity task-specific training (TST) that is monitored, progressed and ideally practiced in real-world environments to enhance learning, transferability and support neurorecovery of motor functions. Findings demonstrate that TST influences activity and participation outcomes, leads to improved cortical reorganization, and focuses on activities that align with a person’s daily life and specific goals. Our MSCanRehab group adapted the same principles to develop a novel comprehensive interdisciplinary approach to cognitive rehabilitation that combines core cognitive process training (CCPT), TST and a modified Cognitive Orientation to Daily Occupational Performance (CO-OP) approach. The cognitive TST was individualized to participant goals identified using the Canadian Occupational Performance Measure and further tailored based on their areas of cognitive weakness. A modified CO-OP process was utilized that incorporated CCPT and cognitive TST personalized to meet meaningful participant goals and improve occupational performance. Cognitive TST utilized goal-directed practice and repetition focused on cognitive skills (vs. impairments) using real-world tasks. Task complexity and challenge was gradually increased and progressively adapted with emphasis on active participation and problem solving. A case example demonstrates how the intervention was implemented. Components of the intervention are described using the TIDieR-Rehab checklist to ensure a comprehensive description, with emphasis on essential elements and dosage parameters.