The experimental group met twice a week for 1-hour sessions for 6 consecutive weeks. Sessions consisted of computer-assisted training of several attention ability and information processing tasks. Cognitive training was performed using the software RehaCom (
www.Schuhfried.at). We decided to use this system because RehaCom is Europe’s leading software for CR, and this is now used in more than 1000 hospitals and practices across Europe. Moreover, several previous studies have used RehaCom to evaluate the impact of CR in patients with schizophrenia,27 MS,8,12 and head trauma.28 This software has a specific interface consisting of a special keyboard that has been designed to minimize the interferences caused by motor and coordination disabilities. This tool can be installed on a standard PC and stimulates specific cognitive functions at different levels of complexity and with different modes of input/output. Each cognitive performance and its progress can be recorded and saved on the hard drive. The study treatment consisted of “divided attention,” “attention and concentration,” and “vigilance” programs. In divided attention, the patient is required to simulate a train driver, carefully observing the control panel of the train and the countryside. Several distractions, such as crossing animals and train speed must be taken into account, with increasing levels of difficulty. In the procedure attention and concentration, an individual picture (target) is presented and then compared with a matrix of pictures. The patient has to recognize the target picture (coded as symbols, items, animals, or abstract figures) and select it from the matrix. The abilities to differentiate and to concentrate are trained simultaneously. The level of difficulty rises as the number and complexity of pictures to recognize increases. Finally, during the vigilance program, the patient is trained to sustain his or her attention for a long period of time by providing response times limited to the various items. The task of the patient is to control a conveyor belt and to select the objects that differ from a sample in one or more details.
The control group underwent a similar exposure to computerized tests, consisting of 12 individual 1-hour sessions over a 6-week period (2 sessions per week). In particular, the control group performed a visuomotor coordination task by using an in-house software with which they had to simply respond quickly and accurately to the appearance of target visual stimuli (numbers 2–4–6–8) on the screen by pressing the corresponding number key on the keyboard. The level of difficulty rises as the speed of external stimulation, defined as interstimulus interval, rises from 3 s (level 1) to 500 ms (level 12). All performances were recorded on an external hard disk and analyzed in our research center. All patients completed the training at home with optimal performance. An experienced treating clinician was responsible for setting up the rehabilitation program and assisting patients during the study and control treatments.
Finally, at the end of the 6-week training, participants from both groups were given a blind evaluation, using the same protocol as at a baseline (T1). Two MS patients from the control group and 1 from the experimental group decided to not continue with the protocol. Thus, 12 MS patients from the experimental group and 11 from the control group completed the protocol.