Rehabilitation of Executive Dysfunction in Multiple Sclerosis: Cognitive, Behavioural and Neurophysiological Effects of Goal Management Training
Year: 2013
Type: dissertation
Study design: Clinical Trial
Abstract: Multiple sclerosis (MS) is a chronic, progressive central nervous system disease characterized by distributed white matter injury. Particularly prevalent in Canada, MS is a leading cause of disability with extended personal and societal costs given its early onset (on average between 20-40 years of age). Deficits in executive functioning are common and detrimental to employment, daily functioning and quality of life, however their precise nature remains underspecified. Two studies were undertaken to: (1) describe the executive processes affected in MS, including neurophysiological correlates, and (2) explore, in a double-blind randomized controlled trial, patients' response to an intervention for improving behavioural self-regulation. Study 1 described significant functional limitations and impairments in processing speed and executive control of attention, memory and working memory in MS patients, both relative to neurologically healthy controls and as a monotonic function of disease severity. Mean amplitudes for event-related potentials (ERPs) including the P3 and the error-related negativity and positivity (ERN, Pe) were linked to behavioural markers of attention control and performance monitoring. ERP amplitudes and ERP-behavioural associations appeared sensitive to the presence and severity of executive dysfunction related to disease progression. In Study 2, these impaired MS patients were randomly assigned to a modified version of Goal Management Training (GMT) or a psycho-educational control group (Brain Health Workshop, BHW). In GMT, patients learned stepwise strategies (Stop-State-Split) to keep on track in their daily activities, including mindfulness training to enhance attentional awareness and control. Rehabilitation outcomes were assessed post-training and at a 6-month follow-up using a multi-level battery. Compared to BHW, GMT was associated with greater improvement on tests of executive-attentional processes as well as functional task performance and observable functioning in daily life activities. ERP-behavioural changes provided corollary evidence of improved self-regulatory processing. This study is among the first to demonstrate improvement in executive functioning compared to an active control condition in MS patients with a range of disease severity and with effects remaining visible at six months. While replication in a larger sample size is needed, results suggest GMT as a potentially effective approach for executive and self-regulatory impairment in people with MS.
Source: TSpace (University of Toronto)
Author: Nadine Richard
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2751346842