The influence of information processing speed on benefit from learning and memory rehabilitation in TBI: a sub-analysis of the TBI-MEM trial.

OBJECTIVE: This study examined the influence of processing speed (PS) on benefit from treatment with the Kessler Foundation modified Story Memory Technique® (KF-mSMT®), a cognitive rehabilitation intervention shown to improve new learning and memory in traumatic brain injury (TBI). SETTING: Non-profit research center. PARTICIPANTS: 62 participants with moderate-to-severe TBI were included, 31 assigned to the treatment group and 31 to the placebo-control group. DESIGN: Double-blind, placebo-controlled, randomized clinical trial. The present study represents a post-hoc analysis to examine the role of PS on treatment efficacy. MAIN MEASURES: Baseline and follow-up neuropsychological assessment including the California Verbal Learning Test, Second Edition (CVLT-II), Memory Assessment Scales - Prose Memory (MAS-PM) and the Symbol Digit Modalities Test (SDMT). RESULTS: A treatment effect was not observed on the CVLT-II learning slope in the treatment group relative to the placebo group post-treatment, after co-varying for education, baseline CVLT slope and PS performance. However, performance on a measure of PS, the SDMT, was a significant predictor of post-treatment change following KF-mSMT® treatment. PS was not a significant predictor of benefit from treatment as documented by the MAS-PM immediate or delayed recall score, both of which showed a significant treatment effect. CONCLUSION: Performance on measures of cognitive dysfunction aside from learning and memory impact the benefit from KF-mSMT® treatment. Implications for cognitive rehabilitation for individuals with TBI are discussed.

The efficacy of speed of processing training for improving processing speed in individuals with multiple sclerosis: a randomized clinical trial.

OBJECTIVE: The current study examines the efficacy of speed of processing training (SOPT) to improve processing speed (PS) in individuals with multiple sclerosis (MS). Outcomes included changes in the useful field of view (UFOV) and neuropsychological evaluation (NPE). METHODS: This double-blind, placebo-controlled randomized clinical trial included 84 participants with clinically definite MS and impaired PS, 43 in the treatment group and 41 in the placebo control group. Participants completed a baseline NPE and a repeat NPE post-treatment. The treatment group was randomized to booster sessions or no contact. Long-term follow-up assessments were completed 6 months after treatment. RESULTS: A significant effect of SOPT was observed on both the UFOV (large effect) and pattern comparison with a similar pattern of results noted on letter comparison, albeit at a trend level. The treatment effect was maintained 6 months later. The impact of booster sessions was not significant. Correlations between degree of improvement on the UFOV and the number of levels completed within each training task were significant for both speed and divided attention indicating that completion of more levels of training correlated with greater benefit. CONCLUSION: SOPT is effective for treating PS deficits in MS with benefit documented on both the UFOV and a neuropsychological measure of PS. Less benefit was observed as the outcome measures became more distinct in cognitive demands from the treatment. Long-term maintenance was observed. The number of training levels completed within the 10-sessions exerted a significant impact on treatment benefit, with more levels completed resulting in greater benefit.

Comparing the Open Trial - Selective Reminding Test results with the California Learning Verbal Test II in multiple sclerosis.

We compared the California Learning Verbal Test II (CVLT II) and the Open Trial-Selective Reminding Test (OT-SRT) in assessing learning in persons with Multiple Sclerosis. One-hundred and twelve participants with multiple sclerosis performed the OT-SRT and the CVLT II on two different days. All participants completed additional cognitive tests assessing information processing speed (IPS), working memory (WM), and executive functions (EF). By definition, all participants were identified as having impaired learning on the OT-SRT (i.e., z score <-1.0); however, only 38 participants (33.9%) were identified as having impaired learning on the CVLT II (i.e., a z score <-1 total correct responses trials 1-5). The sample was thus divided into two groups, those who failed both tests (Fail-2) and those who failed only one (Fail-1). The Fail-2 group showed poorer performance on EF, WM and IPS in comparison with the Fail-1 group. On the CVLT II, the Fail-1 group showed a significantly greater improvement between trials 1 and 5, as compared with the Fail-2 group. However, the two groups performed similarly on the OT-SRT. Correlation analysis showed that EF is positively correlated with CVLT II learning slope but not with OT-SRT learning slope. The CVLT II and the OT-SRT are not equivalent tests: while the CVLT II appears to be sensitive to overall cognitive dysfunction, the OT-SRT is more sensitive to focal learning and memory impairments.