Ava-Kathleen D. Rybicki, MA
Clinical Research Coordinator
Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
Monica Coran Kuns, CCC-SLP CBIS
Speech Language Pathologist
Good Shepard Penn Partners
Philadelphia, Pennsylvania, United States
.jpg "Benjamin Abramoff, MD, MS photo")
Benjamin Abramoff, MD, MS
Physician
Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
Liliana E. E. Pezzin, PhD, JD
Professor and Econometrician
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
Timothy R. Dillingham, MD, MS
Professor and Chair
Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
1. Delineate cognitive effort from fatigue. 2. Define and track cognitive effort using an adaptation of the rate of perceived exertion for physical activity (Borg RPE).
Design: 38 participants with a history of COVID-19 and self-report of lingering cognitive symptoms underwent outpatient in-person treatment. Mean age was 59.5 years (SD= 12.5) with 12% minority participation. Activities were rated on a scale of 0-10 regarding perceived cognitive effort, defined as recruitment of cognitive resources (memory, attention, planning) with increasing level of intensity. Higher ratings indicated higher level of cognitive exertion or acquisition perceived to complete a task. To assist with comprehension of cognitive effort, a 10-point version of the Borg scale was provided as a model before asking participants to rate tasks by perceived cognitive effort. This self-rating was repeated throughout the course of care.
Results:
Two phenomena were observed. Participants demonstrated improved tolerance for higher level CRPE without post-exertional malaise (PEM) post-treatment. Additionally, in some participants a reduction in cognitive exertion to complete the same activity was reported.
An example of each observation is below:
One participant began the course of care reporting pre-treatment activities above a CRPE of 5/10 resulted in PEM. By the final session, he reported completing tasks up to a CRPE of 10/10 without PEM.
Another participant rated reading at a CRPE of 8/10 to start. By the final session, CRPE for the same activity declined to 4/10.
Conclusions: Cognitive effort is a key aspect of cognitive rehabilitation to develop awareness of energy use based on stage of active recovery. Frequent PEM results from reduced knowledge of activity tolerance and how current function differs from pre-morbid capacity. A CRPE scale provides an opportunity to self-assess effort per task to reduce over-exertion. Outlining parameters for cognitive effort allowed participants to see a symptom reduction and increased capacity for cognitive activities.
