Cognitive Rehabilitation Therapy: What It Is, What It Does, and Cognitive Rehabilitation Exercises You Can Try at Home

Written by Matt McMillen
Medically Reviewed by Shruthi N, MD on September 10, 2025
7 min read

Nonrelapsing secondary progressive multiple sclerosis (nrSPMS) comes with many challenges. One of the biggest can be its impact on your cognition, which includes your brain’s ability to think, learn, plan, and solve problems.

Issues with cognition include trouble remembering names, organizing your daily activities, paying bills, and even keeping up with your multiple sclerosis (MS) care, including taking medications and attending doctor appointments.

Cognitive rehabilitation therapy (CRT) can help. Think of it like physical therapy for your brain — you do mental exercises or practice activities that target the areas where you are having difficulty.

“The goals of it are to improve thinking skills and develop strategies that help you to work around any cognitive difficulties that you may have in order to improve your daily life,” says Karen Martinez, PhD, a staff neuropsychologist supporting the Mellen Program for MS at Cleveland Clinic Nevada in Las Vegas, Nevada.

Experts break CRT into two main categories: restorative and compensatory. Which type is good for you depends on your specific needs, but it’s likely you’ll need a mixture of both, Martinez says. Here’s what they involve:

Restorative cognitive rehab

Your nrSPMS can take away some of your brain function, causing cognition problems. Restorative cognitive rehab addresses those losses.

“It aims to strengthen and restore impaired cognitive function by exercising and training,” says Mirza Omari, MD, MPH, a neurologist at NYU Langone Health’s Multiple Sclerosis Comprehensive Care Center in New York City, New York.

This typically involves computer-based programs that boost your brain’s ability to adapt, change, and reorganize its structure and functions, Omari says.

“Our hope is that patients will get better and rewire their brain in a way that forges new neural pathways and allows them to learn new skills, even possibly recover function,” she says.

Examples of computer training include:

Jump the squares. On a computer screen, you follow a path from the first square to the last, moving forward, backward, and sideways according to specific rules. This helps build flexibility in your thinking by requiring you to shift your attention and limit behaviors that might throw you off the path.

Bottle caps. Numbered bottle caps move across your screen. Your task is to remove them in a specific sequence, such as from highest to lowest number, as fast as you can. This challenges your attention, your working memory, and your brain’s processing speed, Omari says.

Such exercises not only retrain your brain. They also inform you of your capacity for things such as paying attention, says Amy Gutierrez, MD, a neurologist with the Orlando Health Neuroscience Institute Neurology Group in Orlando, Florida. Knowing your limits allows you to function effectively within them.

“We help the patient know that, 'hey, I'm really good at concentrating for, say, 15 minutes, and if I exceed that, I’ll become fatigued or unable to continue concentrating on that task,'” Gutierrez says.

Compensatory cognitive rehab

This type of CRT helps you manage daily activities that you may have begun to struggle with, such as planning, organizing, and staying on task.

“Compensatory cognitive rehab focuses on teaching strategies and using tools to help patients cope with their cognitive impairments,” Omari says. “It’s very practical, like using to-do lists and other organizational techniques to manage your day-to-day [activities].”

Another strategy is setting aside a quiet area for focusing on certain tasks, such as making lists, paying bills, or other things that require concentration, Martinez says. “Having a set place to work on specific tasks will cue your brain, telling you this is the place that I really focus and work on my paperwork,” she says.

Compensatory cognitive rehab also helps with:

  • Planning, through the use of calendars — either a physical one placed where you’ll see it every day or a computer-based calendar synced to your phone.
  • Avoiding distractions, such as putting your phone out of reach, turning off the TV or music, and cutting down on anything else that makes it hard to focus.
  • Focusing on one thing at a time, as multitasking can be quite mentally difficult.
  • Making lists and setting reminders so you can better keep track of things you need to do.
  • Scheduling breaks to recharge and to avoid overtaxing yourself.

Several types of specialists get involved in CRT, including speech therapists, occupational therapists, and neuropsychologists, Gutierrez says. You may work with all three, depending on your needs.

Those needs are decided at your checkups, when you have an opportunity to bring up any cognitive issues you've noticed.  Your doctor will also regularly examine you to confirm your cognitive abilities by asking you questions and ordering tests that can spot difficulties you may not have noticed.

For example, Gutierrez uses the symbol digit modalities test with her patients every six months. This tool measures your brain’s processing speed, working memory, and attention. It takes less than five minutes.

“If it picks up anything, we discuss it and what can be done,” Gutierrez says.

According to Omari, CRT should be considered at the time of your diagnosis. One reason — adjusting to this new diagnosis can be overwhelming and trigger cognitive changes, she says.

“At first, they may not be due to the MS itself,” Omari says. “For that reason, I try to integrate this multidisciplinary approach into the treatment plan very early on.” 

Program length

CRT programs typically involve hour-long sessions once or twice a week for a period ranging from 6 to 16 weeks. These can be either one-on-one or group sessions,  Martinez says. The length of your program depends on your specific needs and how many sessions your health insurance will cover.

Along with your sessions, you’ll have homework.

“The expectation is that outside of those clinic sessions, you're practicing the exercises or compensatory strategies at home as well,” Martinez says.

To find cognitive rehabilitation therapy options, start with the doctor who’s managing your MS care, Martinez says.

“Your provider will need to put in a referral to the specialist who can work with you on the cognitive therapy,” she says.

You can also get help finding a therapist through the National Multiple Sclerosis Society.

While insurance typically covers CRT, barriers do exist. You may not live near a center that provides such therapy. Or getting to your sessions may be a burden, either financially or due to MS symptoms such as fatigue. Fortunately, telehealth and home-based programs are becoming more common, Martinez says, thanks in large part to the COVID-19 pandemic.

The impact of nrSPMS varies from person to person, so your results with CRT will be unique. There’s not a lot of research on CRT for people with MS, so experts are not yet certain what works best and what does not work. However, you should expect at least some modest gains in the areas your CRT targets, Martinez says, which can include memory or your brain’s processing speed.

In Omari’s experience, CRT has been very beneficial for her patients.

“The feedback that we get is that it makes a major difference,” she says.

Your CRT therapist will determine specific exercises best suited for you. The following are examples of safe and helpful exercises you can do at home.

Make connections. If you have trouble remembering names, try this:  When you meet someone, note their name as well as some identifying features you can connect to them, such as their hair color. “The more connections that you can make, the stronger those associations can be made within our brain to help you remember a name,” Martinez says.

Practice mindfulness and relaxation exercises. Mindfulness meditation, which grounds you in the present moment, as well as deep breathing, guided imagery, and other relaxation techniques, are very helpful, Omari says. “They support attention and executive function by reducing stress,” she says.

Get regular exercise. Physical exercise is a critical part of your cognitive health, Gutierrez says. “You want to get your heart rate up and increase your blood flow, which is very important to your brain,” she says. 

Ask your doctor what exercises are safe and effective for you. Chair exercises can be great options for those with mobility challenges, Gutierrez says.

Keep your brain active. You can exercise your brain in many ways, based on your own interests. Engage your brain in artistic activities such as creative writing, drawing, and painting. You can also stimulate your brain by learning a new language or how to play a musical instrument.

Problems with your memory, attention, and other types of cognition can be frustrating. Sometimes, they may affect your safety and should be addressed with your doctor right away. According to both Gutierrez and Martinez, trouble managing your self-care is another area of concern that calls for reaching out to your doctor.

“You could have trouble managing medications where you’re making mistakes, such as taking them twice because you forgot you already took them,” says Martinez.

Other red flags include missing appointments or showing up early or late to appointments, Gutierrez says.

“That can be due to increasing confusion,” she says.

If you or someone close to you notices signs such as this, call your doctor. Your MS will change over time, and you may benefit from an adjustment to your cognitive rehab therapy, such as new exercises or strategies.