Defining Cognitive Effort and Energy Expenditure in an Outpatient Speech Therapy Setting

Research Objectives: 1. To define cognitive effort as a separate measure from fatigue.
2. To modify an existing scale for rate of perceived exertion for physical activity (Borg RPE) to define and track cognitive effort.

Design: Descriptive/exploratory study

Setting: Treatment occurred in-person in an outpatient therapy setting.

Participants: 39 participants with a history of Covid-19 and residual cognitive symptoms were included. The mean age was 54.5 years.

Interventions: Cognitive effort was defined as engagement of cognitive resources (memory, attention, planning) with increasing level of intensity or strain. Rating ranged from 0/no cognitive effort to 10/maximal cognitive effort required to complete a task. A sample of this scale compared to the physical RPE scale was provided for context. Participants selected tasks and identified an RPE from 0-10. This was completed throughout the course of care.

Main Outcome Measures: Reported change on the Cognitive RPE (CRPE) rating scale

Results: Participants demonstrated improved tolerance for higher level CRPE with reduced post-exertional malaise (PEM) post-treatment. For example, a participant began course of care experiencing PEM at CRPE of 5/10, increasing to no PEM at CRPE 10/10.

Conclusions: Self-rating of cognitive effort is necessary to increase awareness of task exertion and set appropriate boundaries of energy expenditure threshold throughout the recovery process. Many expect cognitive activities to require the same effort as their pre-morbid level, leading to frequent over-exertion and symptom exacerbation. By creating a numerical representation of effort level, participants can identify when effort level may be elevated and reduce attempts at over-exertion. This allows objective tracking of cognitive load throughout treatment, as effort requirement for frequent tasks declines.

Author(s) Disclosures: The authors declare that they have no competing interests. This study is supported by the National Institutes of Health under grant R01-HD108312-01A1.