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Tsiakiri A, Christidi F, Tsiptsios D, Vlotinou P, Kitmeridou S, Bebeletsi P, Kokkotis C, Serdari A, Tsamakis K, Aggelousis N, Vadikolias K. Processing Speed and Attentional Shift/Mental Flexibility in Patients with Stroke: A Comprehensive Review on the Trail Making Test in Stroke Studies. Neurol Int 2024; 16:210-225. [PMID: 38392955 PMCID: PMC10893544 DOI: 10.3390/neurolint16010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
The Trail Making Test (TMT) is one of the most commonly administered tests in clinical and research neuropsychological settings. The two parts of the test (part A (TMT-A) and part B (TMT-B)) enable the evaluation of visuoperceptual tracking and processing speed (TMT-A), as well as divided attention, set-shifting and cognitive flexibility (TMT-B). The main cognitive processes that are assessed using TMT, i.e., processing speed, divided attention, and cognitive flexibility, are often affected in patients with stroke. Considering the wide use of TMT in research and clinical settings since its introduction in neuropsychological practice, the purpose of our review was to provide a comprehensive overview of the use of TMT in stroke patients. We present the most representative studies assessing processing speed and attentional shift/mental flexibility in stroke settings using TMT and applying scoring methods relying on conventional TMT scores (e.g., time-to-complete part A and part B), as well as derived measures (e.g., TMT-(B-A) difference score, TMT-(B/A) ratio score, errors in part A and part B). We summarize the cognitive processes commonly associated with TMT performance in stroke patients (e.g., executive functions), lesion characteristics and neuroanatomical underpinning of TMT performance post-stroke, the association between TMT performance and patients' instrumental activities of daily living, motor difficulties, speech difficulties, and mood statue, as well as their driving ability. We also highlight how TMT can serve as an objective marker of post-stroke cognitive recovery following the implementation of interventions. Our comprehensive review underscores that the TMT stands as an invaluable asset in the stroke assessment toolkit, contributing nuanced insights into diverse cognitive, functional, and emotional dimensions. As research progresses, continued exploration of the TMT potential across these domains is encouraged, fostering a deeper comprehension of post-stroke dynamics and enhancing patient-centered care across hospitals, rehabilitation centers, research institutions, and community health settings. Its integration into both research and clinical practice reaffirms TMT status as an indispensable instrument in stroke-related evaluations, enabling holistic insights that extend beyond traditional neurological assessments.
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Affiliation(s)
- Anna Tsiakiri
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Foteini Christidi
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Dimitrios Tsiptsios
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Pinelopi Vlotinou
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Sofia Kitmeridou
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Paschalina Bebeletsi
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 691 00 Komotini, Greece; (C.K.); (N.A.)
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece;
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK;
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 691 00 Komotini, Greece; (C.K.); (N.A.)
| | - Konstantinos Vadikolias
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
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Kristensen LQ, van Tulder MW, Rosenbæk F, Muren MA, Kristensen HK, Mokkink LB, Gregersen Oestergaard L. Measurement properties of performance-based instruments for assessing mental function during activity and participation in persons with stroke: A systematic review. Scand J Occup Ther 2023; 30:1489-1510. [PMID: 37725997 DOI: 10.1080/11038128.2023.2258161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Various performance-based instruments exist to assess mental function after stroke and users have to select one for research or clinical practice. OBJECTIVES To evaluate the measurement properties of performance-based instruments to assess (any aspect of) mental function during activity and participation in persons after stroke. MATERIAL AND METHODS We searched in five electronic databases. COSMIN methodology was used to conduct the review. The strength of evidence was assessed using a modified GRADE approach. RESULTS Fifty articles were included reporting on 20 instruments assessing (1) multiple mental functions including ≥ four subdomains (2) attention, memory and executive functions, or single subdomains (3) executive functions, (4) perception, and (5) mental function of language. Highest quality evidence for sufficient results was found for some measurement properties in seven instruments. These instruments included: FIM + FAM, MPAI-4 and EFPT, MET, CBS/KF-NAP, BIT and the Scenario Test. CONCLUSIONS Further studies of high methodological quality are needed that evaluate the measurement properties of instruments to allow clinicians and researchers to select the most suitable performance-based measures for purpose. SIGNIFICANCE Results may be used to select the most suitable performance-based instrument to measure mental function during activity and participation in persons with stroke. TRIAL REGISTRATION NUMBER PROSPERO CRD42018086744.
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Affiliation(s)
- Lola Qvist Kristensen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Maurits W van Tulder
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Human Movement Sciences and Amsterdam Movement Science Research Institute, Faculty Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Frederik Rosenbæk
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Marie Almkvist Muren
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Kaae Kristensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Health Sciences Research Center, University College Lillebaelt, Odense, Denmark
| | - Lidwine B Mokkink
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Asirvatham T. Letter to the Editor: Effects of Cognitive-Physical Dual-Task Training on Executive Function and Activity in the Prefrontal Cortex of Older Adults with Mild Cognitive Impairment. BRAIN & NEUROREHABILITATION 2023; 16:e5. [PMID: 37033008 PMCID: PMC10079480 DOI: 10.12786/bn.2023.16.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 04/05/2023] Open
Affiliation(s)
- Thajus Asirvatham
- Department of Occupational Therapy, Qatar Rehabilitation Institute, Hamad Medical Corporation, Doha, Qatar
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Park JH. Response to Letter to the Editor: Effects of Cognitive-Physical Dual-Task Training on Executive Function and Activity in the Prefrontal Cortex of Older Adults With Mild Cognitive Impairment. BRAIN & NEUROREHABILITATION 2023; 16:e6. [PMID: 37033006 PMCID: PMC10079473 DOI: 10.12786/bn.2023.16.e6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Affiliation(s)
- Jin-Hyuck Park
- Department of Occupational Therapy, Soonchunhyang University, Asan, Korea
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Lee H, Lee K, Lee S. Association of nursing hours with cognitive function, balance, and dependency level of stroke patients. Nurs Open 2022; 10:1735-1743. [PMID: 36303300 PMCID: PMC9912455 DOI: 10.1002/nop2.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/04/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS To examine the association of nursing hours given to patients with stroke with clinical characteristics to predict the nursing care needs. DESIGN Twenty-four-hour observational study METHODS: Nursing hours per patient day (NHPPD) of 171 stroke patients were measured by 146 nursing personnel who worked on the day of the observation. Cognitive function, balance ability and dependency level were assessed using the Korean version of the Mini-Mental State Examination (K-MMSE), the Korean version of the Berg Balance Scale (K-BBS) and the Korean version of the Modified Barthel Index (K-MBI), respectively. RESULTS The NHPPD were moderately correlated with K-MMSE (r = -.450), K-BBS (r = -.529) and K-MBI (r = -.549). The worse the cognitive function, balance ability and dependency level, the more were the nursing hours given to the patients. Therefore, these factors can be considered to be factors that predict nursing care needs for patients with stroke.
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Affiliation(s)
- Haneul Lee
- Department of Physical TherapyCollege of Health Science, Gachon UniversityIncheonSouth Korea
| | - Kyounga Lee
- Department of NursingCollege of Nursing, Gachon UniversityIncheonSouth Korea
| | - Seon‐Heui Lee
- Department of NursingCollege of Nursing, Gachon UniversityIncheonSouth Korea
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An HS, Kim DJ. Effects of activities of daily living-based dual-task training on upper extremity function, cognitive function, and quality of life in stroke patients. Osong Public Health Res Perspect 2021; 12:304-313. [PMID: 34719222 PMCID: PMC8561019 DOI: 10.24171/j.phrp.2021.0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/18/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives The aim of this study was to investigate the effect of daily living dual-task training focused on improving attention and executive function of the upper extremities, cognitive function, and quality of life in stroke patients. Methods We included 30 stroke patients who were hospitalized between July 2020 and October 2020. They were divided into experimental and control groups through randomization. The experimental group performed 20 minutes of dual-task training and received 10 minutes of conventional occupational therapy, while the control group performed 20 minutes of single-task training and received 10 minutes of conventional occupational therapy. Both groups underwent their respective rehabilitation for 30 minutes per session, 5 times per week for 5 weeks. Results Both groups showed significant improvements in upper extremity function, cognitive function, and quality of life; the experimental group showed higher results for all items. A significant between-group difference was observed in the magnitude of the changes. Conclusion In stroke patients, dual-task training that combined attention and executive function with daily living activities was found to be meaningful, as it encouraged active participation and motivation. This study is expected to be used as a foundation for future interventions for stroke patients.
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Affiliation(s)
- Hee-Su An
- Department of Occupational Therapy, Hana General Hospital, Cheongju, Korea
| | - Deok-Ju Kim
- Department of Occupational Therapy, College of Health and Medical Sciences, Cheongju University, Cheongju, Korea
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Conti J, Brucki SMD. Executive Function Performance Test: transcultural adaptation, evaluation of psychometric properties in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:767-774. [PMID: 30570021 DOI: 10.1590/0004-282x20180127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/20/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Executive dysfunction occurs in 18.5% to 39% of patients who present with cognitive impairment. Occupational therapy aims to facilitate independence and autonomy, hence improving quality of life. The Executive Function Performance Test - Brazilian version (EFPT-BR) has been developed to assess the need for assistance in performing four basic daily tasks. The aims of this research were: (1) to offer cross-cultural adaptation in patients with stroke; (2) to assess the psychometric properties of the Brazilian version of the EFPT-BR in patients with stroke; (3) to assess the relationship between scores on the EFPT-BR in patients with stroke, and demographic variables, stroke location, symptoms of anxiety and depression. METHODS The transcultural adaptation and validation were performed based on standard procedures, and psychometric properties were assessed in 86 Brazilian patients who suffered a stroke. RESULTS The test has shown a good internal consistency (Cronbach's alpha: 0.819). The ICC for intra-rater reliability was 0.435 and for the inter-rater was 0.732. Significant correlations between scores in the EFPT-BR and executive measures (verbal fluency test, clock drawing test, digit span - forwards and backwards, zoo map test and Six Elements Test) were observed. CONCLUSION The EFPT-BR is a valid and reliable tool for occupational therapists to assess executive dysfunction in daily routine tasks in patients with stroke in Brazil.
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Affiliation(s)
- Juliana Conti
- Universidade de São Paulo, Hospital das Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brasil
| | - Sonia Maria Dozzi Brucki
- Universidade de São Paulo, Hospital das Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brasil
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