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Akinci M, Burak M, Kasal FZ, Özaslan EA, Huri M, Kurtaran ZA. The Effects of Combined Virtual Reality Exercises and Robot Assisted Gait Training on Cognitive Functions, Daily Living Activities, and Quality of Life in High Functioning Individuals With Subacute Stroke. Percept Mot Skills 2024; 131:756-769. [PMID: 38418444 DOI: 10.1177/00315125241235420] [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] [Indexed: 03/01/2024]
Abstract
Stroke is a global health concern causing significant mortality. Survivors face physical, cognitive, and emotional challenges, affecting their life satisfaction and social participation. Robot-assisted gait training with virtual reality, like Lokomat, is a promising rehabilitation tool. We investigated its impact on cognitive status, activities of daily living, and quality of life in individuals with stroke. Between September 2022 and August 2023, we exposed 34 first stroke patients (8 women, 26 men; M age = 59.15, SD = 11.09; M height = 170.47, SD = 8.13 cm; M weight = 75.97; SD = 10.87 kg; M days since stroke = 70.44, SD = 33.65) in the subacute stage (3-6 months post-stroke) to Lokomat exercise. Participant exclusion criteria were Lokamat exercise inability, disabilities incompatible with intended measurements, and any cognitive limitations. The Control Group (CG) received conventional physiotherapy, while the Lokomat Group (LG) received both conventional physiotherapy and robot-assisted gait training with virtual reality, administered by an occupational therapist. Evaluations were conducted by a physiotherapist who was unaware of the participants' group assignments and included assessments with the Montreal Cognitive Assessment, Lawton Brody Instrumental Activities of Daily Living Scale, and Stroke Specific Quality of Life Scale (SS-QoL). Both groups demonstrated an improved quality of life, but the LG outperformed the CG with regard to SS-QoL (p = .01) on measures of Energy (p = .002) and Mobility (p = .005). Both groups showed improvements in cognitive functioning (p < .001) with no between-group difference, and in activities of daily living (p < .05) for which the LG was superior to the CG (p = .023). Thus, adding robot-assisted gait training with Lokomat and virtual reality improved self-reported quality of life and daily activities at levels beyond conventional physiotherapy for patients in the subacute stroke phase. An incremental impact on cognitive functions was not evident, possibly due to rapid cognitive recovery or this was undetected by limited cognitive testing.
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Affiliation(s)
- Murat Akinci
- Department of Physical Therapy and Rehabilitation, Ankara City Hospital, Ankara, Turkey
| | - Mustafa Burak
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Firat University, Elazığ, Turkey
| | | | - Ezgi Aydın Özaslan
- Department of Physical Therapy and Rehabilitation, Ankara City Hospital, Ankara, Turkey
| | - Meral Huri
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Zeynep Aydan Kurtaran
- Department of Physical Therapy and Rehabilitation, Ankara City Hospital, Ankara, Turkey
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Chen Y, Zhao Z, Huang J, Wang T, Qu Y. Computer-aided cognitive training combined with tDCS can improve post-stroke cognitive impairment and cerebral vasomotor function: a randomized controlled trial. BMC Neurol 2024; 24:132. [PMID: 38641827 PMCID: PMC11027365 DOI: 10.1186/s12883-024-03613-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/26/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Post-stroke cognitive impairment (PSCI) is the focus and difficulty of poststroke rehabilitation intervention with an incidence of up to 61%, which may be related to the deterioration of cerebrovascular function. Computer-aided cognitive training (CACT) can improve cognitive function through scientific training targeting activated brain regions, becoming a popular training method in recent years. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, can regulate the cerebral vascular nerve function, and has an effect on the rehabilitation of cognitive dysfunction after stroke. This study examined the effectiveness of both CACT and tDCS on cognitive and cerebrovascular function after stroke, and explored whether CACT combined with tDCS was more effective. METHODS A total of 72 patients with PSCI were randomly divided into the conventional cognitive training (CCT) group (n = 18), tDCS group (n = 18), CACT group (n = 18), and CACT combined with tDCS group (n = 18). Patients in each group received corresponding 20-minute treatment 15 times a week for 3 consecutive weeks. Montreal Cognitive Assessment (MoCA) and the Instrumental Activities of Daily Living Scale (IADL) were used to assess patients' cognitive function and the activities of daily living ability. Transcranial Doppler ultrasound (TCD) was used to assess cerebrovascular function, including cerebral blood flow velocity (CBFV), pulse index (PI), and breath holding index (BHI). These outcome measures were measured before and after treatment. RESULTS Compared with those at baseline, both the MoCA and IADL scores significantly increased after treatment (P < 0.01) in each group. There was no significantly difference in efficacy among CCT, CACT and tDCS groups. The CACT combined with tDCS group showed greater improvement in MoCA scores compared with the other three groups (P < 0.05), especially in the terms of visuospatial and executive. BHI significantly improved only in CACT combined with tDCS group after treatment (p ≤ 0.05) but not in the other groups. Besides, no significant difference in CBFV or PI was found before and after the treatments in all groups. CONCLUSION Both CACT and tDCS could be used as an alternative to CCT therapy to improve cognitive function and activities of daily living ability after stroke. CACT combined with tDCS may be more effective improving cognitive function and activities of daily living ability in PSCI patients, especially visuospatial and executive abilities, which may be related to improved cerebral vasomotor function reflected by the BHI. TRIAL REGISTRATION NUMBER The study was registered in the Chinese Registry of Clinical Trials (ChiCTR2100054063). Registration date: 12/08/2021.
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Affiliation(s)
- Yin Chen
- Department of Rehabilitation MedicineInstitute/University/Hospita, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Ziqi Zhao
- Department of Rehabilitation MedicineInstitute/University/Hospita, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jiapeng Huang
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Tingting Wang
- Department of Rehabilitation MedicineInstitute/University/Hospita, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yun Qu
- Department of Rehabilitation MedicineInstitute/University/Hospita, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China.
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China.
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, Sichuan, 610041, China.
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Kleih SC, Botrel L. Inconclusive results of slow cortical potential neurofeedback for the treatment of chronic post-stroke attention deficits. Front Hum Neurosci 2024; 18:1301622. [PMID: 38646162 PMCID: PMC11026669 DOI: 10.3389/fnhum.2024.1301622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/06/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Individuals who have suffered a stroke may experience long-lasting cognitive impairments that can worsen if left untreated. We investigated whether voluntary control of slow cortical potentials (SCP) through neurofeedback would help alleviate chronic post-stroke symptoms of impaired attention. Methods The study initially enrolled twenty-eight participants, but due to a high drop-out rate, only sixteen participants completed eight SCP neurofeedback training sessions within three to four weeks. During these sessions, we gave feedback to the participants on their ability to regulate SCPs on a computer screen. Results Our findings showed a non-significant increase in SCP regulation towards cortical negativity. On the behavioral level, we found improved test values in the divided attention and attentional flexibility subtests of the test battery for attention performance. However, we cannot eliminate the possibility that nonspecific effects influenced or caused our results. We have not observed any improvement regarding the effects of attention deficits on participants' daily lives. We identified five individuals who could gain SCP control successfully and consistently towards negativity. In this group of responders, we observed an improvement in the test results related to divided attention but no other attention-related improvements. Discussion Based on our observations, results of SCP neurofeedback training for the treatment of attention deficits after a stroke are inconclusive. More research is necessary to determine the effectiveness of SCP neurofeedback in helping stroke survivors cope with attention-related challenges in their daily lives.
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Affiliation(s)
- Sonja C Kleih
- Institute of Psychology, Biological Psychology Clinical Psychology and Psychotherapy, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Loic Botrel
- Institute of Psychology, Biological Psychology Clinical Psychology and Psychotherapy, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
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Hong R, Li B, Bao Y, Liu L, Jin L. Therapeutic robots for post-stroke rehabilitation. MEDICAL REVIEW (2021) 2024; 4:55-67. [PMID: 38515779 PMCID: PMC10954296 DOI: 10.1515/mr-2023-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/25/2024] [Indexed: 03/23/2024]
Abstract
Stroke is a prevalent, severe, and disabling health-care issue on a global scale, inevitably leading to motor and cognitive deficits. It has become one of the most significant challenges in China, resulting in substantial social and economic burdens. In addition to the medication and surgical interventions during the acute phase, rehabilitation treatment plays a crucial role in stroke care. Robotic technology takes distinct advantages over traditional physical therapy, occupational therapy, and speech therapy, and is increasingly gaining popularity in post-stroke rehabilitation. The use of rehabilitation robots not only alleviates the workload of healthcare professionals but also enhances the prognosis for specific stroke patients. This review presents a concise overview of the application of therapeutic robots in post-stroke rehabilitation, with particular emphasis on the recovery of motor and cognitive function.
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Affiliation(s)
- Ronghua Hong
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bingyu Li
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yunjun Bao
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Lingyu Liu
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Lingjing Jin
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Collaborative Innovation Center for Brain Science, Tongji University, Shanghai, China
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Chan ATC, Ip RTF, Tran JYS, Chan JYC, Tsoi KKF. Computerized cognitive training for memory functions in mild cognitive impairment or dementia: a systematic review and meta-analysis. NPJ Digit Med 2024; 7:1. [PMID: 38172429 PMCID: PMC10764827 DOI: 10.1038/s41746-023-00987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Dementia is a common medical condition in the ageing population, and cognitive intervention is a non-pharmacologic strategy to improve cognitive functions. This meta-analysis evaluated the benefits of computerized cognitive training (CCT) on memory functions in individuals with MCI or dementia. The study was registered prospectively with PROSPERO under CRD42022363715 and received no funding. The search was conducted on MEDLINE, Embase, and PsycINFO on Sept 19, 2022, and Google Scholar on May 9, 2023, to identify randomized controlled trials that examined the effects of CCT on memory outcomes in individuals with MCI or dementia. Mean differences and standard deviations of neuropsychological assessment scores were extracted to derive standardized mean differences. Our search identified 10,678 studies, of which 35 studies were included. Among 1489 participants with MCI, CCT showed improvements in verbal memory (SMD (95%CI) = 0.55 (0.35-0.74)), visual memory (0.36 (0.12-0.60)), and working memory (0.37 (0.10-0.64)). Supervised CCT showed improvements in verbal memory (0.72 (0.45-0.98)), visual memory (0.51 (0.22-0.79)), and working memory (0.33 (0.01-0.66)). Unsupervised CCT showed improvement in verbal memory (0.21 (0.04-0.38)) only. Among 371 participants with dementia, CCT showed improvement in verbal memory (0.64 (0.02-1.27)) only. Inconsistency due to heterogeneity (as indicated by I2 values) is observed, which reduces our confidence in MCI outcomes to a moderate level and dementia outcomes to a low level. The results suggest that CCT is efficacious on various memory domains in individuals with MCI. Although the supervised approach showed greater effects, the unsupervised approach can improve verbal memory while allowing users to receive CCT at home without engaging as many healthcare resources.
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Affiliation(s)
- Aaron T C Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Roy T F Ip
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Joshua Y S Tran
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce Y C Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin K F Tsoi
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, China.
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Maggio MG, Billeri L, Cardile D, Quartarone A, Calabrò RS. The Role of Innovation Technology in the Rehabilitation of Patients Affected by Huntington's Disease: A Scoping Review. Biomedicines 2023; 12:39. [PMID: 38255146 PMCID: PMC10813604 DOI: 10.3390/biomedicines12010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Huntington's disease is an autosomal dominant neurodegenerative disease caused by the repetition of cytosine, adenine, and guanine trinucleotides on the short arm of chromosome 4p16.3 within the Huntingtin gene. In this study, we aim to examine and map the existing evidence on the use of innovations in the rehabilitation of Huntington's disease. A scoping review was conducted on innovative rehabilitative treatments performed on patients with Huntington's disease. A search was performed on PubMed, Embase, Web of Science, and Cochrane databases to screen references of included studies and review articles for additional citations. Of an initial 1117 articles, only 20 met the search criteria. These findings showed that available evidence is still limited and that studies generally had small sample sizes and a high risk of bias. Regarding cognitive rehabilitation, it has emerged that VR- and PC-based methods as well as NIBS techniques are feasible and may have promising effects in individuals with Huntington's disease. On the other hand, scarce evidence was found for cognitive and motor training that might have a slight impact on overall cognitive function in individuals with Huntington's disease. Data show that further investigation is needed to explore the effects of innovative rehabilitation tools on cognition, especially considering that cognitive and psychiatric symptoms can precede the onset of motor symptoms by many years.
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Affiliation(s)
| | | | - Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy; (M.G.M.); (L.B.)
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Maggio MG, De Bartolo D, Calabrò RS, Ciancarelli I, Cerasa A, Tonin P, Di Iulio F, Paolucci S, Antonucci G, Morone G, Iosa M. Computer-assisted cognitive rehabilitation in neurological patients: state-of-art and future perspectives. Front Neurol 2023; 14:1255319. [PMID: 37854065 PMCID: PMC10580980 DOI: 10.3389/fneur.2023.1255319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/31/2023] [Indexed: 10/20/2023] Open
Abstract
Background and aim Advances in computing technology enabled researchers and clinicians to exploit technological devices for cognitive training and rehabilitation interventions. This expert review aims to describe the available software and device used for cognitive training or rehabilitation interventions of patients with neurological disorders. Methods A scoping review was carried out to analyze commercial devices/software for computerized cognitive training (CCT) in terms of feasibility and efficacy in both clinical and home settings. Several cognitive domains responding to the different patients' needs are covered. Results This review showed that cognitive training for patients with neurological diseases is largely covered by several devices that are widely used and validated in the hospital setting but with few translations to remote/home applications. It has been demonstrated that technology and software-based devices are potential and valuable tools to administer remotely cognitive rehabilitation with accessible costs. Conclusion According to our results, CCT entails the possibility to continue cognitive training also in different settings, such as home, which is a significant breakthrough for the improvement of community care. Other possible areas of use should be the increase in the amount of cognitive therapy in the free time during the hospital stay.
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Affiliation(s)
| | - Daniela De Bartolo
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences & Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Antonio Cerasa
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, Messina, Italy
- S’Anna Institute, Crotone, Italy
- Pharmaco Technology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Rende, Italy
| | | | | | | | | | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, Italy
| | - Marco Iosa
- IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
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Dong Q, Yang Y, Tang Q, Yang M, Lan A, Xiao H, Wei J, Cao X, Xian Y, Yang Q, Chen D, Zhao J, Li S. Effects of early cognitive rehabilitation training on cognitive function and quality of life in critically ill patients with cognitive impairment: A randomised controlled trial. Aust Crit Care 2023; 36:708-715. [PMID: 36470777 DOI: 10.1016/j.aucc.2022.10.015] [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: 07/24/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Patients often develop cognitive dysfunction during admission to the ICU and after being transferred out of the ICU, which leads to physical disorders, sleep disorders, and psychological stress.Cognitive rehabilitation training can significantly improve patients' planning, decision-making ability, and executive function. OBJECTIVE The aim of this study was to explore the role of early cognitive rehabilitation training in improving cognitive impairment in critically ill patients. METHODS This study was a prospective, randomised, controlled clinical trial conducted from January 2017 to June 2021. Critically ill patients with cognitive impairment admitted to the Department of Intensive Care Medicine of The Third Hospital of Mianyang were randomly divided into the control (n = 68) and intervention groups (n = 68). Cognitive rehabilitation training (including digital operating system training, music therapy, aerobic training, and mental health intervention) was applied to the patients in the intervention group for 6 months, while the control group did not receive any cognitive intervention. Before 3 and 6 months after enrolment, the Montreal Cognitive Assessment and the 36-Item Short Form Health Survey Scale were used to evaluate cognitive function and quality of life, respectively, in both groups. RESULTS A total of 136 critical patients were included in the final analysis. There were no significant differences in sex, age, years of education, complications, intensive care unit hospitalisation time, mechanical ventilation time, or the total score of the Montreal Cognitive Assessment scale when transferred out of the intensive care unit in 24 hours between the two groups. Six months later, the results of the follow-up showed that the cognitive function score in the intervention group was significantly higher than that in the control group (26.69 ± 2.49 vs. 23.03 ± 3.79). The analysis of quality of life showed that the scores in all areas in the intervention group improved. There were significant differences in physical functioning (69.02 ± 8.14 vs. 63.38 ± 11.94), role physical (62.02 ± 12.18 vs. 58.09 ± 8.83), general health (46.00 ± 15.21 vs. 40.38 ± 13.77), vitality (61.00 ± 11.01 vs. 54.38 ± 13.80), social functioning (70.00 ± 10.29 vs. 64.41 ± 13.61), role emotional (78.00 ± 8.00 vs. 72.15 ± 12.18), and mental health (71.00 ± 12.33 vs. 55.37 ± 10.76) between the two groups (P < 0.05). CONCLUSION Early cognitive rehabilitation training can improve cognitive impairment in critically ill patients and their quality of life.
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Affiliation(s)
- Qionglan Dong
- Department of Critical Care Medicine, Southwest Medical University, LuZhou, Sichuan Province, 646000, China; Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China.
| | - Yuxin Yang
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Qibing Tang
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Mei Yang
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - An Lan
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Hongjun Xiao
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Jiaxun Wei
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Xiaofang Cao
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Yao Xian
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Qi Yang
- Department of Rehabilitation Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Dongmei Chen
- Department of Rehabilitation Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Jun Zhao
- Department of Psychiatry, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Shiyi Li
- Department of Psychiatry, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
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Bonnechère B, Klass M. Cognitive Computerized Training for Older Adults and Patients with Neurological Disorders: Do the Amount and Training Modality Count? An Umbrella Meta-Regression Analysis. Games Health J 2023; 12:100-117. [PMID: 36920851 DOI: 10.1089/g4h.2022.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Numerous applications have been created to train cognition and challenge the brain, a process known as computerized cognitive training (CCT). Despite potential positive results, important questions remain unresolved: the appropriate training duration, the efficacy of CCT depending on its type (commercial or developed in-house for the rehabilitation of specific patients) and delivery mode (at-home or on-site), and the patients most likely to benefit such intervention. This study aims to perform an umbrella meta-analysis and meta-regression to determine if the type of CCT, the delivery mode, the amount of training, and participants' age at inclusion influence the improvement of the cognitive function. To do so, we performed a umbrella meta-analysis. One hundred studies were included in this analysis representing 6407 participants. Statistical improvements were found for the different conditions after the training. We do not find statistical difference between the type of intervention or the delivery mode. No dose-response relationship between the total amount of training and the improvement of cognitive functions was found. CCT is effective in improving cognitive function in patients suffering from neurological conditions and in healthy aging. There is therefore an urgent need for health care systems to recognize its therapeutic potential and to evaluate at a larger scale their integration into the clinical pipeline as preventive and rehabilitation tool.
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Affiliation(s)
- Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.,Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, Diepenbeek, Belgium
| | - Malgorzata Klass
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute (UNI), Université Libre de Bruxelles (ULB), Brussels, Belgium
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Amiri S, Hassani-Abharian P, Vaseghi S, Kazemi R, Nasehi M. Effect of RehaCom cognitive rehabilitation software on working memory and processing speed in chronic ischemic stroke patients. Assist Technol 2023; 35:41-47. [PMID: 34033513 DOI: 10.1080/10400435.2021.1934608] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Stroke survivors need assistance to overcome cognitive impairments. Working memory (WM) and processing speed (PS) as two critical cognitive functions are disrupted by stroke. The goal of this study was to investigate the effect of RehaCom rehabilitation software on WM and PS in participants with chronic ischemic stroke with hemiplegia (right/left side). Participants were selected among stroke patients who were referred to our special rehabilitation clinic. Fifty participants were assigned to control (n = 25) and experimental (n = 25) groups. The results of the experimental group were compared with the control group before and after the treatment with RehaCom (ten 45-min sessions across five weeks, two sessions per week). The results showed a significant improvement in WM and PS in the experimental group in comparison with the control group after a 5-week training with RehaCom. In conclusion, our findings indicate that treatment with RehaCom software improves WM and PS in chronic ischemic stroke participants with hemiplegia. The exact mechanism of RehaCom is largely unknown and further studies are needed, but its effects on the function of brain regions involved in modulating cognitive functions such as the prefrontal cortex, cingulate cortex, and parietal cortex may be mechanisms of interest.
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Affiliation(s)
- Sanaz Amiri
- Department of Psychology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Peyman Hassani-Abharian
- Department of Cognitive Neuroscience, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Salar Vaseghi
- Department of Cognitive Neuroscience, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
- Cognitive and Neuroscience Research Center (CNRC), Amir-Almomenin Hospital, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Rouzbeh Kazemi
- TABASOM Rehabilitation Center for Stroke Patients, Tehran, Iran
| | - Mohammad Nasehi
- Cognitive and Neuroscience Research Center (CNRC), Amir-Almomenin Hospital, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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Oliveri M, Bagnato S, Rizzo S, Imbornone E, Giustiniani A, Catania A, Turriziani P. A novel digital approach for post-stroke cognitive deficits: a pilot study. Restor Neurol Neurosci 2023; 41:103-113. [PMID: 37522228 DOI: 10.3233/rnn-231305] [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] [Indexed: 08/01/2023]
Abstract
BACKGROUND Cognitive dysfunctions after a brain stroke have a huge impact on patients' disability and activities of daily living. Prism adaptation (PA) is currently used in patients with right brain damage to improve lateralized spatial attentional deficits. Recent findings suggest that PA could also be useful for rehabilitation of other cognitive functions. OBJECTIVE In the present study, we tested for the efficacy on cognitive rehabilitation of a novel device in which the procedure of prism adaptation is digitized and followed by cognitive training of attention and executive functions using serious games. METHODS Thirty stroke patients were randomly assigned to two groups: an experimental group of 15 patients, which performed the experimental rehabilitation training using the novel device in 10 consecutive daily sessions; a control group of 15 patients, which performed the routine cognitive training in 10 consecutive daily sessions. Both groups were tested before and after the rehabilitation program on neuropsychological tests (digit and spatial span forward and backward, attentional matrices, Stroop task) and on functional scales (Barthel index and Beck Anxiety Index). RESULTS The main results showed that only patients who received the experimental rehabilitation training improved their scores on tests of digit span forward, spatial span backward, attentional matrices and Stroop. Moreover, patients of the experimental but not of the control group showed a significant correlation between improvement on some tasks (mainly spatial span backward) and improvement on activities of daily living as well as with reduction of anxiety levels. CONCLUSIONS These results suggest that combining digital PA with cognitive training using serious games may be added in clinical settings for cognitive rehabilitation of stroke patients, with beneficial effects extending in promoting independency in activities of daily living and reduction of psychiatric symptoms.
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Affiliation(s)
- Massimiliano Oliveri
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Sergio Bagnato
- Rehabilitation Department, Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation, Cefalù, Italy
| | - Silvia Rizzo
- Rehabilitation Department, Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation, Cefalù, Italy
| | - Emilia Imbornone
- Rehabilitation Department, Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation, Cefalù, Italy
| | | | - Angela Catania
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
- Laboratory of Neuropsychology, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
- International School of Advanced Studies, University of Camerino, Camerino, Italy
| | - Patrizia Turriziani
- Laboratory of Neuropsychology, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
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Maggio MG, Stagnitti MC, Rizzo E, Andaloro A, Manuli A, Bruschetta A, Naro A, Calabrò RS. Limb apraxia in individuals with multiple sclerosis: Is there a role of semi-immersive virtual reality in treating the Cinderella of neuropsychology? Mult Scler Relat Disord 2023; 69:104405. [PMID: 36417812 DOI: 10.1016/j.msard.2022.104405] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Limb apraxia is an acquired cognitive-motor disorder characterized by spatial and temporal disorganization of limb movements, negatively affecting the quality of life of patients, including those with multiple sclerosis (MS). Although recent studies have shown the potential role of VR in increasing cognitive and motor functions, only a few studies have been carried out on the rehabilitation of upper limb apraxia. Hence, our study aims to evaluate the potential efficacy of VR training to improve upper limb ideomotor apraxia in patients with MS. METHODS One hundred and six patients, affected by secondary progressive MS, who attended our Robotic and Behavioral Neurorehabilitation Service from March 2019 to February 2020, were enrolled in this study and randomly divided into two groups: the control group (CG: 53 patients) performed traditional therapy whereas the experimental group (EG:53 patients) received training using semi-immersive VR. All patients underwent the same amount of cognitive training, 3 times a week for 8 weeks. They were submitted to a specific neuropsychological assessment before (T0) and after the rehabilitation treatment (T1). RESULTS The VR training led to a significant improvement in global cognitive functions, with regard to constructive and ideomotor apraxia. On the contrary, the CG achieved significant improvements only in ideomotor apraxia. Moreover, only in the EG, we observed an improvement in the mood at the end of training. CONCLUSION The present study demonstrates that VR rehabilitation can be an effective tool for the treatment of apraxia, which is a neuropsychological problem often underestimated in MS patients. Further studies with long-term follow-up periods are needed to confirm the effect of this promising approach.
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Affiliation(s)
- Maria Grazia Maggio
- University of Catania, Department of Biomedical and Biotechnological Science, Via S. Sofia, 64, 95125 Catania (CT), Italy
| | - Maria Chiara Stagnitti
- Studio di Psicoterapia Relazionale e Riabilitazione Cognitiva, viale Europa, 107, 98121, Messina (ME), Italy
| | - Erika Rizzo
- I.O.M.I. "Franco Scalabrino", Via Consolare Pompea, 360, 98165 Ganzirri, Messina (ME), Italy
| | - Adriana Andaloro
- Studio di Riabilitazione Nutrizionale e Cognitiva, Via Sant'Agostino, 14, 98122, Messina (ME), Italy
| | - Alfredo Manuli
- Azienda Ospedaliera Universitaria di Messina "G. Martino", Via Consolare Valeria, 98125, Messina (ME), Italy
| | - Antongiulio Bruschetta
- Azienda Ospedaliera Universitaria di Messina "G. Martino", Via Consolare Valeria, 98125, Messina (ME), Italy
| | - Antonino Naro
- Azienda Ospedaliera Universitaria di Messina "G. Martino", Via Consolare Valeria, 98125, Messina (ME), Italy
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Fava-Felix PE, Bonome-Vanzelli SRC, Ribeiro FS, Santos FH. Systematic review on post-stroke computerized cognitive training: Unveiling the impact of confounding factors. Front Psychol 2022; 13:985438. [PMID: 36578681 PMCID: PMC9792177 DOI: 10.3389/fpsyg.2022.985438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
Background Stroke is a highly incapacitating disease that can lead to disabilities due to cognitive impairment, physical, emotional, and social sequelae, and a decrease in the quality of life of those affected. Moreover, it has been suggested that cognitive reserve (patients' higher levels of education or having a skilled occupation), for instance, can promote faster cognitive recovery after a stroke. For this reason, this review aims to identify the cognitive, functional, and behavioral effects of computerized rehabilitation in patients aged 50 years or older who had a stroke, considering cognitive reserve proxies. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-PRISMA, and performed the search for peer-reviewed randomized controlled trials without a date restriction on CINAHL, LILACS, PubMed, Scopus, and Web of Science databases were chosen. Results We screened 780 papers and found 19 intervention studies, but only 4 met the inclusion criteria and shared data. These studies included computerized tools for motor and cognitive rehabilitation in the experimental groups. In all studies, computerized training was combined with other interventions, such as standard therapy, occupational therapy, and aerobic exercises. There were 104 participants affected by ischemic or hemorrhagic stroke, predominantly male (57.69%), and all with cognitive impairment. Conclusion Despite a limited number of studies, varied methods and insufficient information available, schooling as a CR proxy combined with high-intensity computerized cognitive training was key to mediating cognitive improvement. The systematic review also identified that the associated ischemic stroke and shorter time of onset for rehabilitation contribute to the cognitive evolution of patients. Findings do not support a greater benefit of computerized cognitive training compared to conventional cognitive therapies. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296193], identifier [CRD42022296193].
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Affiliation(s)
| | | | - Fabiana S. Ribeiro
- Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Flávia H. Santos
- School of Psychology, University College Dublin, Dublin, Ireland
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Neurorehabilitation in Multiple Sclerosis-A Review of Present Approaches and Future Considerations. J Clin Med 2022; 11:jcm11237003. [PMID: 36498578 PMCID: PMC9739865 DOI: 10.3390/jcm11237003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Multiple sclerosis is an increasingly prevalent disease, representing the leading cause of non-traumatic neurological disease in Europe and North America. The most common symptoms include gait deficits, balance and coordination impairments, fatigue, spasticity, dysphagia and an overactive bladder. Neurorehabilitation therapeutic approaches aim to alleviate symptoms and improve the quality of life through promoting positive immunological transformations and neuroplasticity. The purpose of this study is to evaluate the current treatments for the most debilitating symptoms in multiple sclerosis, identify areas for future improvement, and provide a reference guide for practitioners in the field. It analyzes the most cited procedures currently in use for the management of a number of symptoms affecting the majority of patients with multiple sclerosis, from different training routines to cognitive rehabilitation and therapies using physical agents, such as electrostimulation, hydrotherapy, cryotherapy and electromagnetic fields. Furthermore, it investigates the quality of evidence for the aforementioned therapies and the different tests applied in practice to assess their utility. Lastly, the study looks at potential future candidates for the treatment and evaluation of patients with multiple sclerosis and the supposed benefits they could bring in clinical settings.
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Alashram AR, Annino G, Padua E. Rehabilitation interventions for cognitive deficits in stroke survivors: A systematic review of randomized controlled trials. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-27. [PMID: 36194642 DOI: 10.1080/23279095.2022.2130319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Cognitive deficits are one of the most common impairments after stroke. It negatively affects physical and social functioning. Rehabilitation interventions for cognitive deficits post-stroke have taken less consideration. The present study aimed to provide an overview of the effects of various rehabilitation interventions on cognitive functions in patients with stroke. PUBMED, SCOPUS, PEDro, EMBASE, MEDLINE, and REHABDATA were searched for randomized controlled trials (RCTs) investigating the effects of rehabilitation interventions on cognitive domains poststroke until August 2021. The methodological quality of the selected studies was evaluated using the Cochrane Collaboration tool, and the effect sizes were calculated. Forty-four studies met the inclusion criteria. A total of 3561 individuals with stroke, 57.60% of whom were males. The mean age for all participants was 65.48 years. Eighteen RCTs were high, moderate (n = 17), and low methodological quality (n = 9). The results showed evidence for the beneficial effects of many rehabilitation interventions on cognition in individuals with stroke. Rehabilitation plays a crucial role in improving cognitive functions in stroke patients with mild cognitive deficits. Virtual reality (VR), computer-based cognitive rehabilitation (CBCR), and non-aerobic exercises may promote cognitive functions in patients with stroke.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Giuseppe Annino
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Elvira Padua
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
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Robledo-Castro C, Castillo-Ossa LF, Corchado JM. Artificial Cognitive Systems Applied in Executive Function Stimulation and Rehabilitation Programs: A Systematic Review. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2022; 48:2399-2427. [PMID: 36185593 PMCID: PMC9516512 DOI: 10.1007/s13369-022-07292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/11/2022]
Abstract
This article presents a systematic review of studies on cognitive training programs based on artificial cognitive systems and digital technologies and their effect on executive functions. The aim has been to identify which populations have been studied, the characteristics of the implemented programs, the types of implemented cognitive systems and digital technologies, the evaluated executive functions, and the key findings of these studies. The review has been carried out following the PRISMA protocol; five databases have been selected from which 1889 records were extracted. The articles were filtered following established criteria, to give a final selection of 264 articles that have been used for the purposes of this study in the analysis phase. The findings showed that the most studied populations were school-age children and the elderly. The most studied executive functions were working memory and attentional processes, followed by inhibitory control and processing speed. Many programs were commercial, customizable, gamified, and based on classic tasks. Some more recent initiatives have begun to incorporate user-machine interfaces, robotics, and virtual reality, although studies on their effects remain scarce. The studies recognize multiple benefits of computerized neuropsychological stimulation and rehabilitation programs for executive functions in different age groups, but there is a lack of studies in specific population sectors and with more rigorous research designs. Supplementary Information The online version contains supplementary material available at 10.1007/s13369-022-07292-5.
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Affiliation(s)
- Carolina Robledo-Castro
- Currículo, Universidad y Sociedad Research Group, Universidad del Tolima, Calle 42 1-02, 730006299 Ibagué, Colombia
- Ingeniería del Software Research Group, Universidad Autónoma de Manizales, Antigua Estación del Ferrocarril, 170001 Manizales, Colombia
| | - Luis F. Castillo-Ossa
- Ingeniería del Software Research Group, Universidad Autónoma de Manizales, Antigua Estación del Ferrocarril, 170001 Manizales, Colombia
- Inteligencia Artificial Research Group, Universidad de Caldas, Calle 65 26-10, 170002 Manizales, Colombia
- Departamento de Ingeniería Indutrial, Universidad Nacional de Colombia Sede Manizales, Campus La Nubia, 170001 Manizales, Colombia
| | - Juan M. Corchado
- BISITE Research Group, University of Salamanca, Calle Espejo s/n, 37007 Salamanca, Spain
- Air Institute, IoT Digital Innovation Hub, 37188 Salamanca, Spain
- Department of Electronics, Information and Communication, Osaka Institute of Technology, 535-8585 Osaka, Japan
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Kim SH, Gwak DW, Jeong JG, Jung H, Min YS, Kim AR, Jung TD. Effect of computerized cognitive rehabilitation in comparison between young and old age after traumatic brain injury. Medicine (Baltimore) 2022; 101:e29874. [PMID: 35984190 PMCID: PMC9388031 DOI: 10.1097/md.0000000000029874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Cognitive dysfunction reduces patients' quality of life and social participation with traumatic brain injury (TBI). Computerized cognitive rehabilitation is increasingly being used for cognitive therapy in TBI patients. The purpose of this study was to investigate the influence of age on the effect of computerized cognitive rehabilitation in cognitive dysfunction after TBI. MATERIAL AND METHODS A total of 34 patients with cognitive dysfunction after TBI were enrolled. Participants performed 30 sessions of computerized cognitive rehabilitation (Comcog) for 6 weeks. A cognitive evaluation was performed before and after treatment with Mini-Mental State Examination (MMSE) and Computerized Neurophyschologic Test (CNT). RESULTS There were no cognitive tests that differed between the young group and the old group at baseline. However, after computerized cognitive rehabilitation, the young group showed significant improvement compared to the old group in verbal memory, visual memory, attention, and visuo-motor coordination tests. The young group showed improvement in MMSE, verbal and visual memory, and visuo-motor coordination tests after computerized cognitive rehabilitation. In contrast, the old group showed significant improvement only in MMSE and visual learning test, one of the visual memory tests. CONCLUSION Our findings demonstrate that age may be an important factor related to the effect of computer cognitive rehabilitation on cognitive dysfunction after TBI. Methodologically more ordered studies with larger sample sizes are needed in the future.
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Affiliation(s)
- Seong-Hun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Dae-Won Gwak
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jae-Gyeong Jeong
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hyunwoo Jung
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ae-Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- * Correspondence: Tae-Du Jung, Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu 41404, Republic of Korea (e-mail: )
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Gopi Y, Wilding E, Madan CR. Memory rehabilitation: restorative, specific knowledge acquisition, compensatory, and holistic approaches. Cogn Process 2022; 23:537-557. [PMID: 35790619 PMCID: PMC9553770 DOI: 10.1007/s10339-022-01099-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
Memory impairment following an acquired brain injury can negatively impact daily living and quality of life—but can be reduced by memory rehabilitation. Here, we review the literature on four approaches for memory rehabilitation and their associated strategies: (1) the restorative approach, aimed at a return to pre-morbid functioning, (2) the knowledge acquisition approach, involving training on specific information relevant to daily life, (3) the compensatory approach, targeted at improving daily functioning, and (4) the holistic approach, in which social, emotional, and behavioral deficits are addressed alongside cognitive consequences of acquired brain injury. Each memory rehabilitation approach includes specific strategies such as drill and practice (restorative), spaced retrieval (knowledge acquisition), memory aids (compensatory), or a combination of psychotherapy and cognitive strategies (holistic). Past research has demonstrated mixed support for the use of restorative strategies to improve memory function, whereas knowledge acquisition strategies show promising results on trained tasks but little generalization to untrained tasks and activities of daily living. Compensatory strategies remain widely used but require intensive training to be effectively employed. Finally, the holistic approach is becoming more widespread due to improvements in psychosocial wellbeing, yet there are considerable resource and cost requirements. Several factors can influence rehabilitation outcomes including metacognition and emotional disturbances. Considerations for future research to improve the applicability of strategies for memory rehabilitation include assessing memory impairment severity, examining memory needs in daily life, and exploring the long-term effects of memory rehabilitation.
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Affiliation(s)
- Yashoda Gopi
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Edward Wilding
- School of Psychology, University of Birmingham, Birmingham, UK
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Gibson E, Koh CL, Eames S, Bennett S, Scott AM, Hoffmann TC. Occupational therapy for cognitive impairment in stroke patients. Cochrane Database Syst Rev 2022; 3:CD006430. [PMID: 35349186 PMCID: PMC8962963 DOI: 10.1002/14651858.cd006430.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cognitive impairment is a frequent consequence of stroke and can impact on a person's ability to perform everyday activities. Occupational therapists use a range of interventions when working with people who have cognitive impairment poststroke. This is an update of a Cochrane Review published in 2010. OBJECTIVES To assess the impact of occupational therapy on activities of daily living (ADL), both basic and instrumental, global cognitive function, and specific cognitive abilities in people who have cognitive impairment following a stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, four other databases (all last searched September 2020), trial registries, and reference lists. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials that evaluated an intervention for adults with clinically defined stroke and confirmed cognitive impairment. The intervention needed either to be provided by an occupational therapist or considered within the scope of occupational therapy practice as defined in the review. We excluded studies focusing on apraxia or perceptual impairments or virtual reality interventions as these are covered by other Cochrane Reviews. The primary outcome was basic activities of daily living (BADL) such as dressing, feeding, and bathing. Secondary outcomes were instrumental ADL (IADL) (e.g. shopping and meal preparation), community integration and participation, global cognitive function and specific cognitive abilities (including attention, memory, executive function, or a combination of these), and subdomains of these abilities. We included both observed and self-reported outcome measures. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies that met the inclusion criteria, extracted data, and assessed the certainty of the evidence. A third review author moderated disagreements if consensus was not reached. We contacted trial authors for additional information and data, where available. We assessed the certainty of key outcomes using GRADE. MAIN RESULTS: We included 24 trials from 11 countries involving 1142 (analysed) participants (two weeks to eight years since stroke onset). This update includes 23 new trials in addition to the one study included in the previous version. Most were parallel randomised controlled trials except for one cross-over trial and one with a two-by-two factorial design. Most studies had sample sizes under 50 participants. Twenty studies involved a remediation approach to cognitive rehabilitation, particularly using computer-based interventions. The other four involved a compensatory and adaptive approach. The length of interventions ranged from 10 days to 18 weeks, with a mean total length of 19 hours. Control groups mostly received usual rehabilitation or occupational therapy care, with a few receiving an attention control that was comparable to usual care; two had no intervention (i.e. a waiting list). Apart from high risk of performance bias for all but one of the studies, the risk of bias for other aspects was mostly low or unclear. For the primary outcome of BADL, meta-analysis found a small effect on completion of the intervention with a mean difference (MD) of 2.26 on the Functional Independence Measure (FIM) (95% confidence interval (CI) 0.17 to 4.22; P = 0.03, I2 = 0%; 6 studies, 336 participants; low-certainty evidence). Therefore, on average, BADL improved by 2.26 points on the FIM that ranges from 18 (total assist) to 126 (complete independence). On follow-up, there was insufficient evidence of an effect at three months (MD 10.00, 95% CI -0.54 to 20.55; P = 0.06, I2 = 53%; 2 studies, 73 participants; low-certainty evidence), but evidence of an effect at six months (MD 11.38, 95% CI 1.62 to 21.14, I2 = 12%; 2 studies, 73 participants; low-certainty evidence). These differences are below 22 points which is the established minimal clinically important difference (MCID) for the FIM for people with stroke. For IADL, the evidence is very uncertain about an effect (standardised mean difference (SMD) 0.94, 95% CI 0.41 to 1.47; P = 0.0005, I2 = 98%; 2 studies, 88 participants). For community integration, we found insufficient evidence of an effect (SMD 0.09, 95% CI -0.35 to 0.54; P = 0.68, I2 = 0%; 2 studies, 78 participants). There was an improvement of clinical importance in global cognitive functional performance after the intervention (SMD 0.35, 95% CI 0.16 to 0.54; P = 0.0004, I2 = 0%; 9 studies, 432 participants; low-certainty evidence), equating to 1.63 points on the Montreal Cognitive Assessment (MoCA) (95% CI 0.75 to 2.52), which exceeds the anchor-based MCID of the MoCA for stroke rehabilitation patients of 1.22. We found some effect for attention overall (SMD -0.31, 95% CI -0.47 to -0.15; P = 0.0002, I2 = 20%; 13 studies, 620 participants; low-certainty evidence), equating to a difference of 17.31 seconds (95% CI 8.38 to 26.24), and for executive functional performance overall (SMD 0.49, 95% CI 0.31 to 0.66; P < 0.00001, I2 = 74%; 11 studies, 550 participants; very low-certainty evidence), equating to 1.41 points on the Frontal Assessment Battery (range: 0-18). Of the cognitive subdomains, we found evidence of effect of possible clinical importance, immediately after intervention, for sustained visual attention (moderate certainty) equating to 15.63 seconds, for working memory (low certainty) equating to 59.9 seconds, and thinking flexibly (low certainty), compared to control. AUTHORS' CONCLUSIONS The effectiveness of occupational therapy for cognitive impairment poststroke remains unclear. Occupational therapy may result in little to no clinical difference in BADL immediately after intervention and at three and six months' follow-up. Occupational therapy may slightly improve global cognitive performance of a clinically important difference immediately after intervention, likely improves sustained visual attention slightly, and may slightly increase working memory and flexible thinking after intervention. There is evidence of low or very low certainty or insufficient evidence for effect on other cognitive domains, IADL, and community integration and participation. Given the low certainty of much of the evidence in our review, more research is needed to support or refute the effectiveness of occupational therapy for cognitive impairment after stroke. Future trials need improved methodology to address issues including risk of bias and to better report the outcome measures and interventions used.
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Affiliation(s)
- Elizabeth Gibson
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Chia-Lin Koh
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Sally Eames
- Community and Oral Health Innovation and Research Centre, Metro North Hospital and Health Service, Brisbane, Australia
| | - Sally Bennett
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
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Abstract
ABSTRACT To further clarify the effectiveness of virtual reality (VR) in improving cognitive function of patients with mild cognitive impairment (MCI) through meta-analysis, we searched the PubMed, Web of Science, Scopus, MEDLINE, and Cochrane centers for controlled trials of VR in patients with MCI. All analyses were performed using RevMan (Version 5.3; Cochrane Collaboration, Oxford, United Kingdom). The selected data were extracted as 2 × 2 table. All included studies were weighted and aggregated. According to the inclusion criteria and exclusion criteria, five articles were selected for meta-analysis. There was no bias or heterogeneity in the results. We found that the diamond is on the right side of the vertical line and does not intersect with the vertical line. We determined the following values: odds ratio, 1.34; 95% confidence interval, 0.31-2.37; z = 2.55; p = 0.01. VR can effectively improve the cognitive function of MCI patients and delay cognitive impairment, which can be further developed as a treatment to delay the development of MCI.
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Affiliation(s)
- Guanqun Chao
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
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21
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Small R, Wilson PH, Wong D, Rogers JM. Who, what, when, where, why, and how: a systematic review of the quality of post-stroke cognitive rehabilitation protocols. Ann Phys Rehabil Med 2021; 65:101623. [PMID: 34933125 DOI: 10.1016/j.rehab.2021.101623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 11/01/2021] [Accepted: 11/28/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND . Rehabilitation research findings are not routinely incorporated into clinical practice. A key barrier is the quality of reporting in the original study, including who provided the intervention, what it entailed, when and where it occurred, how patient outcomes were monitored, and why the intervention was efficacious. OBJECTIVES . To facilitate clinical implementation of post-stroke cognitive rehabilitation research, we undertook a review to examine the quality of intervention reporting in this literature. METHODS . Four databases were systematically searched, identifying 27 randomised controlled trials of post-stroke cognitive rehabilitation. The quality of intervention protocol descriptions in each study was independently rated by 2 of the authors using the 12-item Template for Intervention Description and Replication (TIDieR) checklist. RESULTS .Why, when, and where items were reported in more than 70% of interventions, what materials and procedures used was described in 50% to 70%, how items were described in approximately half of the interventions, and who provided interventions was reported in 22% of studies. No study addressed all 12 TIDieR items. "Active ingredients" that may further characterise an intervention and the potential mechanisms of action included restorative training, massed practice, feedback, and tailoring demands (present in approximately 50% of studies). CONCLUSIONS . Descriptions of intervention protocols are variable and frequently insufficient, thereby restricting the ability to understand, replicate, and implement evidence-based cognitive rehabilitation. Use of reporting checklists to address this barrier to research translation is a readily achievable and effective means to advance post-stroke care.
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Affiliation(s)
- Rebecca Small
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Peter H Wilson
- Centre for Disability and Development Research, Australian Catholic University, Australia
| | - Dana Wong
- School of Psychology & Public Health, La Trobe University, Bundoora, Australia
| | - Jeffrey M Rogers
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; neuroCare Group, Sydney, Australia.
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22
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Manuli A, Maggio MG, Stagnitti MC, Aliberti R, Cannavò A, Casella C, Milardi D, Bruschetta A, Naro A, Calabrò RS. Is intensive gait training feasible and effective at old age? A retrospective case-control study on the use of Lokomat Free-D in patients with chronic stroke. J Clin Neurosci 2021; 92:159-164. [PMID: 34509244 DOI: 10.1016/j.jocn.2021.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/17/2021] [Accepted: 08/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the last decade, the number of people over 60 has increased, leading to various healthcare problems. The aim of this retrospective study is to evaluate the effects of robotic rehabilitation in elderly patients as well as their perception of usability and adaptation to intensive robotic neurorehabilitation. METHODS This is a retrospective case-control study. Eighty elderly stroke patients were included in the analysis using an electronic data retrieval system. The enrolled patients were divided into two groups: the experimental group (EG) underwent rehabilitation training with Lokomat FreeD, equipped with a VR screen, while the control group (CG) performed traditional rehabilitation training. The two groups matched for age, sex, education, brain injury, stroke interval. The rehabilitation protocol included a total of 40 training sessions. RESULTS Both types of rehabilitation led to an improvement in the perceived level of disability (FIM) and in the performance in gait and balance (TT), highlighting a significant improvement especially in the EG. However, only in the EG, Lokomat training had induced an increase in the distance covered in 10 min (10 m walk test), and a significant improvement in mood (HRS-D). Moreover, Lokomat-FreeD was well tolerated by patients with high levels of usability. CONCLUSIONS Our results suggest that elderly patients may benefit from high-intensity robotic neurorehabilitation using the Lokomat-Pro FreeD.
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Affiliation(s)
| | - Maria Grazia Maggio
- University of Catania, Department of Biomedical and Biotechnological Science, Catania, Italy
| | - Maria Chiara Stagnitti
- Studio di Psicoterapia Relazionale e Riabilitazione Cognitiva, viale Europa, 107, Messina, Italy
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23
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Beyond motor recovery after stroke: The role of hand robotic rehabilitation plus virtual reality in improving cognitive function. J Clin Neurosci 2021; 92:11-16. [PMID: 34509235 DOI: 10.1016/j.jocn.2021.07.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/27/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022]
Abstract
Robot-assisted hand training adopting end-effector devices results in an additional reduction of motor impairment in comparison to usual care alone in different stages of stroke recovery. These devices often allow the patient to perform practical, attentive, and visual-spatial tasks in a semi-virtual reality (VR) setting. We aimed to investigate whether the hand end-effector robotic device AmadeoTM could improve cognitive performance, beyond the motor deficit, as compared to the same amount of occupational treatment focused on the hand. Forty-eight patients (aged 54.3 ± 10.5 years, 62.5% female) affected by either ischemic or hemorrhagic stroke in the chronic phase were enrolled in the study. The experimental group (EG) underwent AmadeoTM robotic training, while the control group (CG) performed occupational therapy involving the upper limb. Patients were assessed at the beginning and at the end of the rehabilitation protocol using a specific neuropsychological battery, as well as motor function tests. The EG showed greater improvements in different cognitive domains, including attentive abilities and executive functions, as well as in hand motor function, as compared to CG. Our study showed that task-oriented VR-based robotic rehabilitation enhanced not only motor function in the paretic arm but also global and specific cognitive abilities in post-stroke patients. We may argue that the hand robotic plus VR-based training may provide patients with an integration of cognitive and motor skill rehabilitation, thus amplifying the functional outcome achievement.
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24
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Xuefang L, Guihua W, Fengru M. The effect of early cognitive training and rehabilitation for patients with cognitive dysfunction in stroke. Int J Methods Psychiatr Res 2021; 30:e1882. [PMID: 34132448 PMCID: PMC8412226 DOI: 10.1002/mpr.1882] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/26/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This article explores the effects of early cognitive training and rehabilitation for patients with cognitive dysfunction in stroke. METHODS Stroke patients have cognitive dysfunction, and the incidence of cognitive dysfunction in stroke patients is six to nine times that of patients without stroke. This article selects 118 patients with stroke in our hospital from August 2017 to August 2019, 42 patients with stroke disorders randomly divided into two groups. Both groups of patients received conventional rehabilitation training, and the observation group performed motion observation therapy in virtual reality equipment based on conventional cognitive training. Analysis of time parameters related to rehabilitation training before and after treatment, and evaluation of standard health effects. RESULTS After 4 weeks of treatment, the cognitive training time parameters of the two groups were compared. The cognitive reaction time was shorter than that before treatment. After treatment, the scores of cognitive training and rehabilitation effects were significantly lower than those before treatment, and the two scores of the observation group were significantly lower than those of the control group. CONCLUSION Stroke patients receive early cognitive training with the support of computer-assisted technology to obtain good rehabilitation results.
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Affiliation(s)
- Liu Xuefang
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Wang Guihua
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Miao Fengru
- Department of Neurology, Aerospace Center Hospital, Beijing, China
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25
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Nie P, Liu F, Lin S, Guo J, Chen X, Chen S, Yu L, Lin R. The effects of computer-assisted cognitive rehabilitation on cognitive impairment after stroke: A systematic review and meta-analysis. J Clin Nurs 2021; 31:1136-1148. [PMID: 34459041 DOI: 10.1111/jocn.16030] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the effectiveness of computer-assisted cognitive rehabilitation in improving cognitive function in patients with post-stroke cognitive impairment. BACKGROUND In recent years, computer-assisted cognitive rehabilitation has been accepted as a good substitute or supplement for traditional cognitive rehabilitation. Some clinical randomised controlled trials have been carried out, but no relevant systematic evaluations have been performed. Therefore, we conducted a systematic review of studies involving computer-assisted cognitive rehabilitation to provide evidence-based data for its promotion and application. METHODS Nine databases (Cochrane Library, PubMed, Web of Science, Embase, OVID, Wanfang Data, CNKI, VIP and SinoMed databases) were systematically searched. Randomised controlled trials that assessed computer-assisted cognitive rehabilitation for patients with post-stroke cognitive impairment were included. Two reviewers appraised the risks of bias through the Cochrane Collaboration's tool and performed the meta-analysis, including the assessment of heterogeneity. We follow the PRISMA 2020 guidelines. RESULTS Thirty-two studies comprising 1837 participants were included. Compared with conventional therapy alone, the addition of computer-assisted cognitive rehabilitation significantly improved the global cognition of patients, evaluated using the Montreal cognitive assessment, mini-mental state examination and Loewenstein occupational therapy cognitive assessment (p < .01 for all tests). The therapy also significantly improved activities of daily living, assessed using the Barthel index, modified Barthel index and functional independence measure (p < .05 for all tests). CONCLUSION Computer-assisted cognitive rehabilitation significantly improved the cognitive function and activities of daily living of patients with post-stroke cognitive impairment. RELEVANCE TO CLINICAL PRACTICE Computer-assisted cognitive rehabilitation can be a valuable technique for cognitive rehabilitation after stroke. It is advantageous for improving patient cognition and restoring the overall functional state of patients. Moreover, the research findings can provide suggestions and inspiration for researchers to implement the proposal, which is conducive to the design of more rigorous and high-quality randomised controlled trials.
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Affiliation(s)
- Pingying Nie
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Fang Liu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shaohong Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jiaying Guo
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xinming Chen
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | | | - Liqiang Yu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ruhui Lin
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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26
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Tarantino V, Burgio F, Toffano R, Rigon E, Meneghello F, Weis L, Vallesi A. Efficacy of a Training on Executive Functions in Potentiating Rehabilitation Effects in Stroke Patients. Brain Sci 2021; 11:1002. [PMID: 34439621 PMCID: PMC8392264 DOI: 10.3390/brainsci11081002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
Cognitive impairment after a stroke has a direct impact on patients' disability. In particular, impairment of Executive Functions (EFs) interferes with re-adaptation to daily life. The aim of this study was to explore whether adding a computer-based training on EFs to an ordinary rehabilitation program, regardless of the specific brain damage and clinical impairment (motor, language, or cognitive), could improve rehabilitation outcomes in patients with stroke. An EF training was designed to have minimal motor and expressive language demands and to be applied to a wide range of clinical conditions. A total of 37 stroke patients were randomly assigned to two groups: a training group, which performed the EF training in addition to the ordinary rehabilitation program (treatment as usual), and a control group, which performed the ordinary rehabilitation exclusively. Both groups were assessed before and after the rehabilitation program on neuropsychological tests covering multiple cognitive domains, and on functional scales (Barthel index, Functional Independence Measure). The results showed that only patients who received the training improved their scores on the Attentional Matrices and Phonemic Fluency tests after the rehabilitation program. Moreover, they showed a greater functional improvement in the Barthel scale as well. These results suggest that combining an EF training with an ordinary rehabilitation program potentiates beneficial effects of the latter, especially in promoting independence in activities of daily living.
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Affiliation(s)
- Vincenza Tarantino
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy
| | - Francesca Burgio
- IRCCS San Camillo Hospital, 30126 Venice, Italy; (F.B.); (R.T.); (E.R.); (F.M.)
| | - Roberta Toffano
- IRCCS San Camillo Hospital, 30126 Venice, Italy; (F.B.); (R.T.); (E.R.); (F.M.)
| | - Elena Rigon
- IRCCS San Camillo Hospital, 30126 Venice, Italy; (F.B.); (R.T.); (E.R.); (F.M.)
| | | | - Luca Weis
- Department of Neuroscience, University of Padova, 35128 Padova, Italy;
| | - Antonino Vallesi
- IRCCS San Camillo Hospital, 30126 Venice, Italy; (F.B.); (R.T.); (E.R.); (F.M.)
- Department of Neuroscience & Padova Neuroscience Center, University of Padova, 35128 Padova, Italy
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27
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Ostrowska PM, Śliwiński M, Studnicki R, Hansdorfer-Korzon R. Telerehabilitation of Post-Stroke Patients as a Therapeutic Solution in the Era of the Covid-19 Pandemic. Healthcare (Basel) 2021; 9:654. [PMID: 34072939 PMCID: PMC8229171 DOI: 10.3390/healthcare9060654] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/11/2023] Open
Abstract
(1) Background: Due to the pandemic caused by the SARS-CoV-2 virus, rehabilitation centres have become less available for neurological patients. This is the result of efforts to physically distance society, to try to slow the spread of the pathogen. Health care facilities were mainly restricted to urgent cases, while most physiotherapy treatments, mainly for patients with chronic conditions, were suspended. Some countries have seen a reduction in acute stroke hospital admissions of from 50% to 80%. One solution to the above problem is the use of telerehabilitation in the home environment as an alternative to inpatient rehabilitation. (2) Aim of the study: The purpose of this review is to analyse the benefits and limitations of teletherapy in relation to the functional condition of post-stroke patients. (3) Methods: Selected publications from 2019 to 2021 on the telerehabilitation of stroke patients were reviewed. The review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. (4) Results: Studies have proven that teletherapy significantly improves the functional condition of post-stroke patients, resulting in improved quality of life and faster return to independence (while maintaining maximum possible precautions related to the SARS-CoV-2 virus pandemic). (5) Conclusions: Analysis of the study results showed comparable effectiveness of rehabilitation in the tele system to inpatient therapy. However, it should be emphasised that patients undergoing telerehabilitation must meet strict conditions to be eligible for this type of treatment program. However, the strength of the evidence itself supporting the effectiveness of this method ranks low due to the limited number of randomised control trials (RCT), small number of participants, and heterogeneous trials.
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Affiliation(s)
- Paulina Magdalena Ostrowska
- Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland; (M.Ś.); (R.S.); (R.H.-K.)
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28
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Zhou Y, Feng H, Li G, Xu C, Wu Y, Li H. Efficacy of computerized cognitive training on improving cognitive functions of stroke patients: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Pract 2021; 28:e12966. [PMID: 34036682 DOI: 10.1111/ijn.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/23/2021] [Accepted: 04/25/2021] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the effects of computerized cognitive training on the cognitive functions of stroke patients. BACKGROUND With increased publications on computerized cognitive training, a meta-analysis is essential to determine the effects of computerized cognitive training among stroke patients. DESIGN A systematic review and meta-analysis of randomized controlled studies. DATA SOURCES Cochrane Library, Pubmed, EBSCO, Scopus, China National Knowledge Infrastructure, China Biology Medicine disc and Wanfang Database were explored to search for research studies from inception to January 2020. REVIEW METHODS Six outcomes indicators were considered to determine the effects of computerized cognitive training. Two reviewers were selected to search and independently appraise the available articles from various databases. Meta-analysis was performed using the RevMan 5.3 software. RESULTS A total of 622 patients with 17 studies were included. Computerized cognitive training significantly improves global cognition, working memory, attention and executive function of stroke patients. However, there was inadequate evidence to demonstrate any effects of computerized cognitive training on activities of daily living and depression. CONCLUSION Computerized cognitive training improves the cognitive functions of stroke patients. However, further research studies are needed to confirm its efficacy in activities of daily living as well as on alleviating depression.
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Affiliation(s)
- Yuxin Zhou
- Department of Nursing, School of Medicine, Southeast University, Nanjing, China
| | - Haixia Feng
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Guohong Li
- Department of Nursing Management, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Cuirong Xu
- Department of Nursing Management, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yanping Wu
- Department of Geriatric, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Huimin Li
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
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29
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Zhao Q, Wang X, Wang T, Dmytriw AA, Zhang X, Yang K, Luo J, Bai X, Jiang N, Yang B, Ma Y, Jiao L, Xie Y. Cognitive rehabilitation interventions after stroke: protocol for a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2021; 10:66. [PMID: 33663590 PMCID: PMC7931553 DOI: 10.1186/s13643-021-01607-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is the second leading cause of death worldwide, and 53.4% of stroke survivors suffer from post-stroke cognitive impairment. Post-stroke cognitive impairment can increase hospitalization rate and cost of care and decrease the quality of life of stroke patients. To date, multiple cognitive rehabilitation interventions have been tested in stroke populations with post-stroke cognitive impairment. However, the most efficacious intervention has not been established. This systematic review aims to compare the efficacy of cognitive rehabilitation interventions for patients with post-stroke cognitive impairment. METHODS We will search MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, PubMed, and clinical trial registries to identify eligible randomized clinical trials with no restrictions in the date of publication and language. Studies conducted with patients aged 18 or over, with the presence of cognitive impairment after being diagnosed with stroke will be included. Studies will be restricted to randomized controlled trials comparing a cognitive rehabilitation intervention with another intervention. The primary outcome is any clinical changes in the general or specific cognitive domain (e.g., executive function, attention, memory, or perception). The secondary outcomes that will be collected include adverse effects (e.g., stroke, disability, or mortality) and quality of life. Two independent reviewers will assess articles to identify trials eligible for inclusion. Data extraction and risk of bias assessment of the included studies will also be done independently. Any discrepancies will be solved by discussion, or a third reviewer will be consulted if necessary. A meta-analysis will be carried out if appropriate. DISCUSSION This systematic review for patients with post-stroke cognitive impairment will assess the efficacy of cognitive rehabilitation interventions. And our results will help clinical decision-making and support the development of clinical practice guidelines. TRIAL REGISTRATION Systematic review registration: PROSPERO CRD42020173988.
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Affiliation(s)
- Qing Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China.,Department of Clinical Medicine, Peking Union Medical College, No. 5 Dongdan Three Street, Beijing, China
| | - Xue Wang
- Medical Library, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Adam A Dmytriw
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, USA
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Kun Yang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Nan Jiang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China
| | - Yunyan Xie
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China.
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30
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Kolskår KK, Richard G, Alnæs D, Dørum ES, Sanders A, Ulrichsen KM, Sánchez JM, Ihle‐Hansen H, Nordvik JE, Westlye LT. Reliability, sensitivity, and predictive value of fMRI during multiple object tracking as a marker of cognitive training gain in combination with tDCS in stroke survivors. Hum Brain Mapp 2021; 42:1167-1181. [PMID: 33216408 PMCID: PMC7856645 DOI: 10.1002/hbm.25284] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022] Open
Abstract
Computerized cognitive training (CCT) combined with transcranial direct current stimulation (tDCS) has showed some promise in alleviating cognitive impairments in patients with brain disorders, but the robustness and possible mechanisms are unclear. In this prospective double-blind randomized clinical trial, we investigated the feasibility and effectiveness of combining CCT and tDCS, and tested the predictive value of and training-related changes in fMRI-based brain activation during attentive performance (multiple object tracking) obtained at inclusion, before initiating training, and after the three-weeks intervention in chronic stroke patients (>6 months since hospital admission). Patients were randomized to one of two groups, receiving CCT and either (a) tDCS targeting left dorsolateral prefrontal cortex (1 mA), or (b) sham tDCS, with 40s active stimulation (1 mA) before fade out of the current. Of note, 77 patients were enrolled in the study, 54 completed the cognitive training, and 48 completed all training and MRI sessions. We found significant improvement in performance across all trained tasks, but no additional gain of tDCS. fMRI-based brain activation showed high reliability, and higher cognitive performance was associated with increased tracking-related activation in the dorsal attention network and default mode network as well as anterior cingulate after compared to before the intervention. We found no significant associations between cognitive gain and brain activation measured before training or in the difference in activation after intervention. Combined, these results show significant training effects on trained cognitive tasks in stroke survivors, with no clear evidence of additional gain of concurrent tDCS.
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Affiliation(s)
- Knut K. Kolskår
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
- Department of PsychologyUniversity of OsloOsloNorway
| | - Geneviève Richard
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
- Department of PsychologyUniversity of OsloOsloNorway
| | - Dag Alnæs
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Bjørknes collegeOsloNorway
| | - Erlend S. Dørum
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
- Department of PsychologyUniversity of OsloOsloNorway
| | - Anne‐Marthe Sanders
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
- Department of PsychologyUniversity of OsloOsloNorway
| | - Kristine M. Ulrichsen
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
- Department of PsychologyUniversity of OsloOsloNorway
| | - Jennifer Monereo Sánchez
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
| | - Hege Ihle‐Hansen
- Department of Geriatric MedicineOslo University HospitalOsloNorway
| | | | - Lars T. Westlye
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of OsloOsloNorway
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31
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De Luca R, Rifici C, Pollicino P, Di Cara M, Miceli S, Sergi G, Sorrenti L, Romano M, Naro A, Billeri L, Lauria P, Caminiti A, Bramanti P, Torrisi M. 'Online therapy' to reduce caregiver's distress and to stimulate post-severe acquired brain injury motor and cognitive recovery: A Sicilian hospital experience in the COVID era. J Telemed Telecare 2021:1357633X21990195. [PMID: 33535914 DOI: 10.1177/1357633x21990195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Severe acquired brain injury(SABI) often results in the deterioration of physical, cognitive and emotional functions in the patient and a significant caregiver's distress syndrome, which is now amplified by the social isolation, depression and financial difficulties related to the COVID-19 pandemic. The use of web-based online-therapy has been shown to be useful to overcome caregiver's distress syndrome and further stimulate cognitive-motor recovery of SABI-patients. Our study aimed to investigate whether a systematic online Skype-therapy(OLST) may be of support in favoring global cognitive and sensory-motor recovery in SABI-patients and reducing caregiver distress. METHODS Twenty-five SABI-subjects in inpatient regimen were provided with intensive OLST with the caregiver for 12 weeks in addition to standard neurorehabilitation. Each subject and caregiver was evaluated before and after the treatment by administering an ad hoc battery. Furthermore, 18 of 27 patients were provided with EEG recording in resting state. RESULTS We found a significant reduction in caregiver's anxiety (p<0.0001) and burden(p<0.0001). Patients showed significant improvement in trunk control (p<0.0001), functional independence (p = 0.005), functional (p = 0.01) and global communication (p = 0.004), cognitive functioning (p = 0.001), and behavioral responsiveness (p = 0.0004). The training yielded a significant connectivity change within the fronto-centro-parietal areas in the delta frequency band (p<0.0001) and the centro-parieto-occipital areas in the alpha range (p = 0.004). DISCUSSION OLST may be a useful and complementary treatment to optimize global cognitive and functional recovery in SABI-subjects and reduce caregivers' concerns in the Covid-era. OLST can foster cognitive-motor recovery potentially by favoring the plasticity-dependent functional recovery. Therefore, OLST could be proposed as a tool allowing social conversations also in the hospital setting.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Paola Lauria
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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32
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Kim HS, Lim KB, Yoo J, Kim YW, Lee SW, Son S, Kim C, Kim J. The efficacy of computerized cognitive rehabilitation in improving attention and executive functions in acquired brain injury patients, in acute and postacute phase. Eur J Phys Rehabil Med 2021; 57:551-559. [PMID: 33448753 DOI: 10.23736/s1973-9087.21.06497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cognitive deficits, particularly executive dysfunction is common following acquired brain injury (ABI) and has detrimental effect on functional status and autonomy in daily life. Among various cognitive training methods, computerized cognitive rehabilitation (CCR) has been investigated as an alternative method to therapist-driven cognitive rehabilitation (TCR). However, previous studies have shown conflicting results on the superiority or inferiority of CCR and TCR. AIM To investigate the efficacy of TCR and CCR in improving executive function in patients with acute-to-subacute ABI. DESIGN A prospective, assessor-blinded randomized controlled trial. SETTING Hospitalized care setting in the department of rehabilitation in a university hospital. POPULATION Thirty-two acute-to-subacute (less than 3 months after onset) ABI patients with executive dysfunctions were included in this study. The mean time after injury was 25.1±18.1 days. METHODS Participants were assigned to the TCR group (N.=14) or the CCR group (N.=18). Each group performed TCR or CCR for 30 minutes each day for two weeks in addition to routine rehabilitation. Neurocognitive function tests to assess complex attention, executive function, general cognitive function (mini-mental status examination [MMSE] and Montreal Cognitive Assessment [MoCA]), and functional evaluations [modified Barthel Index, MBI]) were performed at baseline (T0) and at the end of treatment (T1). RESULTS The TCR and CCR groups showed significant improvements in the MMSE (P=0.004, 0.000), MoCA (P=0.003, 0.006), and MBI (P=0.000, 0.000) scores. TCR and CCR groups both showed significant improvements in some of the complex attention tests (trail-making test A, P=0.002, 0.005) and executive function tests (trail-making test B, P=0.016, 0.016). The TCR group showed significant improvements in the additional executive function tests (phonemic fluency test, P=0.004, semantic fluency test, P=0.001), while the CCR group showed significant improvements in the additional complex attention tests (symbol search, P=0.02, digit symbol coding, P=0.002). In the intergroup comparison of the changes from pre- to postintervention, only the TCR group showed a significant improvement in the phonemic fluency test (P=0.013). CONCLUSIONS TCR might be more effective than CCR in improving frontal lobe-related executive function in ABI patients. CCR might be beneficial for improving psychomotor speed and working memory. CLINICAL REHABILITATION IMPACT TCR or CCR should be chosen according to the targeted domain of cognitive dysfunction in acute-to-subacute ABI patients.
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Affiliation(s)
- Ha Seong Kim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea.,Yonsei University College of Medicine, Seoul, South Korea
| | - Kil-Byung Lim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Jeehyun Yoo
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Wan Lee
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Sungsik Son
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Changgyu Kim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Jiyong Kim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea -
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Borisova V, Isakova E, Kotov S. Cognitive rehabilitation after stroke using non-pharmacological approaches. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:26-32. [DOI: 10.17116/jnevro202112112226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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How may patients with MS benefit from using music assisted therapy? A case-control feasability study investigating motor outcomes and beyond. Mult Scler Relat Disord 2020; 48:102713. [PMID: 33387863 DOI: 10.1016/j.msard.2020.102713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/10/2020] [Accepted: 12/19/2020] [Indexed: 12/16/2022]
Abstract
Motor impairment is the most common symptom in multiple sclerosis (MS), as gait and balance dysfunction are reported in more than 85% of the patients, with considerable consequences on the patient's activities of daily living and psychological status. This study aimed at evaluating the feasibility and potential efficacy of a novel treatment involving music plus treadmill in patients with MS. Ten patients affected by secondary progressive MS were submitted to a specific training using the Gait Trainer (GT) 3, a platform that integrates gait training via a treadmill and rhythmic auditory stimulation. The 30 minutes training was performed three times per week for eight weeks (24 sessions in total). The enrolled patients were compared with a control group (CG) of 10 patients with MS matched for age, gender, disease duration, and EDSS stage. The CG received the same amount of treatment, but using conventional overground gait training. All patients completed the training without reporting any side effects. At the end of the training, CG improved in static and dynamic balance and in mood. Instead, in the EG a significant improvement in static and dynamic balance, walking speed, and mobility, as well as in mood, and perception of quality of life (QoL), both for physical and mental well-being, was found. This exploratory study suggests that GT3 might be a feasible and potentially useful approach for MS gait rehabilitation, thanks to patients' high motivation and good acceptance of the music assisted therapy.
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Kulshrestha S, Agrawal M, Singh AK, Kulshreshtha D. Post Stroke Rehabilitation Using Computer-based Cognitive Intervention (CBCI): A Systematic Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216999200622135105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Cognitive impairment as a consequence of stroke is a major cause affecting
the patient’s functional independence, activity participation, daily living skills, and occupation. Almost
75% of post-stroke patients are diagnosed with significant cognitive impairment, which includes
problems with attention, orientation, memory, language, and perception. Along with effective
pharmaceutical cures, cognitive intervention as a part of rehabilitation approaches that may prevent,
delay, or treat cognitive impairment is becoming increasingly important. Many studies have reported
improvement in cognitive functions of post-stroke patients after using computer-based cognitive
intervention (CBCI). CBCI can be an effective add-on to available rehabilitation programs.
Objective:
This article provides reviews related to relevant literature and, represents a structure to
specify the efficacy of CBCI for the rehabilitation of post-stroke patients for future research.
Methods:
We searched many search engines namely MEDLINE, Web of Science, clinical key and
The Cochrane Library, for studies investigating the effect of cognitive intervention based on a computer
program for post-stroke patients. The results of selected studies were summarized. Total 19
publications from January 2007 to January 2019 are included in this review. The search terms entered
were a combination of these search areas that defined (1) the population as adults who had suffered
a stroke and cognitive dysfunction, (2) intervention search term included cognitive abilities, cognitive
training, and computer-based training; computer-based cognitive intervention for rehabilitation.
Results:
The results after computer-based training showed improvement in various cognitive functions
such as; memory, attention and executive functions of post-stroke patients. However, a significant
difference between the study groups has not been observed in all the studies. Most studies analyzed
in this research project indicated that such interventions might contribute to the improvement
of cognitive function, especially attention concentration and memory. Of the 19 kinds of research
that discussed CBCI outcomes 18 found significant improvements for one or more cognitive functions.
When the effect size for CBCI was reported, effects were large in comparison to other traditional
cognitive interventions of post-stroke patients.
Conclusion:
Studies related to cognitive functions strongly support CBCI except few have reported
a significant difference. The review of all the studies suggests that CBCI may help to change the
functional aspect of post-stroke patients by improving their cognitive functions. In this field, it is a
challenge to conduct well designed and sufficiently powered studies due to low budgets availability,
the limited number of available patients, heterogeneity of the population, and ethical considerations.
Future studies should examine all the challenges, limitations, and valuable insights into the study
and emphasize the need for a carefully designed computer-based cognitive intervention program for
the future. Future studies should target to compare CBCI with active and passive control conditions
and include a larger sample size.
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Affiliation(s)
- Sudhi Kulshrestha
- Amity Institute of Behavioral and Allied Sciences, Amity University, Lucknow, India
| | - Manju Agrawal
- Amity Institute of Behavioral and Allied Sciences, Amity University, Lucknow, India
| | - Ajai K. Singh
- Department of Neurology, Dr. Ram ManoharLohia Institute of Medical Sciences, Lucknow, India
| | - Dinkar Kulshreshtha
- Department of Neurology, Dr. Ram ManoharLohia Institute of Medical Sciences, Lucknow, India
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Ye M, Zhao B, Liu Z, Weng Y, Zhou L. Effectiveness of computer-based training on post-stroke cognitive rehabilitation: A systematic review and meta-analysis. Neuropsychol Rehabil 2020; 32:481-497. [PMID: 33092475 DOI: 10.1080/09602011.2020.1831555] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A systematic review and meta-analysis based on randomized controlled trials (RCTs) from the last 10 years was conducted to identify the effect of computer-based training compared to routine methods on post-stroke cognitive rehabilitation and to provide recommendations for future research. A literature search was performed in the Cochrane Library, EMBASE, PubMed, EBSCO (CINAHL), and Web of Science that focused on studies comparing the effects of computerized cognitive training and routine methods in stroke survivors. After extraction of the study characteristics and methodological quality evaluation, a meta-analysis was conducted using the standard model based on the level of the overall cognitive domain. Ten out of 201 studies were included in the systematic review, with a total of 600 stroke survivors. The average age of the participants ranged from 42.1 to 66 years old, 305 participants used the computer-based training method, and males accounted for approximately 58.5%. All studies compared the baseline characteristics of participants at the onset of their studies, and no significant difference was shown. Six studies that reported the results for the overall cognitive domain were further analyzed by meta-analysis. The outcome of the meta-analysis showed that the effect size was 0.61 with a 95% confidence interval [-0.18, 0.35], and the P value (P = 0.54) indicated no significant difference between the control group and the computer-based cognitive training group. The results of the meta-analysis, based on a limited number of studies, did not show significant superiority of computer-based cognitive training compared to the traditional method in post-stroke patients. More high-quality studies focusing on different illness phases and various types of intervention software should be conducted to improve the meta-analysis and to explore the influence of computer-based cognitive training by subgroup analysis.Abbreviation: CBCT: Computer-based cognitive training; PICOS: Participants, interventions, comparisons, outcomes, and study design.
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Affiliation(s)
- Mingming Ye
- Clinical Nursing Department, School of Nursing, Second Military Medical University, Shanghai, People's Republic of China
| | - Bolun Zhao
- Clinical Nursing Department, School of Nursing, Second Military Medical University, Shanghai, People's Republic of China.,Clinical Nursing Department, School of Nursing, Dalian University, Dalian, People's Republic of China
| | - Zhijian Liu
- Clinical Nursing Department, School of Nursing, Second Military Medical University, Shanghai, People's Republic of China
| | - Yingli Weng
- Clinical Nursing Department, School of Nursing, Second Military Medical University, Shanghai, People's Republic of China
| | - Lanshu Zhou
- Clinical Nursing Department, School of Nursing, Second Military Medical University, Shanghai, People's Republic of China
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Draaisma LR, Wessel MJ, Hummel FC. Neurotechnologies as tools for cognitive rehabilitation in stroke patients. Expert Rev Neurother 2020; 20:1249-1261. [DOI: 10.1080/14737175.2020.1820324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Laurijn R. Draaisma
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI, Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland
| | - Maximilian J. Wessel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI, Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland
| | - Friedhelm C. Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI, Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland
- Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
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Miotto EC, Bazán PR, Batista AX, Conforto AB, Figueiredo EG, Martin MDGM, Avolio IB, Amaro E, Teixeira MJ. Behavioral and Neural Correlates of Cognitive Training and Transfer Effects in Stroke Patients. Front Neurol 2020; 11:1048. [PMID: 33041987 PMCID: PMC7522394 DOI: 10.3389/fneur.2020.01048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
Stroke lesions are frequently followed by cognitive impairments. Cognitive training is a non-pharmacological intervention that can promote neural compensation mechanisms and strategies to remediate cognitive impairments. The aims of this study were: (1) To investigate the cognitive performance, generalization effects, and neural correlates of semantic organization strategy training (SOST) in patients with chronic left frontoparietal stroke and healthy controls (HC); and (2) to compare the behavioral effects and neural correlates of SOST with an active control psychoeducation intervention (PI). In this randomized controlled study, all participants were randomly allocated into two groups, one group received SOST, and the other received PI intervention. Participants underwent two fMRI sessions, one prior and the other, after intervention. In each fMRI session, images were obtained during memory encoding task using a list of semantically related words. We found improved post-intervention memory performance in participants that received SOST (both patients and controls), indicated by number of words recalled, word clustering scores, and performance in a generalization task. The fMRI analysis revealed negative correlation between task performance and regions of the default-mode network. These results suggest that cognitive training using semantic organization strategy can improve episodic memory performance and promote potential functional neuroplasticity in patients with ischemic stroke lesions. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03644290.
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Affiliation(s)
- Eliane C Miotto
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Paulo R Bazán
- Institute of Radiology, LIM-44, University of São Paulo, São Paulo, Brazil
| | - Alana X Batista
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Edson Amaro
- Institute of Radiology, LIM-44, University of São Paulo, São Paulo, Brazil
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Naser Moghadasi A. The role of the brain in the treatment of multiple sclerosis as a connectomopathy. Med Hypotheses 2020; 143:110090. [PMID: 32679428 DOI: 10.1016/j.mehy.2020.110090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/18/2020] [Accepted: 07/05/2020] [Indexed: 12/14/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) causing a variety of symptoms. Although MS is recognized by the demyelinating process, the axonal injury can occur from the start of the disease and lead to neurodegenerative process in the disease. Although MS appears to damage the brain locally, the progressive and neurodegenerative nature of the disease indicate the general and global brain damage. Various studies have indicated this global damage at all areas of white and gray matter. Moreover, the earlier stages of mentioned disease can affect the structural and functional brain connections. Demyelinating lesions, which are local at first glance, lead to a global damage to the functional connections of the brain. Therefore, it seems that the brain network or brain connectome are broadly affected by this disease; therefore, MS can be referred as a connectomopathy. The drugs used in this disease all seek to suppress or regulate the immune system, and the human brain has always been considered as a therapeutic target. However, if the brain is generally involved in the disease, so the treatment should be general. In fact, the treatment process should target the connectomopathy. One of the methods that can be used to achieve the mentioned goal is attending to the role of the brain in its treatment.
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Affiliation(s)
- Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Park HK, Song MK, Kim JH, Han JY. A randomized controlled trial to evaluate the effectiveness and safety of electro acupuncture and transcranial direct current stimulation with computerized cognitive rehabilitation in patients with vascular cognitive impairment. Medicine (Baltimore) 2020; 99:e21263. [PMID: 32702911 PMCID: PMC7373529 DOI: 10.1097/md.0000000000021263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Vascular cognitive impairment (VCI) refers to all cognitive disorders caused by cerebrovascular disorders. For the treatment, many types of pharmacologic and nonpharmacologic treatments are used but their underlying mechanisms and effects are unclear. Regarding nonpharmacologic treatment, electroacupuncture (EA), transcranial direct current stimulation (tDCS), and computerized cognitive rehabilitation treatment (CCRT) are effective. Here, we report the protocol for a randomized controlled trial of the effect and safety of combination therapy of EA or tDCS and CCRT in patients with VCI. METHODS This study will be a prospective, outcome assessor-blinded, parallel-arm, randomized controlled clinical trial. Participants with cognitive impairment caused by stroke after 3 months of onset (n = 45) will be randomly assigned to a CCRT, combination therapy with EA and computerized cognitive rehabilitation treatment, or combination therapy with tDCS and computerized cognitive rehabilitation treatment group. All groups will receive treatment 3 times per week for 8 weeks, giving a total of 24 treatments. The CCRT group will perform a training task like shopping, calculating, and others and involving computerized cognitive assessment and brain training system (RehaCom) for 30 minutes. The combination therapy with EA and computerized cognitive rehabilitation treatment group will receive EA using 8 acupuncture points - baekhoe, sinjeong, both sides of pungji, 4 sites of sishencong - and will be applied using an EA stimulator and receive CCRT for 30 minutes at the same time. The combination therapy with tDCS and computerized cognitive rehabilitation treatment group will receive tDCS treatment and receive CCRT for 30 minutes at the same time. The primary outcome will be evaluated using the Lowenstein occupational therapy cognitive assessment, while other scales assessing walking ability, activities of daily living, and quality of life are considered secondary outcome measures. Outcomes will be evaluated before intervention, at the end of intervention 8 weeks after the first intervention, and 4 weeks after completion of the intervention program. DISCUSSION This study aims to examine the effect and safety of combination therapy with EA or tDCS and CCRT in patients with VCI. This study can be useful in developing new treatment technologies using collaborative research with combined traditional Korean and conventional medicines. TRIAL REGISTRATION This trial has been registered with cris.nih.go.kr (registration number, KCT 0003644 Registered 01 April 2019, http://cris.nih.go.kr).
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Affiliation(s)
- Hyeng Kyu Park
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju City
| | - Min Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju City
| | - Jae Hong Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Dongshin University, Naju City, Republic of Korea
| | - Jae Young Han
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju City
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Abstract
Contemporary cognitive training literature suggests that training on an adaptive task produces improvements only in the trained task or near transfer effects. No study has yet systematically explained the mechanism behind improved performance on the N-back. In this study, we first investigated how improvements in an N-back task using eight pairs of phonologically similar words as stimuli occurred by examining error distributions of the task over training sessions. Nineteen participants (non-native English speakers) trained for 20 sessions over 5 weeks. We observed a reduction in false alarms to non-target words and fewer missed target words. Though the absolute number of phonological-based errors reduced as training progressed, the proportion of this error type did not decrease over time suggesting participants increasingly relied on subvocal rehearsal in completing the N-back. In the second experiment, we evaluated if improvements developed during N-back training transferred to tasks that relied on serial order memory using simple span tasks (letter span with phonologically distinct letters, letter span with phonologically similar letters, digit span forward, and digit span backward). Twenty-nine participants trained on the N-back and 16 trained on the Operation Span (OSPAN) for 15 sessions over 4 weeks. Neither group of participants showed improvements on any of the simple span tasks. In the third experiment, 20 participants (16 native English speakers) trained on the N-back for 15 sessions over 4 weeks also showed increasing reliance on subvocal rehearsal as they progressed through training. Self-report strategy use did not predict improvements on the N-back.
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Maggio MG, Maresca G, Stagnitti MC, Anchesi S, Casella C, Pajno V, De Luca R, Manuli A, Calabrò RS. Social cognition in patients with acquired brain lesions: An overview on an under-reported problem. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:419-431. [PMID: 32301351 DOI: 10.1080/23279095.2020.1753058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Social cognition (SC) consists of mental representations of interpersonal relationships, which are used flexibly by the individual to promote functional social behaviors and achieve the goals. SC is a multidimensional construct and is supported by the activity of distributed neural networks in which different cortical and subcortical regions of the brain are involved. The review aims to evaluate the current literature on SC taking into account how it is compromised in acquired brain injury. Studies performed between 2010 and 2019 and fulfilling the selected criteria were searched on PubMed, Scopus, Cochrane and Web of Sciences databases. Impairment of SC is a neglected but common consequence of ABI, often leading to disordered interpersonal functioning and poor regulation of personal behavior with impaired social adaptation and quality of life of both the patient and his/her family. This review supports the idea that SC could have an important role in the management of neurological patients by both clinicians and caregivers.
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Using telerehabilitation to improve cognitive function in post-stroke survivors: is this the time for the continuity of care? Int J Rehabil Res 2020; 42:344-351. [PMID: 31464812 DOI: 10.1097/mrr.0000000000000369] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Post-stroke cognitive disorders can affect different domains, depending on typology of stroke and lesion localization, onset time, age and diagnostic tools used. In recent years, telerehabilitation using virtual reality has been used to reduce the healthcare costs encouraging continuity of care. The aim of our study is to evaluate the efficacy of a virtual reality rehabilitation system in improving cognitive function in stroke survivors. Forty patients affected by stroke were enrolled in this study and randomized into either the control or the experimental groups in order of recruitment. The study lasted 6 months, and included two phases: (1) during the first phase the experimental group underwent cognitive rehabilitation training using the Virtual Reality Rehabilitation System-Evo, whereas the control group was submitted to standard cognitive training; (2) in the second phase (after discharge), the experimental group was treated by means of virtual reality rehabilitation system Home Tablet (three sessions a week, each session lasting about 50 minutes), and the control group continued the traditional training, with the same amount of treatment. The patients underwent a neuropsychological evaluation before and at the end of the treatment. Linear mixed-effects analysis results showed that the scores of Montreal overall cognitive assessment, attentive matrices, Trail Making Test B, Phonemic Fluency, Semantic Fluency, Rey Auditory Verbal Learning Test I, Hamilton Rating Scale-Anxiety and Hamilton Rating Scale-Depression were affected by the type of the rehabilitative treatment. Our data show the effectiveness of telerehabilitation for the treatment of cognitive disorders following stroke.
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De Luca R, Latella D, Maggio MG, Di Lorenzo G, Maresca G, Sciarrone F, Militi D, Bramanti P, Calabrò RS. Computer assisted cognitive rehabilitation improves visuospatial and executive functions in Parkinson's disease: Preliminary results. NeuroRehabilitation 2020; 45:285-290. [PMID: 31498141 DOI: 10.3233/nre-192789] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disease due to dopamine deficiency in the basal ganglia, leading to motor symptoms such as bradykinesia, tremor, stiffness, and postural instability. This disease may also be associated with a broad spectrum of non-motor symptoms. More than 24% of patients with PD have one or more cognitive symptoms. OBJECTIVE To evaluate the effects of computer-assisted cognitive rehabilitation (CACR) in Parkinson's disease (PD). METHODS Sixty patients with PD were enrolled in this study and were randomly divided into control group (CG) and experimental group (EG). Each participant was evaluated at the beginning (T0) and at the end of training (T1). The CG underwent standard cognitive training (SCT) while EG performed CACR using the ERICA platform, aimed at improving several cognitive domains. In both the group, each training consisted of 3 sessions a week, each of these lasting sixty minutes, for eight weeks. RESULTS Although both the groups had significant improvement after CR, we observed more significant changes in the EG, especially concerning attention, orientation and visual-spatial domains. CONCLUSIONS Our data demonstrate that CACR is more effective than SCT in improving visual-spatial and executive deficits, in patients affected by PD.
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Maggio MG, De Luca R, Manuli A, Buda A, Foti Cuzzola M, Leonardi S, D'Aleo G, Bramanti P, Russo M, Calabrò RS. Do patients with multiple sclerosis benefit from semi-immersive virtual reality? A randomized clinical trial on cognitive and motor outcomes. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:59-65. [PMID: 31920097 DOI: 10.1080/23279095.2019.1708364] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Multiple sclerosis (MS) is a demyelinating disease of autoimmune originate. A large proportion of patient present with cognitive deficits that negatively affect their quality of life, thus, a proper cognitive rehabilitation is mandatory. The aim of this study is to evaluate the effect of semi-immersive virtual reality training (sVRT) on neuropsychological and motor recovery individuals suffering from MS. We enrolled 60 MS patients, randomized into either the control group (CG: 30) undergoing a conventional cognitive training, or the experimental group (EG: 30), which performed sVRT. Cognitive and motor outcomes were investigated through clinical and neuropsychological scales before (T0) and at the end (T1) of each different training. Only in the EG, we observed a significant improvement in cognitive parameters and motor scores. Our data demonstrate that VR cognitive training could potentiate MS patients' rehabilitation outcome, with positive results on both motor and cognitive performance.
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Affiliation(s)
- Maria Grazia Maggio
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Rosaria De Luca
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Alfredo Manuli
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Antonio Buda
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Marilena Foti Cuzzola
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Simona Leonardi
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Giangaetano D'Aleo
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Placido Bramanti
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Margherita Russo
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Rocco Salvatore Calabrò
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
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Liang JH, Lin L, Wang YQ, Jia RX, Qu XY, Li J, Li JY, Qian S, Qian YX, Wang S, Gao Z, Cheng XX, Xu Y. Non-pharmacological therapeutic strategy options for patients with dementia based on cognitive function-A Bayesian network meta-analysis of randomized controlled trials. Ageing Res Rev 2019; 56:100965. [PMID: 31678652 DOI: 10.1016/j.arr.2019.100965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/17/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
Dementia represents one of the most common neurodegenerative disorders in older adults. However, it is still unclear whether non-pharmacological therapies (NPTs) are effective or not and which treatment should be preferred. We applied a series of search strategies to identify eligible randomized controlled trials on 1st October, 2018, investigating the effects of NPTs of dementia in the older persons. Pairwise and network meta-analyses were sequentially performed. A total of 31 trials were included, which enrolled 1895 participants and 7 NPTs. Compared with control group, all the NPTs included were statistically beneficial to cognitive function, and our study indicated Comprehensive Therapy(CT) [the surface under the cumulative ranking curve (SUCRA = 92.42%)] might be the best choice for dementia patients. Our study suggests CT might be the optimal NPT for improving the cognitive function of dementia patients. However, the above conclusions need to be further analyzed.
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Loetscher T, Potter K, Wong D, das Nair R. Cognitive rehabilitation for attention deficits following stroke. Cochrane Database Syst Rev 2019; 2019:CD002842. [PMID: 31706263 PMCID: PMC6953353 DOI: 10.1002/14651858.cd002842.pub3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Many survivors of stroke report attentional impairments, such as diminished concentration and distractibility. However, the effectiveness of cognitive rehabilitation for improving these impairments is uncertain.This is an update of the Cochrane Review first published in 2000 and previously updated in 2013. OBJECTIVES To determine whether people receiving cognitive rehabilitation for attention problems 1. show better outcomes in their attentional functions than those given no treatment or treatment as usual, and 2. have a better functional recovery, in terms of independence in activities of daily living, mood, and quality of life, than those given no treatment or treatment as usual. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PsycBITE, REHABDATA and ongoing trials registers up to February 2019. We screened reference lists and tracked citations using Scopus. SELECTION CRITERIA We included controlled clinical trials (CCTs) and randomised controlled trials (RCTs) of cognitive rehabilitation for impairments of attention for people with stroke. We did not consider listening to music, meditation, yoga, or mindfulness to be a form of cognitive rehabilitation. We only considered trials that selected people with demonstrable or self-reported attentional deficits. The primary outcomes were measures of global attentional functions, and secondary outcomes were measures of attentional domains (i.e. alertness, selective attention, sustained attention, divided attention), functional abilities, mood, and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, and assessed the risk of bias. We used the GRADE approach to assess the certainty of evidence for each outcome. MAIN RESULTS We included no new trials in this update. The results are unchanged from the previous review and are based on the data of six RCTs with 223 participants. All six RCTs compared cognitive rehabilitation with a usual care control. Meta-analyses demonstrated no convincing effect of cognitive rehabilitation on subjective measures of attention either immediately after treatment (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) -0.03 to 1.08; P = 0.06; 2 studies, 53 participants; very low-quality evidence) or at follow-up (SMD 0.16, 95% CI -0.23 to 0.56; P = 0.41; 2 studies, 99 participants; very low-quality evidence). People receiving cognitive rehabilitation (when compared with control) showed that measures of divided attention recorded immediately after treatment may improve (SMD 0.67, 95% CI 0.35 to 0.98; P < 0.0001; 4 studies, 165 participants; low-quality evidence), but it is uncertain that these effects persisted (SMD 0.36, 95% CI -0.04 to 0.76; P = 0.08; 2 studies, 99 participants; very low-quality evidence). There was no evidence for immediate or persistent effects of cognitive rehabilitation on alertness, selective attention, and sustained attention. There was no convincing evidence for immediate or long-term effects of cognitive rehabilitation for attentional problems on functional abilities, mood, and quality of life after stroke. AUTHORS' CONCLUSIONS The effectiveness of cognitive rehabilitation for attention deficits following stroke remains unconfirmed. The results suggest there may be an immediate effect after treatment on attentional abilities, but future studies need to assess what helps this effect persist and generalise to attentional skills in daily life. Trials also need to have higher methodological quality and better reporting.
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Affiliation(s)
- Tobias Loetscher
- University of South AustraliaSchool of PsychologyGPO Box 2471AdelaideSAAustralia5001
| | - Kristy‐Jane Potter
- University of NottinghamDivision of Psychiatry & Applied PsychologyNottinghamNottinghamshireUKNG7 2UH
| | - Dana Wong
- La Trobe UniversitySchool of Psychology and Public HealthMelbourneAustralia
| | - Roshan das Nair
- University of NottinghamDivision of Psychiatry & Applied PsychologyNottinghamNottinghamshireUKNG7 2UH
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Gong K, Zhao L, Guo J, Wang Z. A nomogram to predict cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e17626. [PMID: 31626144 PMCID: PMC6824656 DOI: 10.1097/md.0000000000017626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
To establish a nomogram model to predict early cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients.A retrospective cohort study was held between January 2016 and October 2018. One hundred twenty seven out of 170 consecutive patients with supratentorial spontaneous intracranial hematoma were enrolled in this study. They were divided into development (n = 92) and validation (n = 35) dataset according to their admission time. Mini-mental State Examination (MMSE) was conducted between the third and the sixth month after the onset of stroke. MMSE ≤ 24 was considered as cognitive impairment. Univariate and multivariate logistic regression was used to screen for independent risk factors which correlate with cognitive impairment on the development dataset. A nomogram was built based on Akaike Information Criterion (AIC). Receiver operating characteristic (ROC) curve and calibration curve on development and validation dataset was drawn with each area under the curves (AUC) calculated. The decision curve analysis was also conducted with the development dataset.The bleeding volume, Glasgow Coma Scale (GCS), and intraventricular hemorrhage (IVH) are the most significant risk factors which may cause cognitive impairment both in the univariate and multivariate analysis. The finial model performed good discrimination ability on both development and validation dataset with AUC 0.911 and 0.919. Most patients would benefit from the model according to the decision curve analysis.A nomogram, constructed based on bleeding volume, GCS, and IVH can provide a feasible tool to evaluate cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients.
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Affiliation(s)
| | - Lizheng Zhao
- Department of Rehabilitation, The first Affiliated Hospital of Xia’men University, Xia’men, Fujian, China
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Effects of domotics on cognitive, social and personal functioning in patients with chronic stroke: A pilot study. Disabil Health J 2019; 13:100838. [PMID: 31501039 DOI: 10.1016/j.dhjo.2019.100838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/31/2019] [Accepted: 08/11/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Stroke can cause severe brain lesions, leading to multiple cognitive, emotional and motor disorders. In fact, it is one of the main causes of death and disability worldwide, with a negative impact on quality of life for both patient and caregiver. Home automation (also known as domotics) could allow stroke patients to manage and improve their daily lives. OBJECTIVE The aim of our pilot study was to evaluate the effects of domotics on cognitive functions and personal/social autonomy in patients with stroke. METHODS We enrolled 40 patients affected by chronic stroke undergoing neurorehabilitation at IRCCS Centro Neurolesi (Messina, Italy), between June 2017 and March 2019. All of the patients were randomized into either the control group (undergoing traditional training based on face-to-face interaction between therapist and patient, and practical activities), or the experimental group (undergoing Home Automation training). Each participant was evaluated before and immediately after the training period. Each different training consisted of 3 sessions per week for eight weeks (i.e. a total of 24 sessions), each session lasting about 60 min. For both the conventional and experimental trainings, treatments were performed in groups, and all the patients were provided with the same amount of treatment. RESULTS Patients in the experimental group showed a greater improvement in cognitive and social performance, as compared to the control group. CONCLUSION Our study shows that domotics could be effective in improving social and cognitive functioning, autonomy and functional recovery in patients affected by chronic stroke.
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