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Gangemi A, De Luca R, Fabio RA, Lauria P, Rifici C, Pollicino P, Marra A, Olivo A, Quartarone A, Calabrò RS. Effects of Virtual Reality Cognitive Training on Neuroplasticity: A Quasi-Randomized Clinical Trial in Patients with Stroke. Biomedicines 2023; 11:3225. [PMID: 38137446 PMCID: PMC10740852 DOI: 10.3390/biomedicines11123225] [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: 10/07/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Cognitive Rehabilitation (CR) is a therapeutic approach designed to improve cognitive functioning after a brain injury, including stroke. Two major categories of techniques, namely traditional and advanced (including virtual reality-VR), are widely used in CR for patients with various neurological disorders. More objective outcome measures are needed to better investigate cognitive recovery after a stroke. In the last ten years, the application of electroencephalography (EEG) as a non-invasive and portable neuroimaging method has been explored to extract the hallmarks of neuroplasticity induced by VR rehabilitation approaches, particularly within the chronic stroke population. The aim of this study is to investigate the neurophysiological effects of CR conducted in a virtual environment using the VRRS device. Thirty patients with moderate-to-severe ischemic stroke in the chronic phase (at least 6 months after the event), with a mean age of 58.13 (±8.33) for the experimental group and 57.33 (±11.06) for the control group, were enrolled. They were divided into two groups: an experimental group and a control group, receiving neurocognitive stimulation using VR and the same amount of conventional neurorehabilitation, respectively. To study neuroplasticity changes after the training, we focused on the power band spectra of theta, alpha, and beta EEG rhythms in both groups. We observed that when VR technology was employed to amplify the effects of treatments on cognitive recovery, significant EEG-related neural improvements were detected in the primary motor circuit in terms of power spectral density and time-frequency domains. Indeed, EEG analysis suggested that VR resulted in a significant increase in both the alpha band power in the occipital areas and the beta band power in the frontal areas, while no significant variations were observed in the theta band power. Our data suggest the potential effectiveness of a VR-based rehabilitation approach in promoting neuroplastic changes even in the chronic phase of ischemic stroke.
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Affiliation(s)
- Antonio Gangemi
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113, Cda Casazza, 98124 Messina, Italy; (A.G.); (R.D.L.); (P.L.); (C.R.); (P.P.); (A.M.); (A.O.); (A.Q.)
| | - Rosaria De Luca
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113, Cda Casazza, 98124 Messina, Italy; (A.G.); (R.D.L.); (P.L.); (C.R.); (P.P.); (A.M.); (A.O.); (A.Q.)
| | - Rosa Angela Fabio
- Department of Economics, University of Messina, Via Consolare Valeria, 98125 Messina, Italy;
| | - Paola Lauria
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113, Cda Casazza, 98124 Messina, Italy; (A.G.); (R.D.L.); (P.L.); (C.R.); (P.P.); (A.M.); (A.O.); (A.Q.)
| | - Carmela Rifici
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113, Cda Casazza, 98124 Messina, Italy; (A.G.); (R.D.L.); (P.L.); (C.R.); (P.P.); (A.M.); (A.O.); (A.Q.)
| | - Patrizia Pollicino
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113, Cda Casazza, 98124 Messina, Italy; (A.G.); (R.D.L.); (P.L.); (C.R.); (P.P.); (A.M.); (A.O.); (A.Q.)
| | - Angela Marra
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113, Cda Casazza, 98124 Messina, Italy; (A.G.); (R.D.L.); (P.L.); (C.R.); (P.P.); (A.M.); (A.O.); (A.Q.)
| | - Antonella Olivo
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113, Cda Casazza, 98124 Messina, Italy; (A.G.); (R.D.L.); (P.L.); (C.R.); (P.P.); (A.M.); (A.O.); (A.Q.)
| | - Angelo Quartarone
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113, Cda Casazza, 98124 Messina, Italy; (A.G.); (R.D.L.); (P.L.); (C.R.); (P.P.); (A.M.); (A.O.); (A.Q.)
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113, Cda Casazza, 98124 Messina, Italy; (A.G.); (R.D.L.); (P.L.); (C.R.); (P.P.); (A.M.); (A.O.); (A.Q.)
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Askari S, Harvey K, Sam-Odutola M. Patients experience of cognitive fatigue post-stroke: an exploratory study. Disabil Rehabil 2023:1-8. [PMID: 37937816 DOI: 10.1080/09638288.2023.2280065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/01/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE Cognitive fatigue is commonly reported and described as disabling by patients recovering from neurological conditions including stroke. However, cognitive fatigue is usually underdiagnosed among stroke survivors which leads to a lack of specific treatments for this condition. Therefore, the aim of this study was to explore post-stroke cognitive fatigue as it is experienced by stroke survivors. METHODS This qualitative research followed the principles of descriptive phenomenology within a constructivist paradigm. Individual semi-structured interviews were conducted with stroke survivors experiencing post-stroke cognitive fatigue recruited through the Heart and Stroke Foundation, the Canadian Partnership for Stroke Recovery, and social media posts. Data were analyzed through inductive content analysis. RESULTS Eleven stroke survivors participated. The analysis revealed five themes illustrating the experience and descriptions of post-stroke cognitive fatigue: (1) characteristics, (2) aggravating factors, (3) management, (4) effect of cognitive fatigue on daily life, and (5) social awareness and support. CONCLUSION This study highlights the complexity of post-stroke cognitive fatigue. Cognitive fatigue becomes more evident after discharge; therefore, clinicians should consistently screen for it and provide proper education to the patients and their carers.IMPLICATIONS FOR REHABILITATIONCognitive fatigue is a complex phenomenon that can negatively affect the daily life of stroke survivors.Sensory-overloaded environments, emotional distress, poor sleep, and engaging in complex cognitive tasks can trigger post-stroke cognitive fatigue.More education on the concept of cognitive fatigue should be provided to healthcare providers to be able to identify and manage this symptom properly.
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Affiliation(s)
- Sorayya Askari
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Keri Harvey
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Mary Sam-Odutola
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
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O' Donoghue M, Boland P, Taylor S, Hennessy E, Murphy E, Leahy S, McManus J, Lisiecka D, Purtill H, Galvin R, Hayes S. OptiCogs: feasibility of a multicomponent intervention to rehabilitate people with cognitive impairment post-stroke. Pilot Feasibility Stud 2023; 9:178. [PMID: 37853485 PMCID: PMC10583340 DOI: 10.1186/s40814-023-01300-7] [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: 09/07/2022] [Accepted: 04/10/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Stroke is a leading cause of death and disability worldwide. Despite the prevalence and associated burden of cognitive impairment post-stroke, there is uncertainty regarding optimal cognitive rehabilitation for people post-stroke. This study aimed to assess whether a multicomponent intervention, called OptiCogs, is feasible, acceptable, and safe for people with cognitive impairment post-stroke. A secondary aim was to explore changes in cognitive function, fatigue, quality of life, physical function, and occupational performance, from pre-intervention to post-intervention. METHODS A feasibility study was conducted where people post-stroke with cognitive impairment enrolled in a 6-week multicomponent intervention. The primary outcomes recorded included response rate, recruitment rate, retention rate, adherence to the intervention protocol, adverse events, and acceptability of the intervention to people post-stroke. Secondary outcomes included (i) change in cognitive functioning using the Addenbrooke's Cognitive Examination III, (ii) fatigue using the Fatigue Severity scale, (iii) quality of life using the Stroke Specific Quality of Life scale (iv) physical function using the patient-reported outcomes measurement information system, and (v) patient-reported occupational performance using the Canadian Occupational Performance Measure. The Consolidated Standards of Reporting Trials extension reporting guidelines were followed, for pilot and feasibility studies, to standardize the conduct and reporting of this study. RESULTS The response rate was 10.9%. Nine eligible participants were enrolled during the 4-month recruitment period, with eight participants completing the entire 6-week intervention, as well as the pre- and post-intervention outcome measures. There were no reported adverse events. Participants were satisfied with the intervention and found it acceptable overall. Results of the secondary outcomes were promising for cognitive function (ACE III, pre: 63.3 ± 23.9 to post: 69 ± 24.6), fatigue (FSS, pre: 52.5 ± 7.3 to post: 45.6 ± 7.2), quality of life (SSQoL, pre: 131.0 ± 26.3 to post: 169.9 ± 15.3), physical function (PROMIS-PF, pre: 15.5 ± 6.3 to post: 15.8 ± 5.3), and occupational performance (COPM performance, pre: 9.3 ± 2.3 to post: 22.9 ± 4.2) and COPM satisfaction, pre: 9.9 ± 2.1 to post: 22.7 ± 3.5). CONCLUSION Preliminary results suggest low-modest recruitment and high retention rates for the OptiCogs intervention. Changes in cognitive function, fatigue, quality of life, and self-reported occupational performance show improvement from pre- to post-intervention. These potential benefits require further testing in a larger pilot trial. TRIAL REGISTRATION NCT05414539.
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Affiliation(s)
- Mairéad O' Donoghue
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Pauline Boland
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Sinead Taylor
- Acute Stroke and Neurology Services, UL Hospitals Group, University Hospital Limerick, Limerick, Ireland
| | - Edel Hennessy
- Early Supported Discharge, UL Hospitals Group, University Hospital Limerick, Limerick, Ireland
| | - Eva Murphy
- Early Supported Discharge, UL Hospitals Group, University Hospital Limerick, Limerick, Ireland
| | - Siobhan Leahy
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Mayo Institute of Technology, Dublin Road, GalwayGalway, Ireland
| | - John McManus
- Acute Stroke and Neurology Services, UL Hospitals Group, University Hospital Limerick, Limerick, Ireland
| | - Dominika Lisiecka
- Department of Nursing and Healthcare Sciences, School of Health and Social Sciences, Munster Technological University Kerry Campus, Kerry, Ireland
| | - Helen Purtill
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Sara Hayes
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
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