Background
Cognitive rehabilitation after stroke
Is cognitive rehabilitation’s impact small or are we missing better cognitive rehabilitation methodologies?
Methods
Participants and trial design
Intervention protocol
Interventions description
Paper-and-pencil intervention: the task generator
VR-based intervention: the Reh@City v2.0
Task Generator | Reh@City v2.0 |
---|---|
Cancellation - Find a target stimulus in a pool of distractors. | Buy/collect items at the supermarket, pharmacy, and post-office. |
Numeric Sequences - A numeric sequence is given and the subject has to come up with the missing numbers. | Find bank code. |
Problem Resolution - Two types of problems are presented, numeric calculations or calculations based on textual descriptions of daily activities. | Choose the correct supermarket invoice. |
Association - A number of randomized pairs of items need to be paired correctly. | Cards game at the park. |
Comprehension of Contexts - Some images are given with a number of descriptions. Correct descriptions need to be identified. | Not applicable. |
Image Pairs - A number of pairs of images to be memorized is presented and have to be recalled after 30 min. | Cards game at the park. |
Word Search - A number of words can be found up, down, forward, or diagonally in a pool of randomized letters. | Not applicable. |
Mazes - Finding the way out of a labyrinth. | Find the best route to the next destination in the virtual city. |
Categorization - Grouping items into their underlying categories. The categories have to be guessed from the items. | Select a category of items in the clothing shop. |
Action Sequencing - A list of randomized steps needed for the execution of several activities of daily living is presented. | Organize the steps for an action in the home kitchen, living room or bathroom. |
Memory of Stories - Recalling information about a read story or a picture by answering questions about it. | Memorizing verbal information from a newspaper at the kiosk for a later “true or false” recall. |
TG and Reh@City personalization and adaptation
Experimental setup
Task generator (TG)
Reh@City v2.0
Outcome measures
Primary outcome measures: general cognitive functioning, attention, memory, executive functions and language
Secondary outcome measure: self-perceived impact of cognitive functioning problems
Statistical analysis
Results
Sample description
Reh@City v2.0 (N = 14) | Task Generator (N = 18) | MW | p | |
---|---|---|---|---|
Age (years) | 59.14 ± 11.81 | 65.00 ± 6.20 | 83.500 | .106 |
Gender (M/F) | 5/9 | 11/7 | 94.000 | .161 |
Schooling (years) | 8.00 ± 5.32 | 5.50 ± 3.15 | 100.500 | .276 |
Stroke type (I/H/NS) | 12/2/0 | 14/3/1 | 115.000 | .538 |
Side of lesion (R/L/NS) | 11/3/0 | 9/6/3 | 85.500 | .072 |
Time post-stroke (months) | 45.93 ± 43.56 | 21.33 ± 12.88 | 89.500 | .164 |
Primary outcome measures
MoCA - general cognitive functioning
Reh@City v2.0 | Task Generator | |||||
---|---|---|---|---|---|---|
Pre | Post | FU | Pre | Post | FU | |
Total | 23 (19.8–26) | 25 (23–27.3)* | 28 (22.5–28.5) | 21 (18.8–24.3) | 21 (16.8–23.3) | 23 (19.8–25.3) |
Visuo-Executive | 3.5 (2.8–4) | 4 (3–5) | 4 (4–5) | 3.5 (2–4) | 4 (3–4) | 4 (2.8–5) |
Naming | 3 (2–3) | 3 (2.8–3) | 3 (1.5–3) | 2.5 (2–3) | 2 (1–3) | 3 (2–3) |
Attention | 4 (2.8–5.3) | 5.5 (3–6) | 5 (3–6) | 4 (2–5.3) | 4 (2.8–5) | 4 (3–5.2) |
Language | 2 (1.8–3) | 2 (2–3) | 3 (2–3) | 2 (2–3) | 2 (1–2) | 2 (1–2) |
Abstraction | 2 (1–2) | 2 (1–2) | 2 (1–2) | 1 (1–2) | 2 (0–2) | 1 (1–2) |
Memory | 3 (1–3.5) | 3 (2–4) | 4 (2.5–5) | 2 (0–3.3) | .50 (0–2) | 2.50 (1.8–3.2) |
Orientation | 6 (6–6) | 6 (6–6) | 6 (6–6) | 6 (5–6) | 6 (6–6) | 6 (6–6) |
TMT A & B - attention
Reh@City v2.0 | Task Generator | ||||||
---|---|---|---|---|---|---|---|
Pre | Post | FU | Pre | Post | FU | ||
TMTA | time | 72.5 (49.5–97.5) | 65 (51–86.3) | 70 (30.5–84) | 84 (59.5–114.3) | 72 (58.8–99.5) | 76.5 (59.3–114.3) |
errors | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–.50) | |
TMTB | time | 195 (130.8–360) | 200 (135.5–241) | 190 (61.5–360) | 209.5 (123.3–256.5) | 236 (152–360) | 202 (112.3–360) |
errors | 0 (0–3) | 0.5 (0–1.25) | 1 (0–4.5) | 3 (1.5–6) | 3 (1–4.5) | 2.5 (0–3.8) | |
WMSIII | VPA learning | 2 (.75–4) | 1.5 (1–4) | 5 (1–6) | 1 (0–2) | 1 (.75–2.3) | 1.50 (8–4) |
VPA retention | 75 (0–100) | 100 (74.1–100) | 83.3 (25–93.8) | .00 (0–56.3) | 82.9 (26.5–100) | 82.9 (37.5–100) | |
VPA recognition | 24 (21.8–24) | 24 (24–24) | 24 (24–24) | 23 (19.8–24) | 24 (21–24) | 24 (23.8–24) | |
WAISIII | DSC codification | 28.5 (23.5–36.8) | 33 (26.8–47) | 33 (19–50) | 21.5 (11.8–33) | 26.5 (18.8–38.3) | 27 (16.8–34.3) |
DSC incidental learning | 3 (.0–10.5) | 6.5 (4–11.5) | 10 (3–16) | 4 (1.5–8.8) | 6 (.8–10.5) | 8 (2–14) | |
Symbol Search | 13.5 (9.8–20.5) | 17.5 (10.3–24) | 17 (10–25.5) | 12 (7.8–13.5) | 14 (10–16.5) | 15 (9–20.3) | |
Digit Span | 11 (10–13) | 10 (8.8–13) | 11 (10.5–13.5) | 10 (8–11) | 10.5 (8.8–12) | 10 (9.5–13.3) | |
Vocabulary | 29 (21–34) | 25.5 (12.8–30.3) | 22 (13.5–40) | 19.5 (13–28.5) | 20.5 (12.8–30.3) | 24.5 (16.5–30.3) |
WMS-III verbal paired associates - memory
WAIS-III vocabulary - language
Secondary outcome measure
Patient-reported evaluation of cognitive state
Reh@City v2.0 | Task Generator | |||||
---|---|---|---|---|---|---|
Pre | Post | FU | Pre | Post | FU | |
PRECiS | 13.5 (7–23.8) | 12 (3.8–21.3) | 13 (0–24.5) | 28.5 (6–47) | 18.5 (8.5–44.8) | 13.5 (5.5–30.3) |