Cognitive Rehabilitation - Authors

NOTE: When reviewing the findings of randomized clinical trials (RCTs), repeated measures studies, crossover studies, cohort studies and quasi-experimental studies in the results table, it is important to note that a ‘+’ is indicated only if there was a significant post treatment difference between the treatment group and the control group. For pre-post study designs, a ‘+’ indicates a significant difference from pre to post intervention assessment.

Author, year, PEDro score

Sample size

Intervention

Outcome and significance:
(+) significant (-) not significant

Aben et al., 2013
PEDro score: 8
Country: The Netherlands

153 patients with chronic stroke

Memory self-efficacy training program
(n=77)

vs.

Peer support program
(n=76)

Treatment details:
9 x 1-hour sessions, 2 times/week.

Memory self-efficacy training program: group program with 4-6 participants to teach internal/external memory strategies and psychoeducation regarding the influence of negative perceptual bias.

Peer support program: time-matched general stroke education group program.

At 5 weeks (post-treatment):
(+) Metamemory-In-Adulthood Questionnaire
(-) Center of Epidemiological Studies Depression Scale
(-) EuroQoL EQ5D Questionnaire – utility score
(-) EuroQoL EQ5D Questionnaire – Visual Analogue Scale
(-) WhoQol Brief Questionnaire – psychological quality of life
(-) WhoQol Brief Questionnaire – social quality of life
(-) Auditory Verbal Learning Test – delayed recall
(-) Rivermead Behavioral Memory Test – Story Recall (delayed recall)

Barker-Collo et al., 2009
PEDro score: 8
Country: New Zealand

78 patients with chronic stroke

Attention process training (n=38)

vs.

Standard care (n=40)

Treatment details:
1 hour/weekday for 4 weeks

At 4 weeks (post-treatment):
(+) Integrated Visual Auditory Continuous Performance Test (IVA-CPT) – Full attention
(+) IVA-CPT – Auditory attention
(-) IVA-PCT – Visual attention
(-) Paced Auditory Serial Addition Test
(-) Trail Making Test – A
(-) Trail Making Test – B
(-) Bells Test
(-) Short Form-36 (SF-36) – Physical
(-) SF-36 – Mental

At 6 months (follow-up):
(+) IVA-CPT – Full attention
(-) IVA-CPT – Auditory attention
(-) IVA-PCT – Visual attention
(-) Paced Auditory Serial Addition Test
(-) Trail Making Test – A
(-) Trail Making Test – B
(-) Bells Test
(-) SF-36 – Physical
(-) SF-36 – Mental
(-) Modified Rankin Scale
(-) Cognitive Failure Questionnaire
(-) General Health Questionnaire – 28

Chen et al., 2012
PEDro score: 5
Country: USA

11 patients with acute/subacute stroke

Global attention processing training (n=6)

vs.

Rote repetition training (n=5)

Treatment details:
90 minutes

Global attention processing training (global to local encoding): copying a set of Rey-Osterrieth Complex Figure (ROCF) subunits ranging from general picture to specific details. The sequential tracing from global to local was repeated 5 times.

Rote repetition training (no encoding strategy): copying one ROCF presented entirely (global + specific features). The rote tracing was repeated 5 times.

Both training sessions consisted of 3 phases:
1. Pre-training phase (immediate reproduction of ROCF)
2. training phase
3. Post-training phase (30 minutes after phase 2, delayed reproduction of ROCF)

Immediately post-training:
(-) ROCF Copy/configural organization at encoding
(+) ROCF Immediate recall accuracy score

30 minutes post training:
(-) ROCF Copy/configural organization at encoding
(+) ROCF Delayed recall / recognition score

At 1 day post-training:
(+) ROCF Copy/configural organization at encoding
(+) ROCF Immediate recall accuracy score
(-) ROCF Delayed recall / recognition score

At 2 and 4 weeks post-training:
(-) ROCF Copy/configural organization at encoding
(-) ROCF Immediate recall accuracy score
(-) ROCF Delayed recall / recognition score

Doornhein & De Haan, 1998 
PEDro score: 4
Country: The Netherlands

12 patients with subacute stroke

Cognitive rehabilitation memory training programme (n=6)

vs. 

Non-specific memory training programme (n=6)

Treatment details: 
2 sessions/week (duration not provided) for 4 weeks.

Cognitive rehabilitation memory training programme comprised six simple memory strategies that transferred to daily memory problems.

Non-specific training programme used repetitive drills and practice of memory tasks.

At 4 weeks (post treatment):
+) Name-Face Paired Associated Memory Test
(-) Stylus Maze Test*
(-) 15 Words Test
(-) Oxford Recurring Faces Test
(-) Memory Questionnaire
* There was potentially a ceiling effect for this test.

Faria et al., 2016
PEDro score: 7
Country: Portugal

18 patients with chronic stroke

Virtual reality (VR)-based cognitive rehabilitation (n=9)

vs.

Conventional cognitive rehabilitation (n=9)

Treatment details:
12 x 20-minute sessions over 4-6 weeks (weekly frequency not specified).

VR-based cognitive rehabilitation: Reh@City 3D virtual simulation of a city (environment) that uses daily routines integrating memory, attention, visuo-spatial and executive functioning abilities. Levels of difficulty were adjustable.

Conventional cognitive rehabilitation: time-matched cognitive training comprising puzzles, calculus, problem resolution, shape sorting, etc.

At 4-6 weeks (post-treatment):
(+) Addenbrooke Cognitive Examination (ACE) – total
(+) ACE – attention
(-) ACE – memory
(+) ACE – fluency
(-) ACE – language
(-) ACE – visuospatial
(+) Mini-Mental State Examination
(-) Trail Making Test – A
(-) Trial Making Test – B
(-) Picture Arrangement (WAIS – III)
(-) Stroke Impact Scale

Fish et al., 2008 
PEDro score: 5 randomised control crossover design
Country: UK

36 patients with chronic stroke

Paging system

vs.

No treatment

Treatment details:
The NeuroPager sent reminders to assist with memory and planning.

Group A (n=24)
Group B (n=12)

3-stage trial:

1)    T1 – 2 weeks (baseline, no intervention)

2)    T2 – 7 weeks (Group A: pager; Group B: no pager)

3)    T3 – 7 weeks (Group A: no pager; Group B: pager).

At 9 weeks (post T2):
(+) Memory diary – % of tasks achieved

At 16 weeks (post T3)
(+) Memory diary – % of tasks achieved*
* In favour of Group B vs. Group A.

Note: At 16 weeks Group A’s performance had deteriorated to baseline levels (i.e. participants did not retain the benefits gained immediately post-treatment).

Gamito et al., 2015
PEDro score: 3
Country: Portugal

20 patients with stroke (stage of stroke recovery not specified)

Virtual reality (VR) – based cognitive rehabilitation (n=10)

vs.

No VR-based cognitive rehabilitation (n=10)

Treatment details:
60-minutes/session, 2-3 times/week for 4-6 weeks.

VR-based cognitive rehabilitation: Serious Games application that trained working memory, spatial orientation, selective attention, recognition memory, calculation.

The control group was placed on a waiting list to receive VR cognitive training.

At 4-6 weeks (post-treatment):
(+) Wechsler Memory Scale total score
(+) Toulouse-Pieron Test – work efficiency
(-) Rey Complex Figure – immediate recall

Giaquinto & Fraioli, 2003
PEDro score: 4
Country: Italy

40 patients with acute stroke

Attention training with cutaneous electrical stimulation (n=20)

vs.

No training (n=20)
Treatment details:
40-minute/session, 5 times/week for 3 weeks.

Attention training: computerized discrimination reaction time task.

Electrical stimulation: 0.1ms of pulse duration, 25mA of stimulus amplitude.

Both groups received conventional rehabilitation that comprised physical and occupational therapy (frequency and duration of sessions not specified).

At 3 weeks (post-treatment):
(-) Functional Independence Measure
(+) EEG signals – N140 component of somatosensory event related potential

Mazer et al., 2003
PEDro score: 7
Country: Canada

97 patients with subacute/chronic stroke

Useful Field of View (UFOV) visual attention retraining program

(n=47)

vs.

Traditional computerized visuoperception training (n=50)

Treatment details:
20 x 30-60-minutes/ session, 2-4 times/week for 5 weeks.

UFOV: training of visual processing speed, divided attention, and selective attention using the UFOV computer program

Traditional computerized visuoperception training: using commercially-available computer software (Tetris, Mastermind, Othello, Jigs@w Puzzle).

At 5 weeks (post-treatment):
(-) Useful field of view (UFOV) – total
(-) UFOV – processing speed
(-) UFOV – divided attention
(-) UFOV – selective attention
(-) Complex Reaction Timer
(-) Motor-Free Visual Perception Test
(-) Single and Double Letter Cancellation Test
(-) Money Road Map Test of Direction Change
(-) Trail Making Test A & B
(-) Bells Test
(-) Charron Test
(-) Test of Everyday Attention
(-) On-road driving evaluation

McEwen et al., 2015
PEDro score: 5
Country: Canada

35 patients with acute/subacute stroke

Cognitive Orientation to Daily Occupational Performance (CO-OP)
(n=19)

vs.

Conventional rehabilitation
(n=16)

Treatment details:
CO-OP: 45 minute sessions, approx. 2x/week, maximum of 10 CO-OP sessions + additional conventional rehabilitation (average 13 sessions). CO-OP is a client-centered, performance-based, problem solving approach that enables skill acquisition through a process of strategy use and guided discovery.

Conventional rehabilitation: 45-60 minutes/session, approx. 2x/week, average 12 sessions.

At 10 sessions (post-treatment):
(+) Performance Quality Rating Scale (PQRS) – trained
(+) PQRS – untrained
(-) Canadian Occupational Performance Measure (COPM) – performance trained
(-) COPM – performance untrained
(-) COPM – satisfaction trained
(-) COPM – satisfaction untrained
(-) Self-Efficacy Gauge

At 3 months post-treatment (follow-up):
(+) PQRS – trained
(+) PQRS – untrained
(-) COPM – performance trained
(-) COPM – performance untrained
(-) COPM – satisfaction trained
(-) COPM – satisfaction untrained
(-) CPI – importance of participation
(+) CPI – control over participation*
(-) CPI – satisfaction with participation
(+) Stroke Impact Scale – participation*
(+) Self-Efficacy Gauge*

Note: Median and non-parametric effect sizes were reported given that outcome variables were not normally distributed. Results (+) reflect medium to large effect sizes for the treatment group over the control group.

* Change from post-treatment to follow-up

Polatajko et al., 2012
PEDro score: 4
Country: Canada

20 patients with chronic stroke

Cognitive Orientation to Occupational Performance (CO-OP) approach
(n=11)

vs.

Conventional occupational therapy
(n=9)

Treatment details:
10 1-hour sessions (duration and frequency not specified)

CO-OP: client-centred, performance-based, problem solving approach to enable skill acquisition through a process of strategy use and guided discovery.

Conventional OT: time-matched task-specific and component-based training.

At 10 sessions (post-treatment):
(+) Performance Quality Rating Scale
(+) Canadian Occupational Performance Measure (COPM) – Performance
(-) COPM – Satisfaction

Prokopenko et al., 2013
PEDro score: 6
Country: Russia

43 patients with acute/subacute stroke

Computer training + conventional rehabilitation (n=24)

vs.

Conventional rehabilitation (n=19)

Treatment details:
30-minutes/session, 7 days/week for 2 weeks (up to 15 hours of treatment).

Computer training: Schulte’s tables to improve sustained, selective, divided and alternating attention; included biological feedback.

At 2 weeks (post-treatment):
(-) Mini-Mental Status Examination
(-) Montreal Scale of Cognitive Assessment
(+) Clock Drawing Test
(+) Shulte’s test
(-) Hospital Anxiety and Depression Scale (HADS) – Anxiety
(-) HADS – Depression
(+) Frontal Assessment Battery

Rose et al., 1999
PEDro score: 5
Country: UK

 

48 patients with stroke (phase of stroke recovery not specified) + 48 healthy controls

Active virtual reality (VR) memory retraining program

(n=24 patients with stroke)

vs.

Passive VR memory retraining program

(n=24 patients with stroke)

Treatment details:
1 session (duration not specified)

Active VR memory retraining program: exploration of virtual environment to locate a particular object using a joystick.

Passive VR memory retraining program: passive exploration of a virtual environment to locate a particular object (no joystick).

At end of 1 training session (post-treatment):
(+) Spatial recognition test
(-) Object recognition test

Sturm et al., 1991 
PEDro score: N/A (quasi-experimental cross-over design)

Country: Germany

35 patients with subacute stroke

Early computer assisted reaction training (n=13)
vs.

Late computer assisted reaction training (n=22)

Treatment details:
Computer-assisted reaction training using programmable versions of the Wiener Determinationsgerat (15 minutes) and the Wiener Konzentrationsgerat (a.k.a. Cognitrone, 15 minutes); 14 sessions spread over 3 weeks.

Stage I (training/no training): 3 weeks

Stage II (crossover training/no training): 3 weeks

Stage III (no training): 6 weeks

At 12 weeks (follow-up):
Comparison between treatment and control according to systematic review by Lincoln et al., (2000):
(+) Wiener Determinationsgerat
(-) Wiener Reaktionsgerat
(-) Cognitrone
(+) Wiener Vigilanzgerat
(-) Test d2
(-) Leistungsprufsystern
(-)Wechsler Adult Intelligence Scale – Similarities subscale
(-) Intelligenz-Struktur-Test
(-) Raven Standard Progressive Matrices

Sturm et al., 1997
PEDro score: N/A (non-randomized study)
Country: Germany

38 patients with subacute/chronic stroke.

Game-like computerized adaptive training of attention

Treatment details:
Attention training addressed two of four domains: alertness, vigilance, selective attention and divided attention, whereby each patient received training in their 2 most impaired domains.

Training for each attention domain was provided for 14 x 60-minute sessions over 3 weeks (total 28 sessions/participant).

At end of training period (post-treatment):
(+) Response time without warning signal* (alertness)
(-) Response time with warning signal (alertness)
(+) Hit-rate* (vigilance)
(-) Response with warning (vigilance)
(+) Response time with warning* (selective attention)
(-) Error rate (selective attention)
(-) Response time with warning (divided attention)
(+) Error rate* (divided attention)
*Refers to “domain-specific training effects” where significant improvement are achieved only by specific training vs. unspecific training.

Winkens et al., 2009
PEDro score: 7
Country: The Netherlands

37 patients with subacute/chronic stroke

Time pressure management (n=20)

vs.

Conventional rehabilitation (n=17)

Treatment details:
10 hours at the rate of 1, 1.5, or 2 hours/week.

Time pressure management: teaching preventative and management cognitive strategies.

Conventional therapy: education, practical advice; 1 participating center trained patients to perform tasks while using compensatory strategies.

At 10 hours of treatment (post-treatment):
(+) Information Intake Task (IIT) – no. of strategies
(-) IIT – reproduction score 
(-) Mental Slowness Observation Test (MSOT) – no. of strategies
(-) MSOT – no. of correct elements
(-) MSOT – time
(-) Mental Slowness Questionnaire
(-) Barthel Index
(-) Fatigue Severity Scale
(-) Center for Epidemiologic Studies Depression Scale
(-) EuroQol-5D
(-) Symbol Digit Modalities Test
(-) Paced Auditory Serial Addition Test
(-) Auditory Verbal Learning Test
(-) Trail Making Test – A
(-) Trail Making Test – B

At 3 months (follow-up):
(-) IIT – no. of used strategies
(-) IIT – reproduction score 
(-) MSOT – no. of used strategies
(-) MSOT – no. of correct elements
(+) MSOT – time (sec)
(-) Mental Slowness Questionnaire
(-) Barthel Index
(-) Fatigue Severity Scale
(-) Center for Epidemiologic Studies Depression Scale
(-) EuroQol-5D
(-) Symbol Digit Modalities Test
(-) Paced Auditory Serial Addition Test
(-) Auditory Verbal Learning Test
(-) Trail Making Test – A
(-) Trail Making Test – B

Wolf et al., 2016
PEDro score: 5
Country: Canada

35 patients with acute/subacute stroke

Cognitive Orientation to Daily Occupational Performance (CO-OP) (n=19)

vs.

Conventional occupational therapy (n=16)

Treatment details:
10 sessions (duration and frequency not specified).

CO-OP is a client-centred, performance-based, problem solving approach that enables skill acquisition through a process of strategy use and guided discovery.

At 10 sessions (post-treatment):
(+) Stroke Impact Scale (SIS) – Activities of daily living (ADLs)*
(-) SIS – Mobility
(+) SIS – Hand function*
(+) SIS – Strength*
(+) SIS – Recovery*
(+) SIS – Physical *
(+) SIS – Memory*
(+) SIS – Emotion*
(+) SIS – Communication*
(-) Action Research Arm Test (ARAT)
(+) ARAT – Impairment*
(+) Delis-Kaplan Executive Function System – Trail Making subtest *

At 3 months post-treatment (follow-up):
(-) SIS – ADLs
(-) SIS – Mobility
(+) SIS – Hand function*
(-) SIS – Strength
(-) SIS – Recovery
(-) SIS – Physical
(-) SIS – Memory
(-) SIS – Emotion
(+) SIS – Communication*
(-) ARAT
(+) ARAT – Impairment*
(+) Delis-Kaplan Executive Function System – Trail Making subtest *

* Medium to large effect sizes for the CO-OP approach over the control group

Median and non-parametric effect sizes were reported given that outcome variables were not normally distributed.

 

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