Cognitive Rehabilitation

Evidence Reviewed as of before: 20-04-2017

Author(s)*: Tatiana Ogourtsova, MSc BSc OT; Adam Kagan, B.Sc.; Amy Henderson, PhD Student, Neuroscience; Nicol Korner-Bitensky PhD OT

Editor(s): Annabel McDermott, OT

Patient/Family Information

Introduction

Cognitive skills are characterized as basic mental abilities, including a wide variety of mental processes. For example, perception, memory, problem solving, attention, body awareness in addition to many others. Cognitive abilities can be perceived as fundamental processes since they can shape social, emotional, as well as academic learning. In individuals who have sustained a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, these skills may be altered resulting in deficits in several areas of functioning such as communication, self-care, productivity and leisure. Cognitive rehabilitation is based upon scientific theories that have been derived from various disciplines including cognitive neuroscience, neuropsychology, neurolinguistics, and language and cognitive development. It is a treatment that comprises both medical and therapeutic services, specifically aimed at restoring as many cognitive functions as possible while proposing different compensatory strategies to more fully cope with cognitive deficits. The aim of this module is to address the effectiveness of cognitive rehabilitation for improving attention deficits and memory in patients who have suffered a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Patient/Family Information

What is cognitive rehabilitation?

Cognitive rehabilitation is a goal-oriented program that aims to improve cognitive functions (memory, attention, and concentration) and daily living skills (i.e. using the telephone, managing medication, and handling money) that may have been affected by your strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. The rehabilitation program is developed according to each client’s specific needs. The goal is to improve performance in tasks that are important to you. Two approaches are usually adopted: the remedial (or restorative) approach and the compensatory approach.

www.brainsource.com/brain_rehabilitation.htm

Why use cognitive rehabilitation after a stroke?

Cognitive impairment, a problem involving the mind, is very common following a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. There are different kinds of cognitive impairment, such as forgetfulness, confusion, and/or disorientation, which can interfere with safety, productivity, independence and personal relationships.

Cognitive rehabilitation has been developed by physicians, scientists, and health professionals to improve cognitive function. This therapy also aims to help people with cognitive dysfunction deal with the impact it has on their lives. With the help of cognitive rehabilitation, many people can have a productive and satisfying life following a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

What can I expect before I start therapy?

Your cognitive rehabilitation therapy treatment will be based on your own individual goals and will consider all of your strengths and weaknesses in cognitive function. There are several techniques that can help you to achieve the goals of your treatment, such as auditory and/or visual attentional tasks and memory training. You may be asked to take a variety of neuropsychological tests in order to determine your current cognitive functioning. This will help your therapists develop a suitable treatment plan. Some of these tests may seem to ask silly questions or you may feel nervous trying to answer correctly. Remember that the most important thing before starting therapy is for you and your therapist to understand where you need to focus your therapy efforts. So try to keep that in mind when doing the various tests.

How does the restorative (remedial) approach work?

The goal of this approach is to restore the cognitive functions that have been impaired by a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. It involves practicing the skills with which you have difficulty until you see improvement. The goal is for you to eventually be able to apply the skills you have learned in therapy to real life situations. The restorative approach involves 3 formats: Drill and practice This method is used to reinforce your cognitive capacities through repetitive practice. You can retrain yourself to perform tasks by practicing them over and over until you have mastered them. For example, to relearn a task such as making coffee, you would formulate a series of steps (filling the container with water, grinding the coffee, turning on the machine, etc) and then practice these steps until it becomes second nature once again.

Mnemonic Strategies These are tricks used to help remember specific information such as telephone numbers, vocabulary, appointments. They can also help you to learn new information. Your therapist will help you develop these tricks and you may already have some of your own that you have used in the past. Mnemonic strategies include: Verbal mnemonic strategies Words are used to aid memory. They encompass the use of:

Acronyms: These are abbreviations in which each letter stands for the first letter in the list of words you want to remember. For example, the word ‘HOMES’ can help you remember the names of the Great Lakes: Huron, Ontario, Michigan, Erie, and Superior.
Rhymes: Rhymes are useful in helping to remember facts, such as : “Fourteen hundred and ninety-two, Columbus sailed the ocean blue”
Songs: Songs like the “Alphabet Song” are great for learning and memory – a,b,c,d e,f,g, h,i, j, k, etc.
Acrostics: These are similar to acronyms, but instead of only one word per letter, there can be a sentence assigned to each letter.
Verbal stories: Often explaining something out loud as a story is a useful memory tool.
Coding methods: There are many ways of using code, such as transforming numbers into letters.
http://coe.jmu.edu/LearningToolbox/images/homes.gif

Imagery mnemonic strategies In this form of memory building, visual images are used to aid memory. The best known techniques are the list learning strategies. They include 4 methods:

The method of loci or place method: This is a mnemonic strategy that is very effective for remembering lists. To use this method you choose a place that you are very familiar with (your house for example). Think of different landmarks in that place (the bathroom, the kitchen, the hall, etc) and train yourself to go around the landmarks in a particular order. Let’s say you are trying to remember a shopping list. Imagine each of the items on the list in one of the landmarks you have in mind. For example, you may picture a giant carton of milk on the couch, or a huge banana in the bathtub.
The numeric Pegword method: This method is useful for remembering numbered or ordered information. It involves rhyming words for numbers, since the words may be easier to remember in association with what you are trying to learn. This way, instead of having to memorize numbers, you picture the word associated with them. For example:
- one is bun
- two is shoe
- three is tree
- four is door
- five is hive etc.
The link method: This is when you make simple associations between items in a list, linking them with an image containing all of the items. For example, if the first item on the list was a dog and the second was a motorcycle, then you may try to visualize a dog riding a motorcycle. The fact that this image is bizarre and impossible will help you to remember it.
The visual story method: This involves linking items together in a memorable story. For example, you may try to remember the planets in order of distance from the sun: “As the heat comes off the SUN, the MERCURY in the thermometer rises. Then the thermometer explodes and the mercury droplets fall onto a beautiful goddess named VENUS. To hide form the mercury droplets, Venus digs a big hole in the EARTH….”. http://www.mindtools.com/pages/article/newTIM_01.htm

Computer-based tools Virtual reality Virtual reality is a technology that allows a user to interact with a computer-simulated environment. Examples of cognitive skills that can be improved using virtual reality a

Short-term memory: the capacity to remember information for a short period of time
Selective attention: the ability to concentrate on and perform activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
while filtering out other distractions
Sustained memory: the ability to remain focused for a length of time.
Divided attention“The allocation of attentional resources across more than one task” (Ponsford, 2008, p. 514)
: the capacity to attend to two or more stimuli at the same time.

Other computerized tools Computer software exists to work on different cognitive abilities such as visual memory, verbal memory, attention to visual objects etc.. ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
to work on these functions include the use of numbers, letters, words, and shape sequences. NOTE: Don’t be concerned if you are not familiar with computers – these programs work quite simply and your therapist can show you how to use them easily.

Is restorative therapy effective?

There has not been a lot of research on cognitive retraining for memory and attention. We need more studies before we can say how effective this treatment is for retraining cognitive skills after a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

How does the compensatory approach work?

The compensatory approach is another type of cognitive rehabilitation used with people who have had a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. You or your therapist may turn to the compensatory approach when efforts to restore cognitive function are not working well. Compensatory strategies can be taught by an occupational therapistIn charge of the “assessment of personal and domestic care activities; evaluation and treatment of functional impairments related to change in sensorimotor, cognitive and perceptual abilities; prescription of wheelchairs and bathroom appliances; home visits; patient and family education.”(Suggested by Philips et al, 2002)
, a physiotherapist, or a speech-language pathologist. Family members can also help you find ways to facilitate daily activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
. It is important to be creative when coming up with compensatory techniques. Let people know your preferences in terms of strategies when planningPlanning ability involves anticipating future events, formulating a goal or endpoint, and devising a sequence of steps or actions that will achieve the goal or endpoint” (Anderson, 2008, p. 17)
compensatory techniques. http://www.isabella.org/images/rehab-SpeechTherapy.jpg Compensatory strategies include making changes in your environment (home, school, workplace, etc) or adopting different methods of performing activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
. As well, compensatory strategies involve making use of devices that help with remembering tasks, for example there are many options on wrist-watches and other innovative gadgets that can remind you about a scheduled activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(e.g. visiting a loved one). Other examples of compensatory strategies for memory might be to use an agenda book, a diary or a tape recorder to help to remember things to do.

Is compensatory therapy effective?

Compensatory strategies can possibly work for anyone who has experienced a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More but may be more effective if the person is young and has only one or two cognitive issues (i.e. compensation strategies will work better for someone with only a memory problem than for someone with a memory and a concentration problem). One good quality research study looked at compensatory strategies and their effect on performance of everyday activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
in people with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. The results showed improvement in the time and quality of performance of every day activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
.

External links to helpful sites on cognitive rehabilitation

For further details on the different mnemonic strategies, please visit this link: http://www.memory-key.com/Mnemonics/mnemonics.htm

For the link and story method: http://www.mindtools.com/pages/article/newTIM_01.htm

Clinician Information

Note: When reviewing the findings, it is important to note that they are always made according to randomized clinical trial (RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More) criteria – specifically as compared to a control group. To clarify, if a treatment is “effective” it implies that it is more effective than the control treatment to which it was compared. Non-randomized studies are no longer included when there is sufficient research to indicate strong evidence (level 1a) for an outcome.

Currently, many approaches are used to restore cognitive processes in patients with post-stroke cognitive deficits. These methods include the Cognitive Orientation to daily Occupational Performance (CO-OP) approach, compensatory strategies (e.g. pager system), computer training, various types of attention training and memory training and more recently, virtual reality.

This review of cognitive rehabilitation following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More includes six high quality RCTs, eight fair quality RCTs, one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More and two non-randomized crossover study.

Studies that were not considered suitable for inclusion in this module are identified in the reference list. All outcomes measures referring to executive functions are not included in the in-depth review on this module; Please see the Executive Functions Intervention module for more details on these outcomes.

Results Table

View results table

Outcomes

Acute phase - Attention training + cutaneous electrical stimulation

Functional independence

Not effective

Somatosensory function

Effective

Subacute phase - Memory retraining

Memory

Not effective

Self-reported memory

Not effective

Subacute phase - Sustained attention training

Alertness and attention

Effective

One non-randomized study (Sturm et al., 1991) investigated the effect of sustained attention training on attention deficits in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. This non-randomized crossover study assigned patients to first receive sustained attention training or no training for three weeks, followed by a cross-over period for a further three weeks. Alertness and sustained attention were measured at 12-week follow-up using the Wiener Determinationsgerat, Wiener Reaktionsgerat, Wiener Vigilanzgerat and the Test d2. There was a significant improvement in one measure of alertness (Wiener Determinationsgerat) and one measure of sustained attention (Wiener Vigilanzgerat), in favour of attention training vs. no training.
Note: Results presented above were obtained from a systematic reviewA systematic review is a summary of available research on a given topic that compares studies based on design and methods. It summarizes the findings of each, and points out flaws or potentially confounding variables that may have been overlooked. A critical analysis of each study is done in an effort to rate the value of its stated conclusions. The research findings are then summarized, and a conclusion is provided.
by Lincoln et al., (2000), for the purpose of clarity.

Conclusion: There is limited evidence (Level 2b) from one non-randomized crossover study that cognitive rehabilitation using sustained attention training is more effective than no training in improving some measures of alertness and sustained attention in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Memory

Not effective

One non-randomized study (Sturm et al., 1991) investigated the effect of sustained attention training on memory in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. This non-randomized crossover study assigned patients to first receive sustained attention training or no training for three weeks, followed by a cross-over period for a further three weeks. Memory was measured by the Cognitrone (pattern recognition), Wechsler Adult Intelligence Scale (similarities subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
), Intelligenz-Struktur-Test (similarity recognition) and the Raven Standard Progressive Matrices (pattern completion ability) at 12-week follow-up. No significant between-group differences were found.
Note: Results presented above are from a systematic reviewA systematic review is a summary of available research on a given topic that compares studies based on design and methods. It summarizes the findings of each, and points out flaws or potentially confounding variables that may have been overlooked. A critical analysis of each study is done in an effort to rate the value of its stated conclusions. The research findings are then summarized, and a conclusion is provided.
by Lincoln et al., (2000), for the purpose of clarity.

Conclusion: There is limited evidence (Level 2b) from one non-randomized crossover study that cognitive rehabilitation using sustained attention training is not more effective than no training in improving memory in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Reasoning

Not effective

One non-randomized study (Sturm et al., 1991) investigated the effect of sustained attention training on reasoning in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. This non-randomized cross-over study assigned patients to first receive sustained attention training or no training for three weeks, followed by a cross-over period for a further three weeks. Reasoning was measured by the Leistungsprufsystern at 12-week follow-up. No significant between-group differences were found.
Note: Results presented above are from a systematic reviewA systematic review is a summary of available research on a given topic that compares studies based on design and methods. It summarizes the findings of each, and points out flaws or potentially confounding variables that may have been overlooked. A critical analysis of each study is done in an effort to rate the value of its stated conclusions. The research findings are then summarized, and a conclusion is provided.
by Lincoln et al., (2000), for the purpose of clarity.

Conclusion: There is limited evidence (Level 2b) from one non-randomized crossover study that cognitive rehabilitation using sustained attention training is not more effective than no training in improving reasoning in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Chronic phase - Attention process training

Attention

Effective

Auditory information processing

Not effective

Functional independence

Not effective

Memory

Not effective

Quality of life

Not effective

Unilateral spatial neglect

Not effective

Chronic phase - Cognitive Orientation to Occupational Performance (CO-OP)

Task performance

Effective

Chronic phase - Memory self-efficacy training

Delayed recall

Not effective

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that cognitive rehabilitation using MSE group training is not more effective than a comparison intervention (peer support strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More education program) in improving delayed memory recall in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Depression

Not effective

One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Aben et al., 2013) investigated the effect of memory self-efficacy (MSE) training on depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More randomized patients to MSE group training or a peer support strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More education program. DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
was measured by the Center of Epidemiological Studies – DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale at post-treatment (approximately 5 weeks). No significant between-group differences were found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that cognitive rehabilitation using MSE group training is not more effective than a comparison intervention (peer support strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More education program) in improving depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Memory self-efficacy

Effective

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that cognitive rehabilitation using MSE group training is more effective than a comparison intervention (peer support strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More education program) in improving memory self-efficacy in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Quality of life

Effective

Chronic phase - Pager system

Memory

Effective

One fair quality randomized crossover trial (Fish et al., 2008) investigated the effect of a pager system on memory in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. This fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More randomized patients to use the NeuroPager system or no treatment in a crossover design. Memory was measured by memory diaries (percentage of tasks achieved) at T2 (7 weeks) and T3 (14 weeks). At both post-treatment time points there were significant between-group differences in favour of the group that had just completed the NeuroPager trial. Memory gains were not maintained over time without use of the NeuroPager system.

Chronic phase - Virtual reality

Attention

Effective

Cognition

Effective

Memory

Not effective

Stroke outcomes

Not effective

One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Faria et al., 2016) investigated the effects of virtual-reality (VR)-based cognitive rehabilitation on strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More outcomes in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More randomized patients to receive VR-based cognitive rehabilitation using the Reh@City simulation program, or conventional cognitive rehabilitation. StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More outcomes were measured by the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More Impact Scale at post-treatment (4-6 weeks). No significant between-group differences were found.

Phase not specific to one period - CO-OP

Community participation

Effective

One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (McEwen et al., 2015) investigated the effect of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach on community participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. This fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More to receive CO-OP or conventional rehabilitation. Community participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More was measured by the Community ParticipationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More Indicator (CPI) (Importance of participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More, Control over participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More, Satisfaction with participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More scales) at post-treatment (10 sessions) and at follow-up (3 months); the measure was not used at baseline. Comparison of change scores from post-treatment to follow-up revealed a medium effect sizeEffect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the “effect size correlation”.
(CPI – Control over participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More only), favoring CO-OP vs. conventional rehabilitation.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that the CO-OP approach is more effective than a comparison intervention (conventional rehabilitation) in improving an individual’s sense of control over community participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More among patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
Note: There were no significant differences in an individual’s perceived importance of, or satisfaction with, community participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More.

Occupational performance

Not effective

Self-efficacy

Effective

Stroke outcomes

Effective

Two fair quality RCTs (Wolf et al., 2016, McEwen et al., 2015) investigated the effect of the CO-OP approach on strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More outcomes in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Wolf et al., 2016) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More to receive CO-OP or conventional occupational therapy. StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More outcomes were measured by the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More Impact Scale (ADLs, Mobility, Hand Function, Strength, Recovery, Physical, Memory, Emotion, Communication) at post-treatment (10 sessions) and at 3-month follow-up. Results at post-treatment showed medium to large treatment effect sizes (SIS – ADLs, Hand Function, Strength, Recovery, Physical, Memory, Emotion, Communication), favoring CO-OP vs. conventional occupational therapy. At follow-up, medium effects were maintained for two strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More outcomes (SIS – Hand Function, Communication), favoring CO-OP vs. conventional occupational therapy.

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (McEwen et al., 2015) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More to receive CO-OP or conventional rehabilitation. StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More outcomes were measured by the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More Impact Scale (SIS – ParticipationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
only) at post-treatment (10 sessions) and at 3-month follow-up; the measure was not used at baseline. Comparison of change scores from post-treatment to follow-up revealed a medium treatment effect sizeEffect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the “effect size correlation”.
, favoring CO-OP vs. conventional rehabilitation.

Conclusion: There is limited evidence (Level 2a) from two fair quality RCTs that the CO-OP approach is more effective than a comparison intervention (conventional therapy) in improving aspects of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More outcomes in patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Task performance

Effective

Phase not specific to one period - Computer training

Attention

Effective

The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Prokopenko et al., 2013) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More to receive neuropsychological computer training or conventional rehabilitation. Attention was measured by Shulte’s test at post-treatment (2 weeks). Significant between-group differences were found, favoring computer training vs. conventional rehabilitation.

The non-randomized study (Sturm et al., 1997) assigned patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More to receive computerized attention training. Participants received training that specifically targeted two domains of attention (alertness, vigilance, selective attention or divided attention“The allocation of attentional resources across more than one task” (Ponsford, 2008, p. 514)
), according to each participant’s two most impaired domains. Attention was measured at baseline and at post-treatment 1 and post-treatment 2 (i.e. after each 14-session training period) using a computerised attention test battery (alertness: response time with/without warning signal; vigilance: hit-rate, response with warning; selective attention: error rate, response time with warning; divided attention“The allocation of attentional resources across more than one task” (Ponsford, 2008, p. 514)
: error rate, response time with warning). There were significant improvements in attention (alertness: response time without warning signal; vigilance: hit-rate; selective attention: response time with warning; divided attention“The allocation of attentional resources across more than one task” (Ponsford, 2008, p. 514)
: error rate); results showed a domain-specific training effect (e.g. improved alertness was only achieved following alertness training).

Cognition

Not effective

Mood

Not effective

One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Prokopenko et al., 2013) investigated the effect of computer training on depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
and anxiety in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More to receive neuropsychological computer training or conventional rehabilitation. Mood was measured by the Hospital Anxiety and DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale at post-treatment (2 weeks). No significant between group differences were found.

Visuospatial skills

Effective

Phase not specific to one period - Global attention processing training

Visuospatial memory

Effective

Conclusion: There is limited evidence (Level 2b) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that global attention processing training is more effective than a comparison intervention (rote repetition training with no encoding strategy) in improving visuospatial memory in patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Phase not specific to one period - Time pressure management

Fatigue

Not effective

Functional Independence

Not effective

Information processing

Not effective

Memory

Not effective

Mood

Not effective

One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Winkens et al., 2009) investigated the effect of cognitive rehabilitation using a time pressure management approach on mood in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More randomized patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More to receive time pressure management or conventional rehabilitation. DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
was measured by the Center for Epidemiologic Studies DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale at post-treatment (10 hours of treatment) and at 3-month follow-up. No significant between-group differences were found at either time point.

Quality of life

Not effective

Phase not specific to one period - Virtual Reality

Attention

Effective

One poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Gamito et al., 2015) investigated the effect of virtual-reality (VR)-based cognitive rehabilitation on attention in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. This poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More randomized patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More (stage of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More not specified) to receive VR-based cognitive rehabilitation or no treatment. Sustained attention was measured by the Toulouse-Pieron Test (work efficiency) at post-treatment (4-6 weeks). Significant between-group differences were found, favoring VR-based cognitive rehabilitation vs. no treatment.

Conclusion: There is limited evidence (Level 2b) from one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that VR-based cognitive rehabilitation is more effective than no treatment in improving sustained attention in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Memory

Effective

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Rose et al., 1999) randomized patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More (stage of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More not specified) to receive active VR-based memory retraining program or passive VR-based memory retraining. Memory was measured using spatial and object recognition tests at post-treatment (1 training session). A significant between-group difference in one measure of memory (spatial recognition test) was found, favoring the active VR-based memory retraining program.

The poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Gamito et al., 2015) randomized patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More (stage of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More not specified) to receive VR-based cognitive rehabilitation or no treatment. Memory was measured by the Wechsler Memory Scale (WMS total score) and the Rey-Osterieth Complex Figure (ROCF – immediate recall) at post-treatment (4-6 weeks). Significant between-group differences in memory (WMS total score only) were found, favoring VR-based cognitive rehabilitation vs. no treatment.

Phase not specific to one period - Visual Attention Training

Attention

Not Effective

Driving

Not Effective

Unilateral spatial neglect

Not Effective

Visual attention

Not Effective

Visual perception

Not Effective

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Mazer BL, Sofer S, Korner-Bitensky N, Gelinas I, Hanley J, Wood-Dauphinee S. (2003). Effectiveness of a visual attention retraining program on the driving performance of clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More. Arch Phys Med Rehabil. 2003 Apr;84(4):541-50.

https://www.ncbi.nlm.nih.gov/pubmed/12690593

McEwen, S., Polatajko, H., Baum, C., Rios, J., Cirone, D., Doherty, M., & Wolf, T. (2015). Combined cognitive-strategy and task-specific training improve transfer to untrained activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
in subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More: an exploratory randomized controlled trial. Neurorehabilitation and Neural Repair, 29 (6), 526-36.

http://www.ncbi.nlm.nih.gov/pubmed/25416738

Polatajko, H.J., McEwen, S.E., Ryan, J.D., & Baum, C.M. (2012). Pilot randomized controlled trial investigating cognitive strategy use to improve goal performance after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More. American Journal of Occupational Therapy, 66, 104-9.

http://www.ncbi.nlm.nih.gov/pubmed/22389945

Prokopenko, S.V., Mozheyko, E.Y., Petrova, M.M., Koryagina, T.D., Kaskaeva, D.S., CHernykh, T.V., Shvetzova, I.N., & Bezdenezhnih, A.F. (2013). Correction of post-stroke cognitive impairments using computer programs. Journal of Neurological Sciences, 325, 148-53.

http://www.ncbi.nlm.nih.gov/pubmed/23312291

Rose, D.F., Brooks, B. M., Attree, E. A., Parslow, D. M., Leadbetter, A. G., McNeil, J. E., & Potter, J. (1999). A preliminary investigation into the use of virtual environments in memory retraining after vascular brain injury: indications for future strategy?. Disability and Rehabilitation, 21(12), 548-554.

http://www.tandfonline.com/doi/abs/10.1080/096382899297206

Sturm, W. & Willmes K. (1991). Efficacy of a reaction training on various attentional and cognitive functions in strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More patients. Neuropsychological Rehabilitation, 1, 259-80.

http://www.tandfonline.com/doi/abs/10.1080/09602019108402258

Sturm, W., Willmes, K., Orgass, B., & Hartje, W. (1997). Do specific attention deficits need specific training? Neuropsychological Rehabilitation, 7(2), 81-103.

http://www.tandfonline.com/doi/abs/10.1080/713755526

Winkens, I., Van Heugten, C.M., Wade, D.T., Habets, E.J., & Faostti, L. (2009). Efficacy of time pressure management in strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More patients with slowed information processing: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 90, 1672-9.

http://www.ncbi.nlm.nih.gov/pubmed/19801055

Wolf, T.J., Polatajko, H., Baum, C., Rios, J., Cirone, D., Doherty, M., & McEwen, S. (2016). Combined cognitive-strategy and task-specific training affects cognition and upper-extremity function in subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More: an exploratory randomized controlled trial. The American Journal of Occupational Therapy, 70(2), 1-10.

http://www.ncbi.nlm.nih.gov/pubmed/26943113

Excluded Studies

Cantagallo, A., Maini, M., & Rumiati, R.I. (2012). The cognitive rehabilitation of limb apraxia in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More. Neuropsychological Rehabilitation, 22 (3), 473-88.

Reason for Exclusion: Review

Gray JM, Robertson I, Pentland B, Anderson S. (1992). Microcomputer-based attentional retraining after brain damage: A randomised group controlled trial. Neuropsychological Rehabilitation, 2, 97-115.

Reason for Exclusion: Sample includes other etiology than strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More.

Hildebrandt, H., Bussmann-Mork, B., & Schwendemann, G. (2006). Group therapy for memory impaired patients: a partial remediation is possible. Journal of Neurology, 253(4), 512-519.

Kaschel R., Della Sala S., Cantagallo A., Fahlbock A., Laaksonen R. & Kazen M. (2002). Imagery mnemonics for the rehabilitation of memory: a randomised group controlled trial. Neuropsychological Rehabilitation, 12(2), 127-53.

Reason for Exclusion: Participants with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More represent less than 50% of overall studied sample.

Miller, L. A., & Radford, K. (2014). Testing the effectiveness of group-based memory rehabilitation in chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More patients. Neuropsychological Rehabilitation, 24(5), 721-737.

Reason for Exclusion: Not a RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More, outcomes available in RCTs.

Mount, J., Pierce, S. R., Parker, J., DiEgidio, R., Woessner, R., & Spiegel, L. (2007). Trial and error versus errorless learning of functional skills in patients with acute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More. NeuroRehabilitation, 22(2), 123-132.

Reason for Exclusion: Executive functions training, refer to executive function interventions module.

Ostwald, S. K., Godwin, K. M., Cron, S. G., Kelley, C. P., Hersch, G., & Davis, S. (2014). Home-based psychoeducational and mailed information programs for stroke-caregiving dyads post-discharge: a randomized trial. Disability and Rehabilitation, 36(1), 55-62.

Reason for Exclusion: Not cognitive rehabilitation.

Van de Ven, R., Schmand, B., Groet, E., Veltman, D.J., & Murrem J.M.J. (2015). The effect of computer-based cognitive flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008)
training on recovery of executive function after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More: rationale, design and methods of the TAPASS study. BMC Neurology, 15, 144.

Reason for Exclusion: Study protocol proposal without results.

Rand, D., Eng, J.J., Liu-Ambrose, T., & Tawashy, A.E. (2010). Feasibility of a 6-month exercise and recreation program to improve executive functioning and memory of individuals with chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More. Neurorehabilitation and Neural Repair, 24(8), 722-9.

Westerberg, H., Jacobaeus, H., Hirvikoski, T., Clevberger, P., Östensson, M. L., Bartfai, A., & Klingberg, T. (2007). Computerized working memoryExecutive process responsible for the temporary storage and manipulation of information in both simple (e.g. recalling a series of digits such as a phone number) and complex cognitive tasks (e.g. coordinating two tasks simultaneously) (Van der Linden, 2007)
training after stroke–a pilot study. Brain Injury, 21(1), 21-29.

Reason for Exclusion: Executive functions training, refer to executive function interventions module.

Zagavec, B. S., Lesnik, V.M., & Goljar, N. (2015). Training of selective attention in work-active strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More patients. International Journal of Rehabilitation Research, 38, 370-2.

Zedlitz, A.M.E.E., Rietveld, T.C.M., Geurts, A.C., & Fasotti, L. (2012). Cognitive and graded activity training can alleviate persistent fatigue after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More. StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More, 43, 1046-51.

Reason for Exclusion: Both study groups received cognitive rehabilitation.