PR_278: The Efficacy of a Home-Based Cognitive Rehabilitation Program in Patients With Cognitive Dysfunction After Stroke

Abstract

Objective: To evaluate the efficacy of a home-based cognitive rehabilitation program (HCRP) for chronic stroke patients with cognitive dysfunction. Design: Before-after trial (case series). Setting: General community-based cognitive rehabilitation program. Participants: 6 patients with cognitive dysfunction at least 6 months after stroke onset participated in this study. Inclusion criteria were under age of 65, Korean version of the Mini-Mental Status Examination (K-MMSE) scores between 10 to 24 points, no aphasia and depression, and the participants who had a responsible caregiver for continuous monitoring of individual HCRP. Interventions: We had provided basic instructions and individualized HCRP, which consisted of a total of 2 hours of daily activities, such as study with structured cognitive training materials, reading newspapers, magazines or books, aerobic exercise, and mental exercise (card game, chess, or computer game) and other meta-cognitive activities. Total duration of programs was 12 weeks and patient’s performance was monitored by the same caregiver using a checklist. During the program the occupational therapist communicated with the caregivers once a week to check patient progress, to help resolve any problems, or to provide additional instructions or programs. Main Outcome Measures: K-MMSE, Neurobehavioral Cognitive Status Examination (K-NCSE), cognitive function evaluation for attention, memory, executive function using the Computerized Neuropsychological Test, Lowenstein Occupational Therapist Cognitive Assessment, Korean version of Modified Barthel Index (K-MBI), and Korean instrumental activity of daily living (K-IADL) at the time of initiation and after completion of programs. Results: After completing the 12-week training program, the trained patients showed significantly higher performance in K-IADL (P<.05) and a trend of improvement in K-MMSE (P=.058), K-NCSE (P=.078), K-MBI (P=.068). Conclusions: The individualized HCRP has beneficial effects on chronic stroke patients with cognitive dysfunction, especially on IADL, and HCRP is an effective cognitive rehabilitation method with relatively lower cost than hospital-based training programs.