Abstract
BackgroundStroke survivors frequently suffer from executive impairments even in the chronic phase after stroke, and there is a need for improved rehabilitation of these functions. One way of improving current rehabilitation treatment may be by online cognitive training. Based on a review of the effectiveness of computer-based cognitive training in healthy elderly, we concluded that cognitive flexibility may be a key element for an effective training, which results in improvements not merely on trained tasks but also in untrained tasks (i.e., far transfer). The aim of the current study was to track the behavioral and neural effects of computer-based cognitive flexibility training after stroke. We expected that executive functioning would improve after the cognitive flexibility training, and that neural activity and connectivity would normalize towards what is seen in healthy elderly.Methods/designThe design was a multicenter, double blind, randomized controlled trial (RCT) with three groups: an experimental intervention group, an active control group who did a mock training, and a waiting list control group. Stroke patients (3 months to 5 years post-stroke) with cognitive complaints were included. Training consisted of 58 half-hour sessions spread over 12 weeks. The primary study outcome was objective executive function. Secondary measures were improvement on training tasks, cognitive flexibility, objective cognitive functioning in other domains than the executive domain, subjective cognitive and everyday life functioning, and neural correlates assessed by both structural and resting-state functional Magnetic Resonance Imaging. The three groups were compared at baseline, after six and twelve weeks of training, and four weeks after the end of the training. Furthermore, they were compared to healthy elderly who received the same training.DiscussionThe cognitive flexibility training consisted of several factors deemed important for effects that go beyond improvement on merely the training task themselves. Due to the presence of two control groups, the effects of the training could be compared with spontaneous recovery and with the effects of a mock training. This study provides insight into the potential of online cognitive flexibility training after stroke. We also compared its results with the effectiveness of the same training in healthy elderly.Trial registrationThe Netherlands National Trial Register NTR5174. Registered 22 May 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0397-y) contains supplementary material, which is available to authorized users.
Highlights
Stroke survivors frequently suffer from executive impairments even in the chronic phase after stroke, and there is a need for improved rehabilitation of these functions
We studied whether cognitive flexibility training was more beneficial for those with lower baseline executive performance, and whether this training was more beneficial in the post-acute or in the chronic phase post-stroke
We expected that 35 % of the eligible group would participate in our study, which is approximately 7.5 % of the stroke patients admitted to the rehabilitation centers per year
Summary
Stroke survivors frequently suffer from executive impairments even in the chronic phase after stroke, and there is a need for improved rehabilitation of these functions. In a recent review by our group, we concluded that cognitive training in healthy elderly subjects may result in cognitive improvement, provided that it includes frequent switching between various training tasks [4]. Such cognitive flexibility training improved cognitive functioning even in tasks that were not the focus of training, that is, the effects of the training generalized to so called ‘far transfer tasks’ [5]
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