Cognitive Rehabilitation Approaches Research Articles

Effects of Serious Games in Older Adults With Mild Cognitive Impairment.

The rising prevalence of mild cognitive impairment (MCI) has spurred interest in innovative cognitive rehabilitation approaches, including serious games. This review summarizes randomized clinical trials (RCTs) exploring the impact of serious games on MCI patients. We conducted a comprehensive data search using key terms such as "gamification," "digital therapy," "cognition," "mild cognitive impairment," and "Alzheimer's disease." We exclusively considered published RCTs, excluding animal studies and basic research. We identified eight RCTs. Four RCTs examined the effects of serious games using cognitive training for MCI patients. Notably, one study found that non-specific training (Nintendo Wii) significantly enhanced cognitive function and quality of life compared to cognition-specific computer training (CoTras). Among the remaining three RCTs, one specifically demonstrated that personalized serious game-based cognitive training yielded superior cognitive outcomes and reduced depressive symptoms. One RCT focused on serious games incorporating physical exercise, highlighting the effectiveness of kinetic-based exergaming in enhancing overall cognition. Three RCT focused on combined cognitive training and physical exercise. A double-blind RCT revealed that progressive resistance training or standalone physical exercise outperformed the combined approach in improving executive function and global cognition. Two additional RCTs reported positive outcomes, including improvements in cognitive function and electroencephalogram patterns associated with game-based interventions. Serious games, whether focusing on cognitive training, physical exercise, or a combination of both, have potential to improve cognitive and functional outcomes in individuals with MCI. Further research and standardization of protocols are needed to better understand the full potential of serious games in MCI.

3 Optimizing Cognitive Rehabilitation of the Injured Warfighter

Objective:Many individuals who experienced a mild traumatic brain injury (mTBI) have persistent cognitive complaints. Traditional cognitive rehabilitation (TCR) interventions were primarily developed for severe neurological injury which has limited effectiveness in rehabilitation of active duty military personnel who have the goal of returning to full military operational status. To remain on active duty, warfighters must have sufficient mental competency to safely and effectively function in complex environments such as combat. There is need for a cognitive rehabilitation approach that addresses demands of military personnel to expedite return to duty. The Strategic Memory Advanced Reasoning Training (SMART) program is novel alternative to TCR. SMART is an evidence-based advanced reasoning protocol that enhances cognitive domains essential to military readiness (e.g., mental agility, strategic learning, problem solving, and focus) and requires less than half of the treatment time. The objective of this study was to assess the efficacy of SMART compared to TCR in terms of overall recovery as well as change in specific cognitive domains.Participants and Methods:Participants were recruited from a military treatment facility. All patients had at least one diagnosed mTBI as well as persistent cognitive complaints. Participants completed the Rey-15 to ensure performance validity. Final sample was SMART n = 28 and SCORE n = 19. Primary dependent measure was the Global Deficit Scale (GDS). GDS was calculated from: Hopkins Verbal Learning Test-Revised (HVLT-R); Delis Kaplan Executive Functioning System Color Word (CW) and Trail Making (TM), Paced Auditory Serial Addition Test (PASAT), and the Symbol Digit Modality Test (SDMT). Demographically corrected t-scores were converted to deficit scores as follows: >40 = 0, 35-39 = 1, 30-34 = 2, 25-29 = 3, 20-24 = 4, <20 = 5. Deficit scores were averaged to calculate GDS. For each measure, Hohen’s g was analyzed for effect size comparisons pre-post treatment.Results:Average number of treatment hours was significantly lower in the SMART condition (SMART: M = 18.47 hours, SD = 2.17; TCR: M = 42.42 hours, SD = 3.79, p <.001). A repeated measures ANOVA showed a significant change on GDS post-treatment (F = 30.25, p < .001) with a large effect size (n2 = .402); however, the interventions did not differ on GDS change. Impact on cognitive domains was relatively equivalent for processing speed (SMART h = 0.67 vs TCR h = -.54) and executive function (SMART h = -0.92 vs TCR h = -.85); however, SMART had a larger impact on memory (SMART h = -0.81 vs TCR h = -.39). SMART resulted in large improvements in retention and recognition memory which were minimally impacted by TCR.Conclusions:Both TCR and SMART had comparable effectiveness in improving cognitive impairment, though SMART was completed in less than half of the treatment time. Both interventions had large effect sizes on processing speed and executive functioning; however, SMART was more effective in improving long-term memory. Memory is an integral part of military readiness. Further investigation is required to determine the relative effectiveness of these two approaches to improving cognitive readiness of the warfighter.

The effectiveness of cognitive rehabilitation intervention with the telerehabilitation method for amnestic mild cognitive impairment: A feasibility randomized controlled trial.

Although different cognitive rehabilitation (CR) approaches have been developed for mild cognitive impairment (MCI), a standard method has not been determined for interventions, especially with the telerehabilitation (TR) method, which is one of the alternative solutions to the problems of accessing rehabilitation services. The study was planned to compare the effectiveness of the CR intervention applied in the older adults with amnestic-MCI with face-to-face and TR methods. A total of 68 participants were randomly assigned to the TR and face-to-face groups. TR method was delivered by teleconference method in the participant's own home. A 12-week CR intervention was applied to both groups. Pre- and post-intervention cognitive skills of the participants were evaluated using the Loewenstein occupational therapy cognitive assessment-geriatric (LOTCA-G). Cognitive skills were increased in both groups (p < 0.001). A statistically significant difference was observed between the groups in the post-intervention visual-spatial perception, praxis, and total LOTCA-G scores (p < 0.01). It was determined that a 12-week CR program had positive effects on cognitive functions in the older adults with amnestic MCI. Both TR and face-to-face methods can be used in CR interventions for amnestic MCI. In addition, the TR method can be advantageous in terms of time and accessibility. NCT05664984.

Cognitive Rehabilitation Approaches to Traumatic Brain Injury: A Review of Efficacy and Outcomes

Cognitive rehabilitation is a critical component of intervention for many individuals with both short- and long-term impairments associated with traumatic brain injury (TBI). By focusing on major cognitive domains, emotional processing, and behavioral strategies, clinicians use cognitive rehabilitation to improve cognitive related functional outcomes, quality of life, and social relationships. Cognitive rehabilitation is traditionally divided into restorative and compensatory approaches, though increasingly combined approaches within the larger medical, multidisciplinary team are being incorporated and explored. Literature related to cognitive rehabilitation within the TBI population continues to be needed in order to assist clinicians in developing evidence-based intervention protocols and therapy plans. This paper details current approaches to cognitive rehabilitation and provides an updated review of the literature associated with the efficacy of cognitive rehabilitation. Reviewed evidence supports the use of cognitive rehabilitation to improve multiple cognitive domains, including attention, memory, executive function, and metacognitive skills. The long-term outcomes of continued cognitive rehabilitation services post-TBI are not as comprehensively documented as the relative short-term outcomes. The efficacy of cognitive rehabilitation is impacted by patient-specific variables, timing and intensity of treatment. This paper concludes with noted information related to the limitations of the current evidence of cognitive rehabilitation, including study design concerns, and reduced generalizability of the relevant research.

Motor, cognitive, and combined rehabilitation approaches on MS patients' cognitive impairment.

At the moment, the possible options for the management of cognitive dysfunctions in patients with MS (pMS) are pharmacological interventions, cognitive rehabilitation (CR), and physical exercise. However, worldwide, multimodal programs are infrequently applied in pMS and CR is not easily accessible through the National Health System as MR. The aim of the study is to explore if the combination of motor and cognitive rehabilitation may favor better outcomes on cognitive efficiency compared to separate trainings. Forty-eight pMS were submitted to detailed neuropsychological and motor assessments, before (T0) and after (T1) having performed one of three rehabilitation conditions (two cognitive trainings/week-Reha1; one cognitive and one motor training/week-Reha2; two motor trainings/week-Reha3, for 12weeks); they were randomly assigned to one condition or another. The CR was focused on memory functioning and performed with the Rehacom program. No significant differences in age, sex, education, and disease course were found between the three groups (sig. > .05). Reha1 patients increased only their cognitive performance, and Reha3 only increased their motor performance, while Reha2 increased both cognitive and motor performances. This benefit was also confirmed by the cognitive efficiency expressed by the Cognitive Impairment Index. These data confirm that to include cognitive training within rehabilitation programs may induce important benefits in pMS. Furthermore, pMS seem to benefit from a combined approach (cognitive and motor) more than from CR and motor rehabilitation separately (ClinicalTrial.gov ID: NCT05462678; 14 July 2022, retrospectively registered).

Pediatric Cognitive Rehabilitation Roadmap

<h3>Research Objectives</h3> To provide clinicians with a structured framework for the application of evidence-based cognitive rehabilitation strategies for children with acquired brain injuries across the neurorehabilitation continuum of care. The roadmap aims to provide guidance in the determination of assessments, evidence based therapeutic strategies and goals specific to defined stages of brain recovery. <h3>Design</h3> This proposed roadmap defines four stages of cognitive recovery, including disorders of consciousness, confusional states, cognitive and behavioral dysregulation, and acute cognitive impairment. It provides interdisciplinary assessment tools to identify a patient's current stage, monitor progress, and determine transitions between stages. It also utilizes research from ACRM's cognitive rehabilitation training, along with additional pediatric specific evidence-based cognitive rehabilitation interventions, to guide the selection of cognitive rehabilitation approaches specific to each stage of recovery based on variables such as allowance of errors, types of cues and the timing of feedback necessary for optimal acquisition. To implement this interdisciplinary cognitive rehabilitation program at our hospital, our staff first completed ACRM online cognitive rehabilitation training. We then conducted in-services to train our staff on the use of the roadmap to guide the application of the stage specific assessments and strategies within our pediatric ABI population. <h3>Setting</h3> Blythedale Children's Hospital (inpatient and day hospital neurorehabilitation program). <h3>Participants</h3> Pediatric ABI patients admitted to our hospital. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> N/A. <h3>Results</h3> This roadmap has assisted in individualized treatment planning, school accommodations, and transition planning, along with improvement in interdisciplinary communication and collaboration. It also resulted in clearer guidelines for families and schools on how to accommodate students' deficits to improve daily function and adjust plan to foster increased independence over time. <h3>Conclusions</h3> This pediatric cognitive therapy roadmap aims to improve overall pediatric cognitive rehabilitation including staff competency, caregiver education, and classroom recommendations. We also hope this tool and its breakdown of the brain injury recovery trajectory into four stages may provide additional prognostic indicators in future research. <h3>Author(s) Disclosures</h3> No disclosures to report.

A randomised controlled trial evaluating two cognitive rehabilitation approaches for cancer survivors with perceived cognitive impairment

PurposeUp to 70% of survivors report cognitive symptoms after chemotherapy. We compared two cognitive rehabilitation programs to a control group in cancer survivors.MethodsStudy population were adult cancer survivors with cognitive symptoms 6–60 months after adjuvant chemotherapy. Participants randomised to: Attention Process Training (APT), Compensatory Strategy Training (CST), or control group. Active interventions comprised 6–week, 2–h/week small group sessions. Assessments: pre- and post-intervention, 6- and 12-months later. Primary outcome was change in cognitive symptoms (FACT-COG-PCI subscale) between baseline and post-intervention. Secondary endpoints included objective neuropsychological performance, Functional Impact Assessment (FIA), patient-reported outcome measures, and associations. Analyses were on an intention-to-treat basis. Analysis of covariance mixed models were used for continuous outcomes.ResultsSixty-five participants were randomised (APT n = 21; CST n = 24; controls n = 20): 94% breast cancer, median age 54. Median time since chemotherapy 20.7 months. FACT-COG-PCI, clinical neuropsychological T-scores, and FIA improved in all groups over time, but no significant differences between arms. On mean neuropsychological T-scores 19/65 (29%) were impaired at baseline; post-intervention impairment controls 31.3%, CST 16.7%, APT 20.0%. On FIA at baseline, nine were impaired; this decreased to three post-intervention (one/group). FACT-COG-PCI was weakly associated with neuropsychological tests (rho = 0.24, p = 0.051) at baseline, and had no association with FIA. Neuropsychological total mean T-score was moderately positively associated with FIA (rho = 0.37, p = 0.003).ConclusionThere were no significant differences between intervention groups and controls using linear mixed models adjusted for baseline scores.Implications for Cancer SurvivorsCognitive symptoms and neuropsychological test scores improve over time.

Prospective e memory impairment related to cancer: a systematic review

Cognitive complaints and alterations related to cancer may reduce well-being, quality of life, and daily functioning. More recently, prospective memory (PM), i.e., the ability to plan a future intention, to maintain it during a variable delay time in which people are typically engaged in other tasks, and to retrieve it when the expected circumstances arise, has fostered increased attention in cancer research. Examples are to remember to ask for a certain information during a medical appointment (event-based PM/EBPM) or to take medication at certain hours (time-based PM/TBPM). This work aimed to provide an overview of the main findings related to PM functioning in people with history of cancer. A qualitative systematic review of the literature was conducted following the PRISMA guidelines and 20 articles published between 2000 and 2020 were included. People with cancer history (vs. healthy controls) tended to report more PM complaints and worst objective PM performance, especially when considering EBPM tasks. Some treatments such as chemotherapy, androgen deprivation therapy, and radiotherapy negatively impacted PM. Importantly, changes in PM were associated with lower quality of life. Also, fatigue and depression appeared to contribute to PM impairment. A puzzling finding was the lack of association between objective and subjective measures of PM, which implies that different facets might underly cancer-related PM changes. Taken together, the inclusion of PM measures when probing cancer-related cognitive impairment is relevant not only to better assess and characterize the cancer experience across time, but also to inform interventions and cognitive rehabilitation approaches.

Developing the Rationale for Including Virtual Reality in Cognitive Rehabilitation and Exercise Training Approaches for Managing Cognitive Dysfunction in MS

Cognitive impairment is a common and detrimental consequence of multiple sclerosis (MS) and current rehabilitation methods are insufficient. Cognitive rehabilitation (CR) and exercise training (ET) are the most promising behavioral approaches to mitigate cognitive deficits, but effects are small and do not effectively translate to improvements in everyday function. This article presents a conceptual framework supporting the use of virtual reality (VR) as an ideal, common adjuvant traditional CR and ET in MS. VR could strengthen the effects of CR and ET by increasing sensory input and promoting multisensory integration and processing during rehabilitation. For ET specifically, VR can also help incorporate components of CR into exercise sessions. In addition, VR can enhance the transfer of cognitive improvements to everyday functioning by providing a more ecologically valid training environment. There is a clear interest in adding VR to traditional rehabilitation techniques for neurological populations, a stronger body of evidence of this unique approach is needed in MS. Finally, to better understand how to best utilize VR in rehabilitation for cognitive deficits in MS, more systematic research is needed to better understand the mechanism(s) of action of VR with CR and ET.

Multi-level outcomes for young adults with acquired brain injury through a remote intensive cognitive rehabilitation approach: a pilot intervention study

ABSTRACT Objective To investigate the effects of the Intensive Cognitive and Communication Rehabilitation (ICCR) program for young adults with acquired brain injury (ABI) using a quasi-experimental pilot intervention study design while transitioning to remote implementation. Method Twelve young adults with chronic ABI (treatment n = 7; control n = 5) participated in ICCR (i.e., lectures, seminars, individual cognitive rehabilitation (CR), technology training) for six hours/day, four days/week, for one or two 12-week semesters. Outcomes included classroom metrics, individual therapy performance, including Goal Attainment Scaling (GAS), standardized cognitive-linguistic assessments, and participation and health-related quality of life (QOL) measures. Results In the first semester (in-person and remote), treatment participants significantly improved in classroom exams; individual therapy (i.e., memory, writing, GAS); executive function and participation measures, but not QOL. In the second semester (remote), treatment participants significantly improved in classroom exams; essay writing; individual therapy (i.e., writing and GAS); and memory assessment, but not in participation or QOL. Treatment participants enrolled in consecutive semesters significantly improved in classroom exams, individual therapy (i.e., memory), participation and QOL, but not on standardized cognitive assessments. Controls demonstrated no significant group-level gains. Conclusion These preliminary results highlight the benefit of intensive, integrated, and contextualized CR for this population and show promise for its remote delivery.

Cognitive recovery in people with relapsing/remitting multiple sclerosis: A randomized clinical trial on virtual reality-based neurorehabilitation

BackgroundMultiple sclerosis (MS) can adversely affect several domains of cognitive function, including attention, information processing, memory and learning, executive functions and visuospatial skills. In recent years, technological innovations have proven effective in improving motor and cognitive impairment in neurological patients, including those affected by MS. ObjectiveThe study aims to evaluate cognitive outcomes after rehabilitation training with the Virtual Reality rehabilitation system (VRRS) in patients suffering from MS. MethodsAll patients were randomized into either the control group (CG: 15 patients) receiving conventional cognitive rehab or the experimental group (EG) using virtual reality (VR) (15 patients). Both groups underwent the same amount of cognitive training, 3 times a week for 8 weeks. They were submitted to neuropsychological assessment before (T0) and after the rehabilitation treatment (T1). ResultsOur data showed that both conventional and VR cognitive rehabilitation approaches improved mood (p < 0.001) and visuospatial skills. However, only in the EG a significant improvement in specific cognitive domains (p < 0.001), including learning ability, short-term verbal memory, lexical access ability, as well as quality of life related to mental states, was found. ConclusionsThe present study demonstrated that VR can be a motivational and effective tool for cognitive recovery in MS patients.

The impact of cognitive rehabilitation on quality of life in multiple sclerosis: A pilot study.

BackgroundCognitive impairment in people with multiple sclerosis (pwMS) negatively impacts daily function and quality of life (QoL). Prior studies of cognitive rehabilitation in pwMS have shown limited benefit but many focused on cognitive function scores rather than QoL measures. Studies using QoL metrics primarily evaluated group cognitive rehabilitation, which may be less appropriate due to variable cognitive profiles in pwMS. This study assesses the impact of an individualized cognitive rehabilitation approach on QoL in MS.MethodsWe performed a retrospective chart review of NeuroQoL assessments done by pwMS (n = 12, mean age 47.9 ± 4.0 years, 75% female, 100% White, 75% RRMS) before and after participation in an individualized compensatory cognitive program. We used a comparison group of pwMS who were candidates for the program but did not participate (n = 9, mean age 48.9 ± 4.4 years, 88.9% female, 100% White, 66.7% RRMS)ResultsPwMS who participated in the rehabilitation program saw improvements in Sleep Disturbance (50.5 from 55.5, p = 0.005), Fatigue (52.5 from 57.0, p = 0.024), Anxiety (49.8 from 55.4, p = 0.011), and Cognitive Function (39.3 from 36.7, p = 0.049).ConclusionsIndividualized compensatory cognitive rehabilitation appears effective for improving QoL measures in pwMS with cognitive complaints, supporting the need for further randomized controlled prospective analysis of this intervention.

Interprofessional Collaborative Management of Postconcussion Cognitive Symptoms.

Purpose The purpose of this clinical focus article is to illustrate an interprofessional cognitive rehabilitation approach. Invited experts representing physical medicine and rehabilitation, clinical neuropsychology/rehabilitation psychology, registered nurse care coordination, and speech-language pathology share viewpoints from their discipline to engage in collaborative interventions with the goal of enhancing treatment outcomes. Conclusions Treating the multifactorial symptoms of concussion requires expertise from an interdisciplinary team (IDT) of professionals, contributing unique perspectives and providing integrative services to optimize rehabilitation outcomes for patients. Speech-language pathologists serve an important role on IDTs to deliver personalized, targeted therapies for prolonged or persistent postconcussion cognitive impairment.

Cognitive Function in Older Adults With Cancer: Assessment, Management, and Research Opportunities.

Article Tools REVIEW ARTICLES Caring for Older Adults With Cancer Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.21.00239 Journal of Clinical Oncology - published online before print May 27, 2021 PMID: 34043437 Cognitive Function in Older Adults With Cancer: Assessment, Management, and Research Opportunities Allison Magnuson , DO, MS1xAllison MagnusonSearch for articles by this author; Tim Ahles, PhD2xTim AhlesSearch for articles by this author; Bihong T. Chen , MD, PhD3xBihong T. ChenSearch for articles by this author; Jeanne Mandelblatt , MD4xJeanne MandelblattSearch for articles by this author; and Michelle C. Janelsins , PhD, MS5xMichelle C. JanelsinsSearch for articles by this author Show More 1Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY2Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY3Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA4Georgetown-Lombardi Comprehensive Cancer Center, Cancer Control Program, Georgetown University Medical Center, Washington, DC5Department of Surgery, Cancer Control, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY https://doi.org/10.1200/JCO.21.00239 First Page Full Text PDF Figures and Tables © 2021 by American Society of Clinical OncologyCONTEXTKey ObjectiveWhat are the methods for assessing cognitive function and managing cancer-related cognitive decline (CRCD) in older adults?Knowledge GeneratedNational guidelines recommend validated tools to assess cognitive function and screen older adults with cancer for cognitive problems, including self-report scales, performance-based measures, or a combination of both. Risk factors for the development of CRCD in older adults include low cognitive reserve, comorbidities, and frailty, and a growing body of literature suggests benefit for CRCD interventions, including cognitive rehabilitation approaches and physical activity, but further evidence in the older adult population is needed.RelevanceCognitive function is critical for an older patient's ability to conduct daily activities and maintain independence. Evaluating cognitive function may help inform older patients and their oncologists about the risks of CRCD, provide monitoring for early detection of CRCD, and allow an opportunity to intervene to optimize cognitive function.SUPPORTSupported in part by the National Institute of Health (NIH), National Institute on Aging (NIA), Beeson Career Development Award (K76 AG064394 to A.M.), and NIH National Cancer Institute (R01CA129769, R01AG068193, and R35CA197289 to J.M.; R01 CA218496, U54 CA137788, and P30 CA 008748 to T.A., and R01CA231014 and R01CA249467 to M.C.J.).AUTHOR CONTRIBUTIONSConception and design: All authorsCollection and assembly of data: All authorsData analysis and interpretation: All authorsManuscript writing: All authorsFinal approval of manuscript: All authorsAccountable for all aspects of the work: All authorsAUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTERESTCognitive Function in Older Adults with Cancer: Assessment, Management, and Research OpportunitiesThe following represents disclosure information provided by the authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).Michelle C. JanelsinsConsulting or Advisory Role: Charles River AnalyticsNo other potential conflicts of interest were reported.

Use of a randomized clinical trial design to study cognitive rehabilitation approaches to enhance warfighter performance

Within the military, cognitive readiness is essential to ensure the warfighter can return to highly demanding combat training and deployment operations. The warfighter must be able to make split second decisions and adapt to new tools and environments. After a traumatic brain injury, clinicians helping the warfighter must have techniques that address warfighter cognitive readiness. Current rehabilitation for cognitive complaints used in military medicine are modeled after civilian therapies which focus on remediating moderate to severe impairment through building compensatory strategies. This traditional approach to cognitive rehabilitation does not translate well to mild traumatic brain injury (mTBI) where impairments are subtle, nor does it meet the needs of our warfighters in deployed and combat training environments. Challenging our current methods is critical in adapting to the needs of this highly valued population to ensure that our warfighters are able to carry out mission critical decision making. Here we present a review of our best current practices for cognitive rehabilitation, describe the limitations our traditional approaches impose for mTBI in military personnel, and present an alternative treatment called Strategic Memory Advanced Reasoning Training (SMART) that can be adopted through a randomized clinical trial design. We propose directly comparing traditional treatment approaches with a novel cognitive rehabilitation strategy which has been well validated outside of the military setting. Procedures were developed to execute this clinical trial in a way that is most relevant to the study population by establishing ecologically valid outcome metrics.

Neurophysiological mechanisms and perspective for the use of dual tasks inrecovering cognitive function after cardiac surgery

This review encompasses current trends regarding the use of dual tasks in recovering of cognitive functions in patients with ageassociated cognitive decline, traumatic brain injury and brain ischemia. The dual task represents a cognitive rehabilitation approach which implies the simultaneous execution of physical activity (walking, running or postural training) and cognitive tasks (internal counting, short-term memory and attention tasks, divergent tasks). Dual tasks with the simultaneous involvement of motor and cognitive functions are associated with specific features of brain activity and permit evaluation of the brain compensatory resources both in the normal state and in ageassociated cognitive decline or ischemic/ traumatic injury. The review also describes the basic neurophysiological mechanisms of the dual task-associated action on cognitive functions including transfer and interference. Performing of complex, multidirectional tasks provides a more efficient coordination of cognitive processes and improves the opportunities for successful cognitive functioning. The work underlines the high prevalence of cognitive impairment in cardiac surgery patients and shows the prospects of using dual tasks for the postoperative cognitive recovery. We assume that the rehabilitation using dual tasks involving brain areas providing executive control, working memory, attention and motor control can result in a pronounced cognitive recovery in cardiac surgery patients with cognitive impairment.

A comparison of two personalization and adaptive cognitive rehabilitation approaches: a randomized controlled trial with chronic stroke patients

BackgroundPaper-and-pencil tasks are still widely used for cognitive rehabilitation despite the proliferation of new computer-based methods, like VR-based simulations of ADL’s. Studies have established construct validity of VR assessment tools with their paper-and-pencil version by demonstrating significant associations with their traditional construct-driven measures. However, VR rehabilitation intervention tools are mostly developed to include mechanisms such as personalization and adaptation, elements that are disregarded in their paper-and-pencil counterparts, which is a strong limitation of comparison studies. Here we compare the clinical impact of a personalized and adapted paper-and-pencil training and a content equivalent and more ecologically valid VR-based ADL’s simulation.MethodsWe have performed a trial with 36 stroke patients comparing Reh@City v2.0 (adaptive cognitive training through everyday tasks VR simulations) with Task Generator (TG: content equivalent and adaptive paper-and-pencil training). The intervention comprised 12 sessions, with a neuropsychological assessment pre, post-intervention and follow-up, having as primary outcomes: general cognitive functioning (assessed by the Montreal Cognitive Assessment - MoCA), attention, memory, executive functions and language specific domains.ResultsA within-group analysis revealed that the Reh@City v2.0 improved general cognitive functioning, attention, visuospatial ability and executive functions. These improvements generalized to verbal memory, processing speed and self-perceived cognitive deficits specific assessments. TG only improved in orientation domain on the MoCA, and specific processing speed and verbal memory outcomes. However, at follow-up, processing speed and verbal memory improvements were maintained, and a new one was revealed in language. A between-groups analysis revealed Reh@City v2.0 superiority in general cognitive functioning, visuospatial ability, and executive functions on the MoCA.ConclusionsThe Reh@City v2.0 intervention with higher ecological validity revealed higher effectiveness with improvements in different cognitive domains and self-perceived cognitive deficits in everyday life, and the TG intervention retained fewer cognitive gains for longer.Trial registrationThe trial is registered at ClinicalTrials.gov, number NCT02857803. Registered 5 August 2016, .

Computerized cognitive training using virtual reality on everyday life activities for patients recovering from stroke

Purpose Recent studies argue that the use of virtual reality tasks depicting activities daily living may be effective means for cognitive rehabilitation. The aim of this study was to test an ecologically oriented approach in virtual reality resembling the demands of everyday life activities for cognitive rehabilitation following stroke. Materials and Methods The sample comprised 30 sub-acute stroke patients recovering from stroke in a rehabilitation hospital. They were assessed in a single-arm pre-post intervention study on global cognition, executive functions, memory and attention abilities. The intervention consisted of virtual reality in a multidomain cognitive training approach depicting everyday life tasks (preparing food, choosing clothes, shopping, etc.). Results Improvements were found in the assessed cognitive domains at 6 to 10 post-treatment sessions. In-depth analysis through reliable change scores has suggested larger treatment effects on global cognition. Conclusions Overall results suggest that the use of virtual reality-based exercises on everyday life activities may be a useful cognitive rehabilitation approach to provide short-term gains in cognition following stroke. Implications for rehabilitation Virtual reality-based cognitive rehabilitation resembling everyday life activities may provide short-term gains in cognition of stroke patients; Consistent improvements in executive functions may require higher treatment dosage than for improvements in global cognition.

Cognitive Rehabilitation for Cognitive Dysfunction after Cancer and Cancer Treatment: Implications for Nursing Practice.

To provide an overview of cognitive rehabilitation approaches for cognitive dysfunction after cancer and cancer treatment. Review and synthesis of empirical articles. Cognitive rehabilitation approaches, including cognitive behavioral therapy and cognitive training, for cognitive dysfunction appear feasible to deliver, satisfactory to participants, and have shown promising results in cancer survivors. Future research is needed to address optimal dose, delivery method, access, cost, and the vulnerable aging cancer survivor population. Oncology nurses must understand the available evidence and be able to provide information and options to cancer survivors to address cognitive changes after cancer.

Social rehabilitation for military veterans with traumatic brain injury, psychological trauma, and chronic neuropsychiatric symptoms: Intervention development and initial outcomes.

A subset of military veterans who have experienced both traumatic brain injury and psychological trauma present with chronic neuropsychiatric symptoms and experience persistent obstacles to social reintegration. This project aimed to develop a novel treatment targeting the unmet social rehabilitation needs of these veterans. Initial intervention development, feasibility, and outcome data are explored. Four treatment groups were conducted (n = 20). A treatment workbook was developed during Groups 1 and 2 (n = 10) and research data were collected from Groups 3 and 4 (n = 10). There was a 0% attrition rate across all groups with unanimous requests for additional sessions. T test effect sizes were analyzed with bias-corrected Hedges' g. Improvements were observed on measures of depression (p = .026, g = 0.73), empathic perspective taking (p = .007, g = 0.94), social cognition (p = .002-.678, g = 0.27-1.30 across multiple measures), social relationships (p = .007, g = 1.50), traumatic brain injury-related quality of life (social: p = .014, g = 0.68, emotional: p = .009, g = 1.28) and nonsocial executive functioning (p = .006, g = 0.54). Preliminary evidence from this exploratory study suggests that targeting multiple layers of social competence using a combined psychotherapy and cognitive rehabilitation approach holds promise. Larger, controlled studies are needed to further evaluate the feasibility and efficacy of this intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).