Traditional Cognitive Rehabilitation Research Articles

Efficacy of Nonpharmacological Interventions in Cognitive Impairment: Systematic Review And Network Meta-Analysis

There is currently no known cure for cognitive impairment, which highlights the need to explore other ways of managing this condition. This topic has recently become an area of active research. However, the availability of nonpharmacological options poses a challenge when trying to determine the best treatment for improving cognitive function. We conducted a systematic review and a Bayesian network meta-analysis to compare the effects of nonpharmacological interventions on global cognition in patients with mild cognitive impairment and dementia. The nonpharmacological interventions were classified as aerobic exercise, strength exercise, multicomponent physical exercise, other physical exercises, tai chi, mind-body exercises, traditional cognitive rehabilitation, computer-based cognitive rehabilitation, occupational therapy, music therapy, physical-cognitive rehabilitation, and reminiscence therapy. Physical-cognitive rehabilitation emerged as the most effective nonpharmacological intervention for enhancing global cognition in patients with unspecified cognitive impairment and dementia, whereas occupational therapy focused on dual-task interventions was found to be the most effective nonpharmacological intervention for mild cognitive impairment. These results underscore the importance of adopting a dual approach to managing cognitive impairment, integrating both cognitive and physical rehabilitation within the same intervention.

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.

Symposium 11: Military TBI: Neural and Clinical Correlates of Cognitive Function

Summary Abstract:This symposium will highlight recent advances in understanding, assessment, and treatment of the effect traumatic brain injury has on cognitive functioning in military Service Members and Veterans. Since 2000, U.S. Service Members have sustained over 450,000 brain injuries, the majority of which are mild. Although TBI mechanisms and characteristics among Service Members can differ from civilians in significant ways, research being conducted at Department of Defense and Veterans Affairs sites to address this problem can also yield benefits to civilians with TBI. Four presentations will focus on various aspects of TBI evaluation and treatment based on findings from their own research. Dr. Mark Ettenhofer will present findings relating to promising new eye tracking measures and their relationship to standardized cognitive test results among Service Members with mild traumatic brain injury. Next, Dr. Victoria Merritt will examine the role of symptom attribution on treatment-seeking Veterans with a remote history of traumatic brain injury. In particular, Dr. Merritt will be examining both self-reported symptoms as well as performance on objective neurocognitive tests. Dr. Jason Bailie will describe an ongoing study comparing a novel approach to cognitive rehabilitation, Strategic Memory Advanced Reasoning Training (SMART), to traditional cognitive rehabilitation interventions in Active Duty Service Members. The results of this study have significant implications for treatment of all individuals with chronic symptoms following mTBI, regardless of military status. Finally, Dr. Jared Rowland will present findings on the influence of mild traumatic brain injury and blast exposure on the relationship between brain function, cognitive outcomes, and symptom severity in a sample of Iraq and Afghanistan combat veterans. This study will demonstrate how the relationship between aspects of the functional connectome and cognitive function are changed by TBI and blast. Overall, these studies highlight novel approaches to the understanding, assessment, and treatment of TBI being implemented in the Department of Defense and Veterans Affairs that have high applicability to the civilian population.

Когнітивна реабілітація у пацієнтів з церебральною патологією

The purpose of the study was to compare the effectiveness of various strategies of cognitive rehabilitation in neurosurgical pathology of the brain. Materials and methods. The dynamics of cognitive impairment was studied in 153 neurosurgical patients (95 men, 70 women, with mean age of 62.1±11.4 years) at stage II of rehabilitation. The severity of the deficiency of higher cortical functions was assessed upon admission and after 30 days in the rehabilitation department. The Roshchina test, the Mini-Mental State Examination, the Food and Behaviour Research, and the Hamilton Depression Rating Scale were used to detect depression. Results and discussion. The problem of diagnosis, treatment and prevention of cerebrovascular and neurodegenerative diseases is considered as an interdisciplinary one. The neurosurgical component of emergency care for patients who have undergone cerebrovascular accidents, in the event of complications, remains the only hope for their survival and reduction of disability. At the same time, in the treatment of these patients, medical rehabilitation is of great importance – a multifaceted, difficult process, the main purpose of which is to restore or compensate for the lost functions of the human body that have arisen as a result of various diseases of the central or peripheral nervous system. But in the literature data there is not enough information about the effect of drug and physiotherapy methods on higher nervous activity. When analyzing the dynamics of indicators of the scoring of higher cortical functions, it was found that in all groups of patients, cognitive rehabilitation led to positive results. The obtained data showed the effectiveness of traditional cognitive rehabilitation in neurosurgical patients by all assessment methods, which was enhanced when combined with drug therapy with memantine and citicoline. The addition of photochromotherapy to restorative treatment significantly improved higher cortical functions compared to a group of patients who received only neuropsychological correction procedures. The indicators of the Mini-Mental State Examination, the Food and Behaviour Research, and Roshchina's test when applying transcranial electromagnetic stimulation against the background of classes with a neuropsychologist were higher, although they were not significantly different from the control group. Similar results were obtained when traditional psychocorrection was replaced by computer training. Conclusion. The combination of neuropsychological, medical and physiotherapeutic methods at the stage of rehabilitation can significantly improve the results of rehabilitation treatment

Gender Influences Virtual Reality-Based Recovery of Cognitive Functions in Patients with Traumatic Brain Injury: A Secondary Analysis of a Randomized Clinical Trial.

The rehabilitation of cognitive deficits in individuals with traumatic brain injury is essential for promoting patients’ recovery and autonomy. Virtual reality (VR) training is a powerful tool for reaching this target, although the effectiveness of this intervention could be interfered with by several factors. In this study, we evaluated if demographical and clinical variables could be related to the recovery of cognitive function in TBI patients after a well-validated VR training. One hundred patients with TBI were enrolled in this study and equally randomized into the Traditional Cognitive Rehabilitation Group (TCRG: n = 50) or Virtual Reality Training Group (VRTG: n = 50). The VRTG underwent a VRT with BTs-N, whereas the TCRG received standard cognitive treatment. All the patients were evaluated by a complete neuropsychological battery before (T0) and after the end of the training (T1). We found that the VR-related improvement in mood, as well as cognitive flexibility, and selective attention were influenced by gender. Indeed, females who underwent VR training were those showing better cognitive recovery. This study highlights the importance of evaluating gender effects in planning cognitive rehabilitation programs. The inclusion of different repetitions and modalities of VR training should be considered for TBI male patients.

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.

The effects of computer-assisted cognitive rehabilitation on cognitive impairment after stroke: A systematic review and meta-analysis.

To determine the effectiveness of computer-assisted cognitive rehabilitation in improving cognitive function in patients with post-stroke cognitive impairment. In recent years, computer-assisted cognitive rehabilitation has been accepted as a good substitute or supplement for traditional cognitive rehabilitation. Some clinical randomised controlled trials have been carried out, but no relevant systematic evaluations have been performed. Therefore, we conducted a systematic review of studies involving computer-assisted cognitive rehabilitation to provide evidence-based data for its promotion and application. Nine databases (Cochrane Library, PubMed, Web of Science, Embase, OVID, Wanfang Data, CNKI, VIP and SinoMed databases) were systematically searched. Randomised controlled trials that assessed computer-assisted cognitive rehabilitation for patients with post-stroke cognitive impairment were included. Two reviewers appraised the risks of bias through the Cochrane Collaboration's tool and performed the meta-analysis, including the assessment of heterogeneity. We follow the PRISMA 2020guidelines. Thirty-two studies comprising 1837 participants were included. Compared with conventional therapy alone, the addition of computer-assisted cognitive rehabilitation significantly improved the global cognition of patients, evaluated using the Montreal cognitive assessment, mini-mental state examination and Loewenstein occupational therapy cognitive assessment (p<.01 for all tests). The therapy also significantly improved activities of daily living, assessed using the Barthel index, modified Barthel index and functional independence measure (p<.05 for all tests). Computer-assisted cognitive rehabilitation significantly improved the cognitive function and activities of daily living of patients with post-stroke cognitive impairment. Computer-assisted cognitive rehabilitation can be a valuable technique for cognitive rehabilitation after stroke. It is advantageous for improving patient cognition and restoring the overall functional state of patients. Moreover, the research findings can provide suggestions and inspiration for researchers to implement the proposal, which is conducive to the design of more rigorous and high-quality randomised controlled trials.

Physical Activity and Cognition: A Narrative Review

Introduction. Cognitive rehabilitation programs have traditionally focused on mental strategies targeting executive-functions, memory, and language. However, researchers are increasingly exploiting avenues to enhance benefits of cognitive training to facilitate neuroplasticity through integrative therapies. Purpose. The aim of this paper is to provide an overview of the evidence that supports addition of physical activity into traditional cognitive rehabilitation, creating a more integrated treatment approach. Specifically, the evidence focuses on increased levels of Brain-Derived neurotrophic factor (BDNF), a specific growth factor in neuroplasticity, following physical activity. Method. This narrative review chose a representative sample of the evidence that informs cognitive gains as a result of physical activity, with an emphasis on BDNF. A comprehensive review of the literature was conducted across PubMed, Cinahl, and PsycInfo, and a representative sample of the evidence was selected that informs the effects of physical activity on cognition, as well as the relationship with BDNF. Conclusion. The review supports the addition of physical activity into cognitive rehabilitation programs to enhanced cognition in clinical populations. However, more evidence is needed to support the duration and type of activity that would produce the most benefit.

A Pilot Investigation of Computerized Cognitive Rehabilitation for Post-Stroke Patients: Cognitive Function and Satisfaction

The aim of this pilot study was to investigate the effects of computerized cognitive rehabilitation on patients after they had each experienced an acute stroke and evaluate the association between rehabilitation satisfaction and age. Eighteen patients who had each experienced an acute stroke participated in the study. They were assigned to two groups: the experimental group (n = 12) and control group (n = 6). Interventions were performed with each group for 30 minutes per day, five times per week, for four weeks. The experimental group engaged in computerized cognitive rehabilitation, and the control group participated in traditional cognitive rehabilitation. In addition, both groups engaged in traditional cognitive rehabilitation for four weeks according to an established schedule. The Lowenstein Occupational Therapy Cognitive Assessment test (LOTCA) was performed to measure cognitive function. The Visual Analog Satisfaction Scale (VASS) was used to measure satisfaction with cognitive rehabilitation—specifically, overall satisfaction, therapeutic effects, interest, and intention to reuse. After the interventions, total cognitive function scores for both groups were significantly improved compared to scores before the interventions. However, the experimental group showed significant improvement in more sub-items of cognitive function compared to the control group. There was no significant difference in satisfaction between the two groups after the interventions. In the experimental group, overall satisfaction and interest in computerized cognitive rehabilitation were significantly lower among elderly participants when compared to middle-aged participants. Computerized cognitive rehabilitation may have a positive effect on cognitive function improvement. However, computerized cognitive rehabilitation programs must be developed to meet the specific characteristics and needs of elderly stroke patients.

Improving Cognitive Function after Traumatic Brain Injury: A Clinical Trial on the Potential Use of the Semi-Immersive Virtual Reality.

Traumatic brain injury (TBI) is the most common cause of long-term disability and death among young adults, and it represents an enormous socioeconomic and healthcare burden. Our purpose is to evaluate the effects of a virtual reality training with BTs-Nirvana (BTs-N) on the recovery of cognitive functions in TBI subjects, using the interactive semi-immersive program. One hundred patients with TBI were enrolled in this study and randomized into either the Traditional Cognitive Rehabilitation Group (TCRG: n = 50) or the Virtual Reality Training Group (VRTG: n = 50). The VRTG underwent a VRT with BTs-N, whereas the TCRG received a standard cognitive treatment. Each treatment session lasted 60 minutes and was repeated three times a week for 8 weeks. All of the patients were evaluated by a specific psychometric battery before (T0) and immediately (T1) after the end of the training. VRTG and TCRG had a significant improvement in cognitive functioning and in mood, but only VRTG presented with a significant increase in cognitive flexibility and shifting skills and in selective attention. In conclusion, our results suggest that VR may be a useful and effective approach for the rehabilitation of patients with TBI, leading to better cognitive and behavioral outcomes.

Longitudinal Clinical and Neuroimaging Evaluation of Symptomatic Concussion in 10- to 14-year-old Youth Athletes.

This study longitudinally assessed 10- to 14-year-old patients with sports and recreational concussion (n = 22) who remained symptomatic 3 to 4weeks post-injury compared with typically developing controls (n = 24). Examination by multi-modal magnetic resonance imaging (MRI) and multi-domain clinical outcome measures was completed at 1-month and 6-months post-injury. Concussion patients showed evidence of improvement by 6-month follow-up in domains of cognitive function, whereas measures of psychological health were less resolved with patients exhibiting sustained symptoms of depression, behavior impairment, and concussion symptoms. Quantitative neuroimaging measures identified measures indicative of chronic injury with regional reductions observed by both volumetric segmentation and white matter fractional anisotropy (FA) from diffusion tensor imaging (DTI). Volumetric reductions (p < 0.01) were observed in the middle anterior and posterior portions of the corpus callosum, and right caudal anterior cingulate cortex of patients, although none held after strict correction. Examination of the FA data identified significant reductions in the left middle frontal gyrus white matter (p = 0.0003). Linear regression analysis on the 6-month depression outcome variable using the initial clinical, demographic, and imaging measures identified the top predictive models to include concussion diagnosis, and initial symptoms of depression, concussion symptoms, and sleep impairment with additional contribution from other measures of mental health, behavior impairment, and quality of life depending on the model (adjusted r-squared = 0.69 indicating strong predictive ability). This study supports further inclusion of mental health rehabilitation and imaging supplementing traditional cognitive rehabilitation strategies employed in these young athletes.

Computer Aided Technology-Based Cognitive Rehabilitation Efficacy Against Patients’ Cerebral Stroke

Cognitive dysfunction caused by cerebral stroke in different degrees throws patients into troubles in daily life. It, therefore, has been a great challenge about how to develop a positive and accurate diagnosis and treatment program against cognitive impairments and in favor of rehabilitation of patients after cerebral stroke. This paper investigates 128 cases of stroke patients randomly chosen and included into the traditional rehabilitation and computer-aided training groups who respectively received routine drug and traditional cognitive rehabilitation therapies for 4 weeks, except that the computer-aided training group also underwent a computer-aided cognitive exercises. A Montreal Cognitive Assessment (MOCA) was introduced for rating both groups. After a comparative analysis was conducted on the results, it turns out that, after cerebral stroke of patients, whether the traditional cognitive rehabilitation therapy or the computer-aided cognitive therapy they received, the cognitive dysfunction can be relieved, but the computer-aided training process, as an adjuvant therapy, has a more significant efficacy against this symptom. It is proved that the Computer Aided Technology (CAT) has played a great role in the rehabilitation of patients with cognitive dysfunction after cerebral stroke, which attributes to its strong targeted therapy, practicality, time-saving and less effort, and good scientificity. Not only that, it also has a great practical significance for clinical cognitive rehabilitation.

Remediation of impairments in facial affect recognition in schizophrenia: Efficacy and specificity of a new training program

ObjectiveSchizophrenia patients often exhibit impairments in facial affect recognition which contribute to their poor social functioning. These impairments are stable in the course of the disorder and seem not to be affected by conventional treatment. The present study investigates the efficacy and specificity of a new training program for the remediation of such impairments. MethodA newly developed training program tackling affect recognition (TAR) was compared with a cognitive remediation training program (CRT) and treatment as usual (TAU) within a randomized three group pre-post design in n=77 post-acute schizophrenia patients. The TAR is a computer-aided 12-session program focussing on facial affect recognition, whereas the CRT aims to improve attention, memory and executive functioning. Facial affect recognition, face recognition, and neurocognitive performance were assessed before (T0) and after (T1) the six week training phase. During the training period all patients received antipsychotic medication. ResultsPatients under TAR significantly improved in facial affect recognition, with recognition performance after training approaching the level of healthy controls from former studies. Patients under CRT and those without special training (TAU) did not improve in affect recognition, though patients under CRT improved in verbal memory functions. ConclusionAccording to these results, remediation of disturbed facial affect recognition in schizophrenia patients is possible, but not achievable with a traditional cognitive rehabilitation program such as the CRT. Instead, functional specialized remediation programs such as the newly developed TAR are a more suitable option.

Historical review of computer-assisted cognitive retraining.

This article details the introduction and development of the use of microcomputers as adjuncts to traditional cognitive rehabilitation of persons with acquired brain injury. The initial application of video games as therapeutic recreation in the late 1970s was soon followed in the early 1980s by the use of the first personal computers and available educational software. By the mid-1980s, both the IBM PC and Macintosh platforms were established, along with simplified programming languages that allowed individuals without extensive technical expertise to develop their own software. Several rehabilitation clinicians began to produce and market specially written cognitive retraining software for one or the other platform. Their work was detailed and reviewed, as was recently released software from commercial sources. The latter discussion included the latest developments in the rehabilitation applications of personal digital assistants and related organizing, reminding, and dictation devices. A summary of research on the general and specific efficacy of computer-assisted cognitive retraining illustrated the lingering controversy and skepticism that have been associated with this field since its inception. Computer-assisted cognitive retraining (CACR) can be an effective adjunct to a comprehensive program of cognitive rehabilitation. Training needs to be focused, structured, monitored, and as ecologically relevant as possible for optimum effect. Transfer or training or generalizability of skills remains a key issue in the field and should be considered the key criterion in evaluating whether to initiate or continue CACR.