Comparison of changes in cognitive functions of post-stroke patients with the computer-based cognitive intervention (PABLO system) and conventional cognitive intervention (Paper-Pencil method)

2021 ◽  
Vol 17 ◽  
Author(s):  
Sudhi Kulshrestha ◽  
Manju Agrawal ◽  
Ajai K Singh ◽  
Akash Ved
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Functions ◽  
Research Work ◽  
Cognitive Intervention ◽  
Stroke Patients ◽  
Post Stroke ◽  
Group A ◽  
Computer Based ◽  
Attention Memory ◽  
Group B

Background: Cognitive functions are mental series of activities that allow us to carry out any activity. The most important cognitive functions are orientation, attention, memory, executive functions, language, and visuospatial skills. Cognitive impairment is a prevalent consequence of stroke. Prognosis of stroke recovery can be estimated through the severity of cognitive impairment. The objective of this research work was to compare the changes in cognitive functions of post-stroke patients with the computer-based cognitive intervention (CBCI) using PABLO system and conventional cognitive intervention (CCI) using paper-pencil method. Methods: Total 80 stroke patients with cognitive impairment were selected and divided into two groups. The Group A received intervention through PABLO System (CBCI) and the Group B received the cognitive intervention through Paper Pencil method (CCI). Pre and post-assessment of cognitive functions like verbal fluency, language, orientation and attention, memory, visuospatial and mini mental state examination for both the groups were done by Addenbrooke Cognitive Examination-Revised (ACE-R) scale. Result: After the intervention of 4 weeks, patients of both groups showed improvement in cognitive functions. However, the group A scored higher in comparison to group B. Conclusion: Data suggest that both the interventions will bring the changes in cognitive functions post-stroke patients but CBCI may be much more effective in improving cognitive functions of stroke patients.

Post Stroke Rehabilitation Using Computer-based Cognitive Intervention (CBCI): A Systematic Review

2020 ◽  
Vol 16 (2) ◽  
pp. 93-102
Author(s):  
Sudhi Kulshrestha ◽  
Manju Agrawal ◽  
Ajai K. Singh ◽  
Dinkar Kulshreshtha
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Functions ◽  
Cognitive Intervention ◽  
Cochrane Library ◽  
Stroke Patients ◽  
Future Studies ◽  
Computer Based Training ◽  
Post Stroke ◽  
Significant Difference ◽  
Computer Based

Background: Cognitive impairment as a consequence of stroke is a major cause affecting the patient’s functional independence, activity participation, daily living skills, and occupation. Almost 75% of post-stroke patients are diagnosed with significant cognitive impairment, which includes problems with attention, orientation, memory, language, and perception. Along with effective pharmaceutical cures, cognitive intervention as a part of rehabilitation approaches that may prevent, delay, or treat cognitive impairment is becoming increasingly important. Many studies have reported improvement in cognitive functions of post-stroke patients after using computer-based cognitive intervention (CBCI). CBCI can be an effective add-on to available rehabilitation programs. Objective: This article provides reviews related to relevant literature and, represents a structure to specify the efficacy of CBCI for the rehabilitation of post-stroke patients for future research. Methods: We searched many search engines namely MEDLINE, Web of Science, clinical key and The Cochrane Library, for studies investigating the effect of cognitive intervention based on a computer program for post-stroke patients. The results of selected studies were summarized. Total 19 publications from January 2007 to January 2019 are included in this review. The search terms entered were a combination of these search areas that defined (1) the population as adults who had suffered a stroke and cognitive dysfunction, (2) intervention search term included cognitive abilities, cognitive training, and computer-based training; computer-based cognitive intervention for rehabilitation. Results: The results after computer-based training showed improvement in various cognitive functions such as; memory, attention and executive functions of post-stroke patients. However, a significant difference between the study groups has not been observed in all the studies. Most studies analyzed in this research project indicated that such interventions might contribute to the improvement of cognitive function, especially attention concentration and memory. Of the 19 kinds of research that discussed CBCI outcomes 18 found significant improvements for one or more cognitive functions. When the effect size for CBCI was reported, effects were large in comparison to other traditional cognitive interventions of post-stroke patients. Conclusion: Studies related to cognitive functions strongly support CBCI except few have reported a significant difference. The review of all the studies suggests that CBCI may help to change the functional aspect of post-stroke patients by improving their cognitive functions. In this field, it is a challenge to conduct well designed and sufficiently powered studies due to low budgets availability, the limited number of available patients, heterogeneity of the population, and ethical considerations. Future studies should examine all the challenges, limitations, and valuable insights into the study and emphasize the need for a carefully designed computer-based cognitive intervention program for the future. Future studies should target to compare CBCI with active and passive control conditions and include a larger sample size.

scholarly journals Cognitive impairment and dementia

2018 ◽  
pp. 10-15
Author(s):  
V. A. Parfenov ◽  
S. V. Verbitskaya
Keyword(s):  
Cognitive Impairment ◽  
Brain Damage ◽  
Cognitive Functions ◽  
Stroke Prevention ◽  
Stroke Patients ◽  
Acquired Disability ◽  
Post Stroke ◽  
Treatment And Prevention ◽  
Meta Analyses

Cognitive impairment (CI) is one of the causes of acquired disability in post-stroke patients. The article presents an analysis of the prevalence, pathogenesis, manifestations, diagnosis, treatment and prevention of post-stroke CI. It is noted that CI can be caused not only by focal vascular brain damage, but also by the presence of concomitant vascular and degenerative lesions in stroke patients. The authors present the results of their own study of CI in 350 patients after stroke within 5 years. The treatment and prevention of CI progression are based on stroke prevention, non-pharmaceutical and pharmaceutical methods for improving cognitive functions. The article discusses data on the use of Cerebrolysin in post-stroke patients, the results of the two latter meta-analyses of Cerebrolysin use.

scholarly journals Efficacy of motor therapy over sensorimotor therapy in upper limb functions of post stroke patients

Biomedicine ◽  
2021 ◽  
Vol 41 (1) ◽  
pp. 120-124
Author(s):  
V. Rajalaxmi ◽  
M. Tharunya ◽  
S.S. Subramanian ◽  
G. Vaishnavi ◽  
Chandra Kumar K ◽  
...  
Keyword(s):  
Upper Limb ◽  
Fine Motor ◽  
Stroke Patients ◽  
Mean Values ◽  
Post Stroke ◽  
Medical College ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Nine Hole Peg Test

Introduction and Aim:Strokeis one of the leading causes of death and disability in India. The incidence of stroke rapidly increases with age, doubling for each decade after 55.In the majority of patients the upper limb is severely impaired than lower limb. The aim of this study was to analyze the efficacy of motor therapy over sensorimotor therapy in upper limb functions of post stroke patients.   Materials and Methods: This was an experimental study, of pre-post type, that was conducted in the outpatient department of Physiotherapy at ACS Medical College and Hospital,chennai.30 samples were selected from 45 volunteers according to inclusion criteria and the study was conducted for Group A received sensorimotor therapy for one session/day for 6 days a week for 12 weeks. Group B received motor therapy for one session/day for 6 days a week for 12 weeks. Pre and post measurement were done using motor assessment scale, stroke upper limb capacity scale, action research arm test and nine-hole peg test.   Results: There was a significant difference in mean values of group A and B on comparison. Group A seems to be more effective than group B.   Conclusion: The study concludes that both motor therapy and sensorimotor therapy are beneficial in stroke rehabilitation, but sensorimotor therapy is more effective in improving the gross and fine motor skills of the upper limb of stroke patients.

scholarly journals Slower EEG alpha generation, synchronization and “flow”—possible biomarkers of cognitive impairment and neuropathology of minor stroke

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3839 ◽  
Author(s):  
Jelena Petrovic ◽  
Vuk Milosevic ◽  
Miroslava Zivkovic ◽  
Dragan Stojanov ◽  
Olga Milojkovic ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Frontal Cortex ◽  
Cognitive Functions ◽  
Alpha Activity ◽  
Electrode Placement ◽  
Minor Stroke ◽  
Stroke Patients ◽  
Post Stroke ◽  
Alpha Frequency ◽  
Eeg Alpha

Background We investigated EEG rhythms, particularly alpha activity, and their relationship to post-stroke neuropathology and cognitive functions in the subacute and chronic stages of minor strokes. Methods We included 10 patients with right middle cerebral artery (MCA) ischemic strokes and 11 healthy controls. All the assessments of stroke patients were done both in the subacute and chronic stages. Neurological impairment was measured using the National Institute of Health Stroke Scale (NIHSS), whereas cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) and MoCA memory index (MoCA-MIS). The EEG was recorded using a 19 channel EEG system with standard EEG electrode placement. In particular, we analyzed the EEGs derived from the four lateral frontal (F3, F7, F4, F8), and corresponding lateral posterior (P3, P4, T5, T6) electrodes. Quantitative EEG analysis included: the group FFT spectra, the weighted average of alpha frequency (αAVG), the group probability density distributions of all conventional EEG frequency band relative amplitudes (EEG microstructure), the inter- and intra-hemispheric coherences, and the topographic distribution of alpha carrier frequency phase potentials (PPs). Statistical analysis was done using a Kruskal–Wallis ANOVA with a post-hoc Mann–Whitney U two-tailed test, and Spearman’s correlation. Results We demonstrated transient cognitive impairment alongside a slower alpha frequency (αAVG) in the subacute right MCA stroke patients vs. the controls. This slower alpha frequency showed no amplitude change, but was highly synchronized intra-hemispherically, overlying the ipsi-lesional hemisphere, and inter-hemispherically, overlying the frontal cortex. In addition, the disturbances in EEG alpha activity in subacute stroke patients were expressed as a decrease in alpha PPs over the frontal cortex and an altered “alpha flow”, indicating the sustained augmentation of inter-hemispheric interactions. Although the stroke induced slower alpha was a transient phenomenon, the increased alpha intra-hemispheric synchronization, overlying the ipsi-lesional hemisphere, the increased alpha F3–F4 inter-hemispheric synchronization, the delayed alpha waves, and the newly established inter-hemispheric “alpha flow” within the frontal cortex, remained as a permanent consequence of the minor stroke. This newly established frontal inter-hemispheric “alpha flow” represented a permanent consequence of the “hidden” stroke neuropathology, despite the fact that cognitive impairment has been returned to the control values. All the detected permanent changes at the EEG level with no cognitive impairment after a minor stroke could be a way for the brain to compensate for the lesion and restore the lost function. Discussion Our study indicates slower EEG alpha generation, synchronization and “flow” as potential biomarkers of cognitive impairment onset and/or compensatory post-stroke re-organizational processes.

scholarly journals Effect of Post-Stroke Motor Training on EEG Movement-Related Cortical Potentials

2020 ◽  
Author(s):  
Maryam Butt ◽  
Golshah Naghdy ◽  
Fazel Naghdy ◽  
Geoffrey Murray ◽  
Haiping Du
Keyword(s):  
Low Cost ◽  
Motor Training ◽  
Clinical Test ◽  
Kinematic Parameters ◽  
Eeg Signals ◽  
Hand Rehabilitation ◽  
Stroke Patients ◽  
Post Stroke ◽  
Group A ◽  
Group B

Abstract BackgroundRehabilitation of post-stroke patients with motor impairments promotes re-learning of lost motor functions through the brain neuroplasticity. Monitoring of electroencephalogram (EEG) signals has the potential to show neuroplasticity changes that take place during motor training.MethodsIn this study, an EEG-derived time-domain pattern namely movement-related cortical potential (MRCP) was deployed to assess the effect of motor training in seven post-stroke patients. Patients were divided into two groups; group A comprising four subjects with supratentorial lesions and group B consisting of three subjects with infratentorial lesions. Both groups participated in motor training with an AMADEO hand rehabilitation device. During pre and post-training periods, EEG signals at eight selected electrodes were recorded. In addition, hand-kinematic parameters, and clinical tests were measured at the beginning and the end of all training sessions.ResultsThe negative peak of the MRCP signals decreased at all electrodes and reached significance in seven of eight electrodes for group A after 12 training sessions, while it was decreased at all electrodes and reached significance in two of eight electrodes for group B after 24 sessions according to paired t-test (p < 0.05). Moreover, these MRCP changes correlated with improvements in kinematic parameters and clinical test results for both groups.ConclusionsThis study shows that robot-assisted training that improves clinical outcomes is associated with MRCP pattern changes. Subjects with infratentorial strokes improved slower clinically compared to subjects with supratentorial strokes. This was consistent with the longer rehabilitation required for this group of patients to produce significant changes in MRCP. The reduction of negative peaks of the MRCP signal indicates that neurological pathways are established and less cortical resources are needed for motor tasks. This study demonstrates the significance of EEG as a practical and low-cost tool in detecting patterns associated with brain neuroplasticity in the course of motor re-learning. Ethics ApprovalThe procedures performed in this study were approved by the University of Wollongong Ethics Committee (Ethics application number: 2014/400) on 03/07/2017.

scholarly journals Comparison of Traditional Versus Computer-Based Cognitive Training on Cognition in Elderly with Mild Cognitive Impairment

2021 ◽  
pp. 180-185
Author(s):  
Dr. Vidhi Shah ◽  
Bhakti Panchal ◽  
Dr. Tushar Palekar ◽  
Padmaja Guruprasad ◽  
Pooja Pokar ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Training ◽  
Medial Temporal Lobe ◽  
Cognitive Rehabilitation ◽  
Significant Difference ◽  
Group A ◽  
Computer Based ◽  
Group B ◽  
Moca Score

Normal ageing cause alterations in the prefrontal cortex, medial temporal lobe system, hippocampus and cerebellum. These changes are the cause of mild cognitive impairment in terms of decreased memory function, reduced speed and executive functions, personality and behavioral disturbances. Computer-based cognitive training is a new tool used for cognitive rehabilitation. This randomized control trial includes 50 subjects, Group A received computer-based cognitive training (n=25) by using BrainHQ app and Group B received Tradition cognitive training (n=25) for 3 weeks. Montreal cognitive assessment (MOCA) was taken as outcome measure. The comparison of difference of pre and post MOCA score between Group A and Group B shows p=0.002. Also comparison of MOCA score between male and female of group A shows statistically significant difference with respect to MALE P=0.008 and FEMALE P=0.000.This study provides a strong evidence that Computer Based Cognitive Training showed added improvements in cognition function compared to traditional training.

Brain parenchymal fraction and post-stroke cognitive impairment in chronic focal stroke patients

2017 ◽  
Vol 381 ◽  
pp. 197
Author(s):  
K. Honjo ◽  
D. Nyenhuis ◽  
F. Gao ◽  
C. Scott ◽  
A. Ganda ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Stroke Patients ◽  
Post Stroke ◽  
Brain Parenchymal Fraction ◽  
Brain Parenchymal

scholarly journals COGNITIVE IMPAIRMENT, THEIR DYNAMICS AND STRUCTURE IN THE ACUTE AND RECOVERY PERIODS OF STROKE, DEPENDING ON ARTERIAL HYPERTENSION SEVERITY AND DURATION

2018 ◽  
Vol 13 (3-4) ◽  
pp. 22-27
Author(s):  
T.M. Cherenko ◽  
Yu.L. Heletyuk
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Arterial Hypertension ◽  
Blood Pressure Monitoring ◽  
Cognitive Status ◽  
Neurological Deficits ◽  
Stroke Patients ◽  
Mean Values ◽  
Post Stroke ◽  
The Mean

Relevance. Cognitive impairment is common in the post-stroke period. Different characteristics of arterial hypertension (AH), namely its severity, duration and variability of blood pressure, can affect the development of cognitive impairment in stroke patients. Objective: to investigate cognitive impairment, their dynamics and structure in acute and recovering stroke periods, depending on the arterial hypertension severity and duration. Materials and methods. 150 patients with a primary ischemic stroke and history of hypertension: 74 (49,3 %) women and 76 (50,7 %) men, the mean age (67,4±0,7) years have been examined. Neurological deficits was evaluated by the NIHSS scale. The cognitive status was evaluated by the MMSE scale at the end of an acute period of 21 days and 1 year. Diagnosis of hypertension was based on the clinical and instrumental examination results and medical documents. Daily blood pressure monitoring was using on admission and every 4 hours during 6 days of acute stroke stage. Mean SBP, mean DBP, maximum SBP and DBP, standard deviation (SD) of SBP and DBP were studied. Results. By the mean score on the MMSE scale, there are differences in patients during acute post-stroke period, depending on the severity of hypertension: 27,2±0,6 points in the case of hypertension stage 1, 24,3±0,6 in the case of hypertension stage 2 and 20,7±0,8 in case of AH stage 3, (p=0.001). By this indicator, patients with different AH duration were different: 26,4±0,9 points; 25,1±0,5 points; 20,5±0,7 points, respectively. The significance of these differences by the mean values of MMSE score was obtained in patients with a duration of AH less than 5 years and more than 10 years, as well as when comparing the group of "6-10 years" and "over 10 years" (p=0,001). Significant differences in the structure of cognitive deficits severity, depending on the hypertension stage and its duration, were observed only in patients with moderate and severe stroke (p=0,006). Cognitive deterioration a year after a stroke was observed in 40 (31,5 %) patients. They have significantly higher mean values SD 1-3, SD 1-6, SBP on the first day after a stroke, and duration of hypertension. Conclusions. The relationship between the degree of intellectual decline and the duration of hypertension (r=0,592, p=0,001), severity of hypertension (r=0,459, p=0,001) was found. The severity of the neurological deficiency affects the structure of cognitive impairment at discharge in patients with different severity and duration of hypertension, and higher mean values of the variability of blood pressure from 1 to 6 days, SBP on the first day after stroke and higher duration of hypertension in the history is associated with a negative dynamics of cognitive impairment in stroke patients in a year after stroke.

scholarly journals EFFICACY OF ROLLING BOARD PERTURBATION TRAINING ON BALANCE AMONG HEMIPARETIC STROKE PATIENTS - A COMPARATIVE STUDY

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Dr. Senthil kumar ◽  
Dr. Franklin Shaju M.K m k ◽  
Dr. Vijaya Senthil Kumar kumar ◽  
Dr. A. velmurugan
Keyword(s):  
Public Health Problem ◽  
Berg Balance Scale ◽  
Major Public Health Problem ◽  
Stroke Patients ◽  
Perturbation Training ◽  
Before And After ◽  
Group A ◽  
Hemiparetic Stroke ◽  
Conventional Physiotherapy ◽  
Group B

Background of the study: Stroke is a major public health problem that ranks in the top four causes of death in most of the countries and is responsible for a large proportion of the burden of neurologic disorders. Patients with stroke have poor balance because they cannot control dynamically the size of the base of support or the location of the line of gravity. Perturbation training undergoes the maximal sway possible without losing his balance. Objective of the study: The objective of the study is to find the effects of rolling board perturbation training on balance among hemiparetic stroke patients. Methodology: Thirty clinically diagnosed hemiparetic stroke patients were selected based on the inclusion and exclusion criteria. They were randomly allocated into two groups (Group A and Group B) consists of 15 subjects each. Group A received conventional physiotherapy alone and group B received rolling board perturbation training along with conventional physiotherapy. Intervention lasted for 4 weeks, three days in a week and one hour per day. Balance was measured before and after 4 weeks of intervention by berg balance scale. Conclusion: Both conventional physiotherapy alone and rolling board perturbation training along with conventional physiotherapy significantly improved balance among hemiparetic stroke patients. When comparing both rolling board perturbation training along with conventional physiotherapy is more effective than conventional physiotherapy alone in improving balance among hemiparetic stroke patients.

scholarly journals Association among depression, cognitive impairment and executive dysfunction after stroke

2012 ◽  
Vol 6 (3) ◽  
pp. 152-157 ◽  
Author(s):  
Luisa Terroni ◽  
Matildes F.M. Sobreiro ◽  
Adriana B. Conforto ◽  
Carla C. Adda ◽  
Valeri D. Guajardo ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Neuropsychological Tests ◽  
Executive Dysfunction ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Adequate Treatment ◽  
Post Stroke ◽  
Quantitative Studies ◽  
Post Stroke Depression ◽  
The Relationship

ABSTRACT The relationship between depression and cognitive impairment, frequent after stroke, is complex and has not been sufficiently elucidated. Objective: To review the relationship between post-stroke depression and cognitive impairment. Methods: We performed a PubMed database search spanning the last ten years, using the terms post-stroke depression, cognitive dysfunction, cognitive impairment and neuropsychological tests. Our target studies were original quantitative studies that investigated the relationship between post-stroke depression (PSD) and cognitive impairment in stroke patients. Articles published in English, Spanish, Italian and Portuguese were considered. Selection criteria were the use of neuropsychological tests to assess cognitive function, and of either instruments to diagnose major depression, or scales to assess depressive symptoms, within the first three months after stroke. Results: Six original quantitative studies fulfilled the criteria. The prevalence of PSD within the first three months after stroke ranged from 22% to 31%. Incidence ranged from 25% to 27% and was evaluated in only two studies. PSD was associated with increased cognitive impairment. Cognitive impairment was reported in 35.2% to 87% of the patients. Post-stroke cognitive deficits were reported mostly in executive function, memory, language, and speed of processing. Conclusion: Executive dysfunction and depression occur in stroke survivors, are frequently coexistent, and also associated with worse stroke prognosis. Healthcare professionals need to address and provide adequate treatment for depression and executive dysfunctions in stroke patients early in the first three months after stroke. Future studies should evaluate the efficacy of programs evaluating the early detection and treatment of PSD and executive dysfunction in stroke survivors.

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