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

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Author(s): Sudhi Kulshrestha*, Manju Agrawal, Ajai K Singh, Dinkar Kulshreshtha

Journal Name: Current Psychiatry Research and Reviews
Formerly: Current Psychiatry Reviews

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Background: Cognitive impairment as a consequence of stroke is a major cause affecting 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 reviews the relevant literature and, as a synthesis, represents a structure that future research could use to specify the effectiveness of CBCI for the rehabilitation of post stroke patients.

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 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.

Result: The results after computer based training showed positive improvement in various cognitive functions such as; memory, attention and executive functions of post stroke patients. However, not all the studies reported to have observed a significant difference between the study groups. Mostly studies analysed in this research project indicated that such interventions might contribute to improvement of cognitive function, especially attention concentration and memory. Of the 19 researches that discussed CBCI outcomes 18 found significant improvements for one or more cog-nitive functions. When 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 favours CBCI except few have reported a significant difference. The review of all the studies suggests us that CBCI may help to change 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, limited number of available patients, heterogeneity of the population, and ethical considerations. Future studies should examine all the challenges, limitations and valuable insights of the study and emphasize the need of 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 larger sample size.

Keywords: Cognitive impairment, stroke, cognition, CBCI, Cognitive rehabilitation.

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(E-pub Ahead of Print)
DOI: 10.2174/2666082216999200622135105
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