Change of Cognitive Functions after Stroke with Rehabilitation Systems

Abstract The objective of this study is to assess and compare the effect of applying a computerised cognitive training programme and virtual environment rehabilitation system on cognitive functions in patients after a stroke. Methods. A controlled trial included 121 persons referred to second stage rehabilitation. The subjects were differentiated into three impact groups by a single blinded trial. Results. The trial revealed that cognitive functions improved in all patient groups (p<0.001). A paired comparison analysis of all groups demonstrated a tendency for cognitive functions, evaluated by the MoCA–LT test, to be more strongly improved in patients who practised a computerised cognitive training programme during their OT sessions than those who did not (p=0.054). Conclusions. The final outcome of the trial was that cognitive functions significantly improved in patients who practised computerised cognitive training programmes or virtual environment rehabilitation systems, compared to those participants who only had occupational therapy sessions.


Intervention
The T1 group participated in a programme that included individual occupational therapy (OT) sessions (five times a week) with an aim of improving the existing cognitive impairments.
During the sessions, participants were given tasks to train spatial perception, memory, attention concentration, and problem solving.
All these functions were trained with the help of conventional "pencil-and-paper" cognition training tasks.

Results
The study presents the results of the 121-subject

Discussion
The Recommendations for cognitive rehabilitation are rather general and usually differ at a low evidence-based level [17]. Most studies that analyse the applicability of CCT programmes or VE rehabilitation systems concentrate on the training of specific cognitive fields such as memory [23,24,25,26], attention concentration [23,25,27], or other functions [24]. The present study focused on assessment of changes in overall cognitive functions. of duration and intensity [7,12]. In the present trial, the interactive rehabilitation means were practised for four weeks; meanwhile, the duration in other trials varied from two weeks to three months or longer [12, 20-24, 28, 29]. Researchers indicated the need for an appropriate practise duration for the training to be more effective, since a short-termed cognitive training usually renders only a brief and temporary effect [10,12]. However, van de monitoring of the patient's performance for evaluation and feedback [33]. When compared with conventional OT sessions, the engagement of patients in interactive activities is stronger, they strive to complete the task, seek new challenges, and train their imagination; these factors were also observed in the present study.
In their study, Lee et al. indicated that the use of CCT programmes improved the achievements of the trial subjects, and the patients were proud to be able to use the computer and show it to others [34]. The subjects of the present trial were also highly interested in the activities that were practised; they provided more comments on the success and failure, and expressed their emotions. Thus, it is possible to consider that the positive atmosphere made an impact on improvement of the results. These considerations are supported by previous studies from different experts [33,35].
Other researchers have stated that CCT programmes as well as VE rehabilitation systems might be very beneficial if practised in combination [28,29,36] rather than separately, although both of these tools have an advantage over the conventional cognition stimulation means [29]. In the present trial, each group practised a separate interactive tool, and their impacts were not combined. However, in future trials, there is an intention to combine the application of these means.

Limitation of the study
The generalisation of the study results highlight the elderly intended to refuse to participate and indicated that they did not know how to operate the interactive means, and they were stressed because of lack of self-confidence due to a possible inability to perform the given tasks properly. Another limitation of this study was that we had to overestimate the limits of self-sufficiency (BI 50-65) and cannot say what the adaptability of this data would be in another patient's self-sufficiency level. Therefore, it would be appropriate to design a simpler operation for the applied technologies.