A comparative study of the effectiveness of Non-computer and Computer-based Cognitive Rehabilitation Interventions on Auditory/Visual Working Memory of Stroke Patients

Background. Given the fact that there is contradictory evidence regarding the effectiveness of computerized cognitive rehabilitation interventions, the present study intended to compare the potential effects of non-computer and computer-based cognitive rehabilitation interventions on the memory of stroke patients in Tabriz. Methods. To this end, we conducted a quasi-experimental study with a pretest-posttest control group design. The population of the study included individuals who were admitted to a hospital in Tabriz, Iran, for the treatment of stroke. After identifying


Background
Since the overall prevalence of stroke in Iran is significantly high, identifying and resolving cognitive problems of stroke patients are of great importance.Therapeutic interventions in cognitive rehabilitation are used to empower patients to reduce, control, and adapt to cognitive deficits.However, the assessment of the efficacy of cognitive rehabilitation is challeging and the literature also shows that related findings are inconclusive.There has lately been a trend towards computer-based cognitive rehabilitation in modern therapeutic interventions.In fact, the limitations associated with the traditional non-computer interventions could be seen as the main reasons for the use of computerized approaches to cognitive rehabilitation.However, there is a paucity of studies comparing the effectiveness of computerized and non-computerized interventions in cognitive rehabilitation.Therefore, this study aimed to compare the effects of computer-based cognitive rehabilitation intervention with traditional noncomputer intervention on working memory (visual/auditory) in patients with stroke.

Methods
The present study was a quasi-experimental study with a pretest-posttest design and a control group.The intended population included all those individuals who were admitted to Imam Reza Hospital in Tabriz for the treatment of stroke during 2020-2021 and had a medical record with a definite diagnosis by the neurologists of the hospital.We were able to purposively select 45 stroke patients who met the inclusion criteria.We randomly assigned the participants to one of the three groups: computer-based group (n =15), non-computer group (n =15), and waiting list control group (n =15).
During the data collection process, we evaluated the working memory of the participants using Wechsler's Digit Span subscale (Wechsler, 2003).The validity and reliability of this test have been confirmed in different research studies (Fadaei, Bigdeli & Miladi Gorji,2014;Abedi, Sadeghi & Rabiee,2015).As for the computer-based cognitive rehabilitation therapy, we opted for Captain's Log software.As for the non-computer intervention, a structured guide that included visual and auditory tasks of working memory was used.This researchermade rehabilitation package was based on the workbooks (Ekhtiari & Rezapour,1395; Powell,2013) that focus on exercises for cognitive rehabilitation.In addition, due to the unfavorable conditions of the participants of the present study, it was necessary to observe a number of ethical rules.For example, the treatment process and the time required for it were fully explained to the participants.Additionally, the participants, together with a family member, expressed their informed consent to participate in the research.To protect the privacy and confidentiality of the patients, the names of the participants were not mentioned in the reports.Besides, the patients and families were reassured that they could benefit from the results of the study if they wished.We also included a control group (the waiting-list group) in the treatment process.

Results
Although the descriptive findings from the posttest scores suggested that there were differences in the post-test mean scores of the auditory memory and visual memory between groups, it was deemed necessary to analyze the data using inferential statistics.To explore the effects of the cognitive rehabilitation interventions on participants' auditory and visual memory, we considered the analysis of covariance (ANCOVA) appropriate for this study.Results related to assumption testing showed no violation of the assumptions of the normality, equality of variances, and homogeneity of regression slopes.
To test the first hypothesis (H

Conclusion
Based on the results, computer-based and noncomputer cognitive rehabilitation interventions were able to improve visual-auditory working memory in patients with stroke.Although research evidence suggests that cognitive rehabilitation is useful in treating working memory disorders due to brain injury, some studies have shown that computerassisted training programs do not have a significant positive effect on memory.Given the conflicting results and the lack of sufficient studies, this issue deserves more attention.The important point to consider is that there has been an upsurge of computer-based interventions that overshadow traditional interventions.These types of movements need to be accurately tested in further investigations so that potential ambiguities can be gradually removed and the right direction of interventions for the victims of this disease becomes known.