| Abstract: | Objectives: To test the hypotheses that (1) a structured learning environment and computer-based cognitive training will improve cognition in elderly, extended acute (phase 1B) medical inpatients admitted for deconditioning secondary to cardiac disease, who demonstrate cognitive deficits on admission; and (2) a change in cognition will lead to improved functional outcomes. Design: Experimental, prospective, randomized, single-factor, pretest-posttest design. Setting: Phase 1B inpatient medical rehabilitation unit using a multidisciplinary approach. Participants: 50 patients (47 completed the study) admitted to a phase 1B inpatient medical rehabilitation unit who met study inclusion criteria (Mini-Mental State Examination score, <25; >1wk length of stay [LOS], cardiac diagnosis) were randomly assigned to a cognitive training group (experimental, n=25) or standard treatment (control, n=22) group. Interventions: Groups received 3 to 6 hours of daily standard therapy. The experimental group also received computer-based cognitive training sessions 3 times/wk, 20 min/session, and a morning and evening group session designed to improve memory and organization skills. Main Outcome Measures: For hypothesis 1, cognitive portion of the FIM™ instrument. For hypothesis 2, LOS, falls, number of home services on discharge, discharge placement, total and motor FIM scores, and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results: There were no significant differences in baseline characteristics. The experimental group showed a significantly greater percentage improvement for the cognitive portion of the FIM (23.6%±18.4% vs 11.8%±17.2%, P=.035). LOS, falls, home services, discharge placement, total FIM, motor FIM, and 7 of 8 of the SF-36 subscales did not differ between the groups. The control group showed a significantly greater percentage improvement on the physical functioning subscale of the SF-36 (130.0%±67.1% vs 83.3%±66.5%, P=.008). Conclusions: The structured learning environment and computer-based training program showed improvements in cognition, as measured by the cognitive portion of the FIM. However, there were no differences in functional outcomes. |
