Transfer of training effects in stroke patients with apraxia: an exploratory study

The goal of the present study was to examine the transfer of the effects of cognitive strategy training for stroke patients with apraxia from trained to non-trained tasks. In strategy training, the occurrence of transfer is expected as the training programme is aimed, not at relearning specific tasks, but at teaching patients new ways to handle the problems resulting from the impairment. Exploratory analyses were conducted on data previously collected in a randomised controlled trial on the efficacy of the strategy training. A total of 113 left hemisphere stroke patients were randomly assigned to a strategy training group and a group receiving occupational therapy as usual. Assessment of apraxia, motor functioning and activities of daily living (ADL) took place at baseline, after an eight-week treatment period, and five months after baseline. The primary outcome measure consisted of standardised ADL observations of trained and non-trained tasks. The analyses showed that in both treatment groups, the scores on the ADL observations for non-trained tasks improved significantly after eight weeks of training as compared with the baseline score. Change scores of non-trained activities were larger in the strategy training group as compared with the usual treatment group. By using previously collected data we are able to illustrate the potential transfer of treatment effects in a large sample of stroke patients. We found indications for the occurrence of transfer, although the study was not originally designed for the purpose of evaluating transfer. Therefore these results are worth exploring more profoundly. We will further investigate our preliminary conclusions in a new prospective study which is specifically designed to examine the transfer of training effects.     

Transfer of training effects in stroke patients with apraxia: An exploratory study

The goal of the present study was to examine the transfer of the effects of cognitive strategy training for stroke patients with apraxia from trained to non-trained tasks. In strategy training, the occurrence of transfer is expected as the training programme is aimed, not at relearning specific tasks, but at teaching patients new ways to handle the problems resulting from the impairment. Exploratory analyses were conducted on data previously collected in a randomised controlled trial on the efficacy of the strategy training. A total of 113 left hemisphere stroke patients were randomly assigned to a strategy training group and a group receiving occupational therapy as usual. Assessment of apraxia, motor functioning and activities of daily living (ADL) took place at baseline, after an eight-week treatment period, and five months after baseline. The primary outcome measure consisted of standardised ADL observations of trained and non-trained tasks. The analyses showed that in both treatment groups, the scores on the ADL observations for non-trained tasks improved significantly after eight weeks of training as compared with the baseline score. Change scores of non-trained activities were larger in the strategy training group as compared with the usual treatment group.

By using previously collected data we are able to illustrate the potential transfer of treatment effects in a large sample of stroke patients. We found indications for the occurrence of transfer, although the study was not originally designed for the purpose of evaluating transfer. Therefore these results are worth exploring more profoundly. We will further investigate our preliminary conclusions in a new prospective study which is specifically designed to examine the transfer of training effects.     

The cognitive rehabilitation of limb apraxia in patients with stroke

Apraxia is a higher level motor deficit that occurs when processing a goal-directed action. The apraxic deficit can manifest itself in absence of sensory input deficits or motor output deficits, neglect, frontal inertia or dementia. According to a clinical classification still largely in use, there are two main forms of limb apraxia: ideomotor (IMA) and ideational (IA), observed when a patient is required to imitate a gesture or use an object, respectively. In the present review, we examined only the cognitive treatments of both types of limb apraxia of a vascular aetiology. Despite the high prevalence of limb apraxia caused by left brain damage, and the fact that apraxia has been known for over a century, the literature regarding its rehabilitation is still very limited. This is partly due to the nature of the recovery from the deficit, and in part to the automatic-voluntary dissociation. Here we review those treatments that have proved most successful in helping patients to recover from limb apraxia.     

Efficacy of strategy training in left hemisphere stroke patients with apraxia: A randomised clinical trial

The objective of the present study was to determine in a controlled study the efficacy of strategy training in left hemisphere stroke patients with apraxia. A total of 113 left hemisphere stroke patients with apraxia were randomly assigned to two treatment groups; (1) strategy training integrated into usual occupational therapy and (2) usual occupational therapy only. Assessments took place at baseline, after an 8 week treatment period and 5 months after baseline (follow-up). Patients were assessed on apraxia, motor functioning and activities of daily living (ADL). The primary outcome measure was a standardised ADL observation by a blinded research assistant. Additional ADL measures were used as secondary outcome measures (Barthel ADL index, ADL judgement by occupational therapist and by patient). After 8 weeks of treatment, patients who received strategy training (n = 43) improved significantly more than patients in the usual treatment group (n = 39) on the ADL observations (mean change .24; 90% CI, .15–.34 vs. .12, .03–.21). This reflects a small to medium effect (effect size .37) of strategy training on ADL functioning. With respect to the secondary outcome measures a medium effect (effect size .47) was found on the Barthel ADL index. No beneficial effects of strategy training were found after 5 months (at follow-up). In this trial evidence was found for the short-term effectiveness of strategy training in left hemisphere stroke patients with apraxia.     

The effect of early cognitive training and rehabilitation for patients with cognitive dysfunction in stroke

ObjectiveThis article explores the effects of early cognitive training and rehabilitation for patients with cognitive dysfunction in stroke.MethodsStroke patients have cognitive dysfunction, and the incidence of cognitive dysfunction in stroke patients is six to nine times that of patients without stroke. This article selects 118 patients with stroke in our hospital from August 2017 to August 2019, 42 patients with stroke disorders randomly divided into two groups. Both groups of patients received conventional rehabilitation training, and the observation group performed motion observation therapy in virtual reality equipment based on conventional cognitive training. Analysis of time parameters related to rehabilitation training before and after treatment, and evaluation of standard health effects.ResultsAfter 4 weeks of treatment, the cognitive training time parameters of the two groups were compared. The cognitive reaction time was shorter than that before treatment. After treatment, the scores of cognitive training and rehabilitation effects were significantly lower than those before treatment, and the two scores of the observation group were significantly lower than those of the control group.ConclusionStroke patients receive early cognitive training with the support of computer‐assisted technology to obtain good rehabilitation results.     

Efficacy of a reaction training on various attentional and cognitive functions in stroke patients

Abstract

The efficacy of a computer-assisted reaction training on various attentional and cognitive functions was studied in stroke patients with lateralised cortical lesions. Patients were tested three times with a comprehensive test battery comprising several attention tests, as well as more general cognitive tasks, with the aim of separating training effects from spontaneous recovery and trivial practice effects. An additional follow-up assessment—carried out 6 weeks after the end of training—was employed to examine the stability of training effects. At baseline the right-hemisphere-damaged patients showed more pronounced impairments of sustained attention and vigilance, whereas the left-brain-damaged patients performed worse in choice reaction tasks, making more false-positive responses. Both groups showed significant training effects for a number of attention functions, but not for vigilance, and there was no generalisation of the training effects to more general cognitive functions. Overall, the training effects were less pronounced for the right-brain-damaged group.     

Mnemonic strategy training partially restores hippocampal activity in patients with mild cognitive impairment

Learning and memory deficits typify patients with mild cognitive impairment (MCI) and are generally attributed to medial temporal lobe dysfunction. Although the hippocampus is perhaps the most commonly studied neuroanatomical structure in these patients, there have been few attempts to identify rehabilitative interventions that facilitate its functioning. Here, we present results from a randomized, controlled, single‐blind study in which patients with MCI and healthy elderly controls (HEC) were randomized to either three sessions of mnemonic strategy training (MS) or a matched‐exposure control group (XP). All participants underwent pre‐ and posttraining fMRI scanning as they encoded and retrieved object–location associations. For the current report, fMRI analyses were restricted to the hippocampus, as defined anatomically. Before training, MCI patients showed reduced hippocampal activity during both encoding and retrieval, relative to HEC. Following training, the MCI MS group demonstrated increased activity during both encoding and retrieval. There were significant differences between the MCI MS and MCI XP groups during retrieval, especially within the right hippocampus. Thus, MS facilitated hippocampal functioning in a partially restorative manner. We conclude that cognitive rehabilitation techniques may help mitigate hippocampal dysfunction in MCI patients. © 2012 Wiley Periodicals, Inc.     

Rehabilitation of limb apraxia improves daily life activities in patients with stroke

We randomly assigned 33 patients with left hemisphere stroke, limb apraxia, and aphasia to an apraxia or a control (aphasia) treatment group. Before and after each treatment, patients underwent a comprehensive neuropsychological testing battery and a caregiver evaluation of patient's activities of daily life (ADL) independence. Apraxia severity was related with ADL independence. Control (aphasia) treatment improved patients' language and intelligence performance. Apraxia treatment specifically improved praxic function and ADL.     

Familial cognitive impairment with ataxia with oculomotor apraxia

Ataxia with oculomotor apraxia is an autosomal recessive inherited disease characterized by childhood onset of progressive cerebellar ataxia, oculomotor apraxia, and progressive motor peripheral neuropathy. The mean age at onset is approximately 4.7 years, with oculomotor apraxia appearing a few years later. Diagnosis is based on molecular genetic analysis for mutations of the aprataxin (APTX) gene (chromosome 9p13.1; ataxia with oculomotor apraxia 1). Ataxia with oculomotor apraxia 2 is caused by an unknown gene mutation at locus 9q34. We describe two siblings, born to consanguineous parents, who had clinical features of cerebellar ataxia, tremor, dysarthria, oculomotor apraxia, and motor peripheral neuropathy. Brain magnetic resonance imaging showed cerebellar atrophy and mild brainstem atrophy. Electromyography showed signs of axonal neuropathy. The molecular genetic analysis demonstrated the APTX mutation W279X at locus 9p13.3 (ataxia with oculomotor apraxia 1 disease), and psychologic studies showed mild cognitive impairment. We suggest that mentation can be compromised in ataxia with oculomotor apraxia 1.     

Screening for cognitive impairment in patients with acute stroke

BACKGROUND: Formal assessment of cognitive impairment is rare in acute stroke, yet. It was the goal to utilize easy-to-apply established screening tests to assess cognitive impairment from any cause in patients with acute ischemic stroke. METHODS: 209 consecutive patients (69.8 +/- 13.3 years, mean +/- SD; 117 male, 92 female) admitted to an acute stroke unit, which serves as a community stroke center, and diagnosed as having acute cerebral ischemia from any cause were investigated within 24 h of stroke onset and in part followed up after 3 months. Orientation and aphasia were assessed with the ADAScog subscales orientation and aphasia, verbal memory with Buschke's Memory Impairment Screen, and concentration/working memory with a letter sorting test. RESULTS: On admission, 74.6% were impaired on the Memory Impairment Screen, 77.0% on the letter sorting test, 45.0 and 24.9% on the ADAScog subscales aphasia and orientation. Results of the Memory Impairment Screen and letter sorting test were similar at the follow-up after 3 months. CONCLUSION: Formal brief assessment of cognitive deficits with tests not requiring motor capabilities in unselected patients with an acute cerebral ischemic event reveals widespread deficits. This needs to be considered when obtaining informed consent from the patients and instructing them. Routine formalized screening may thus improve care for patients with acute stroke. Patients with impairment on admission should be followed up, diagnosed concerning preexisting or poststroke dementia with a more extensive workup and eventually treated.     

针药结合认知训练干预脑卒中后轻度认知障碍疗效观察

目的 探讨针药合用联合认知训练对卒中后轻度认知功能障碍(MCI)的疗效.方法 将符合入选标准的90例患者随机分为针刺组、中药组和针药组.3组患者在个性化认知康复训练的基础上,分别给予针刺、中药和针药治疗.治疗前后分别用改良长谷川痴呆量表(HDS)、Barthel指数(BI)和Fugl-meyer运动功能评分量表(FMA...     

Transfer of stroke patients impairs eligibility for endovascular stroke treatment

Background

Many patients who are potentially eligible for endovascular stroke treatment (EST) receive intravenous rtPA in the closest stroke unit before being transferred to tertiary centres for EST. It has been shown that clinical outcome of transferred and EST-treated patients is comparable to that of patients with direct access to EST. We analysed clinical outcome of patients, who were transferred and eventually not treated due to clinical and/or radiological deterioration.

Effects of cognitive motor dual-task training on stroke patients: A RCT-based meta-analysis

Based on a randomized controlled trial (RCT), this meta-analysis aimed to comprehensively analyze the effects of cognitive motor dual-task training (CMDT) on stroke patients. The electronic databases PubMed, Embase, and the Cochrane Library were searched for papers on the influence of CMDT on stroke patients. Weighted mean difference (WMD) and 95% confidence interval (95% CI) were used as effect sizes. Cochran’s Q and I² tests were performed for heterogeneity. Thirteen articles involving 326 patients were included in the study. The meta-analysis showed that CMDT significantly improved the walking balance of patients with stroke (P = 0.01). In addition, CMDT significantly improved the gait ability of patients with stroke (P < 0.0001). Furthermore, CMDT had a significant effect on the improvement of upper limb ability in patients with stroke (P < 0.00001). CMDT could significantly improve balance ability, gait, and upper limb function in patients with chronic stroke, which is worthy of clinical promotion.     

The effects of computer-based cognitive rehabilitation in patients with visuospatial neglect following stroke: a systematic review

Objectives: To identify studies concerning the effects of computer based cognitive rehabilitation (CBCR) on visuospatial neglect (VN) after stroke to summarize the current state of knowledge in this research field and make recommendations for future research.

Methods: Four electronic databases were systematically searched. Authors of relevant studies were contacted to detect unpublished data or articles not found by searching databases. Data was extracted from included studies using predefined coding schemes and characteristics and results of individual studies were summarized qualitatively.

Selection criteria: Studies were included if at least 50% of the included patients had a stroke, if the studies explored the effects of CBCR as a primary intervention for rehabilitation of VN and if they included neuropsychological outcome measures for the presence of VN.

Results: Seven studies were included. Six of the seven studies suggested positive effects of CBCR on VN after stroke. However, the study that did not find these effects was also the study with the strongest methodological quality. All included studies consisted of small samples, varied greatly in design and had various methodological limitations.

Conclusion: Because the existing literature is very sparse and studies have various methodological limitations, it is currently not possible to either support or reject the effects of CBCR on VN after stroke. Future studies should aim to compare CBCR with active and passive control conditions and include larger samples in randomized and blinded designs.     

脑电仿生电刺激对脑梗死后认知功能障碍的影响

目的观察脑电仿生电刺激小脑顶核对脑梗死后认知功能障碍的影响,并探讨其可能的机制。方法选取脑梗死后并发认知功能障碍患者50例,随机分成治疗组与对照组各25例。2组患者均接受康复治疗及认知功能训练,治疗组同时加用脑电仿生电刺激进行干预。2组患者分别于治疗前后应用蒙特利尔认知评估量表(MoCA)、简易精神状态量表(MMSE)评定认知功能变化,采用经颅多普勒超声(TCD)评估颅内动脉血流动力学改变。结果治疗后2组患者MoCA评分、MMSE评分均较组内治疗前提高(P<0.05),且治疗组评分明显较对照组高,差异有统计学意义(P<0.05)。治疗后2组患者颅内动脉血流动力学较组内治疗前改善(P<0.05),且治疗组较对照组改善更显著,差异有统计学意义(P<0.05)。治疗组与对照组总有效率分别为92%和64%,差异有统计学意义(P<0.05)。结论脑电仿生电刺激小脑顶核可有效改善脑梗死患者的认知功能,其可能机制是通过改善患者的脑循环进一步改善认知功能。     

Positive effects of computer-based cognitive training in adults with mild cognitive impairment

Considering the high risk for individuals with amnestic Mild Cognitive Impairment (A-MCI) to progress towards Alzheimer's disease (AD), we investigated the efficacy of a non-pharmacological intervention, that is, cognitive training that could reduce cognitive difficulties and delay the cognitive decline. For this, we evaluated the efficacy of a 12-week computer-based memory-attention training program based on recognition in subjects with A-MCI and compared their performances with those of A-MCI controls trained in cognitively stimulating activities. The effect of training was assessed by comparing outcome measures in pre- and post-tests 15 days before and after training. To evaluate the duration of training benefits, a follow-up test session was performed 6 months after memory and attention training or cognitively stimulating activities. Outcome measures showed that the trained group, compared to control group, improved episodic recall and recognition. Six months after training, scores remained at the level of the post-test. Since the training program was exclusively based on recognition, our results showed a generalization from recognition to recall processes, which are memory components that represent part of the core cognitive impairments in individuals at risk of converting to AD. Thus, cognitive training based on recognition holds promise as a preventive therapeutic method and could be proposed as a non-pharmacological early-intervention strategy. Future investigations need to focus on methodological constraints and delineating possible neuroplastic mechanisms of action.     

认知训练同步经颅直流电刺激治疗对卒中后认知障碍患者工作记忆的改善效果

目的 分析认知训练同步经颅直流电刺激（tDCS）治疗卒中后认知碍（PSCI）患者工作记忆的疗效。方法 选取2022年12月至2023年7月徐州市中心医院康复科和徐州市康复医院收治的60例PSCI患者为研究对象,采用随机数字表法分为伪刺激组、试验组A和试验组B,每组20例。3组患者均接受常规药物治疗和康复训练,伪刺激组在此基础上同时接受认知训练和tDCS伪刺激;试验组A同时接受认知训练和tDCS治疗;试验组B于认知训练结束2 h后接受tDCS治疗。认知训练与tDCS治疗均为5次/周,持续4周。在治疗前后分别采用蒙特利尔认知评估量表（MoCA）、数字广度测试（DST）、n-back任务（包括0-back、1-back）、改良Barthel指数（MBI）及定量脑电图[包括功率比指数（DTABR）、α波相对功率（αRP）及θ波相对功率（θRP）]比较3组患者的认知功能、工作记忆储存和信息编码能力、数字工作记忆、日常生活自理能力及脑神经功能。结果 3组患者治疗前的MoCA、DST、0-back、1-back、MBI得分以及DTABR、αRP、θRP比较,差异均无统计学意义（均P>0.05）...     

Robot-assisted gait training for patients with hemiparesis due to stroke

Robot-assisted devices are becoming a popular alternative to manual facilitation in stroke rehabilitation. These devices have the potential to reduce therapist burden and treatment costs; however, their effectiveness in terms of functional recovery remains in question. This pilot study compared the outcomes of a stroke rehabilitation program that incorporates robot-assisted gait training (RAGT) with a more traditional therapy program that does not. Twenty hemiparetic stroke patients were recruited at a rehabilitation hospital in Houston, Texas, and were randomly assigned to 2 groups. The control group (n = 10) received 24 1-hour sessions of conventional physical therapy, whereas the RAGT group (n = 10) received 24 1-hour sessions of conventional physical therapy combined with RAGT on a treadmill. Gait function was assessed before and after treatment by an 8-m walk test, a 3-minute walk test, and the Tinetti balance assessment. Both groups showed significant improvement in all 3 outcome measures following treatment (P < .05), but there was no difference between groups. It is concluded that RAGT may provide improvements in balance and gait comparable with conventional physical therapy. A larger multicenter trial is required to investigate the effectiveness of RAGT in hemiparetic stroke.