Title : Computer cognitive training in acute stroke
Abstract:
Introduction: The first in Russia computer complex of neuropsychological programs for cognitive rehabilitation was developed at the department of Neurology and medical rehabilitation of Krasnoyarsk State Medical University. It consists of some computer programs modules that are focused on training of different cognitive functions such as memory, attention, counting, etc. This method has shown effectiveness in patients with vascular cognitive impairments in early recovering period of stroke.
Objectives: To evaluate effectiveness of neuropsychological computer programs for correction cognitive impairments in patients in acute ischemic stroke.
Methods: The study was conducted in the local stroke center from 2010 till 2012. 144 patients met including criteria. All participants were randomized into four groups. Patients in groups 1 and 2 were examined after 2-5 days from beginning of stroke, and participants in groups 3 and 4 – 8-10 days after stroke. Apart from medical treatment, patients in the intervention groups (group 1 and group 3) had 10 daily training sessions of 20 min duration with neuropsychological computer programs. We assessed cognitive, neurological, affective states before and after training period. Patients in the group 3 were also examined in follow up.
Results: In the group 1 and the group 2 after training period we observed statistically significant improvements on all cognitive scales. Comparing the results after treatment between groups 1 and 2, we didn’t find significant differences on MMSE (p=0.853), FAB (p=0.06), Clock drawing test (0.934), Phonetic and Semantic Speech tests (p= 0.28 and p=0.87).
Patients in the groups 3 and 4 were observed from 8-10 days after stroke. It was found that in 10 days of treatment (18-20 days after stroke onset) cognitive functions statistically improved on all cognitive scales: MMSE, FAB,CDT, Phonetic and Semantic Speech tests in both groups (3 and 4). Though better effects were achieved in the intervention group (group 3) comparing with the control group (group 4) on MMSE (p?0.001), FAB (p?0.001), Phonetic Speech test (p=0.003), Semantic Speech tests (p?0.001).
36 participants in the group 3 were examined in 6-8 months after the computer cognitive training. There were no statistically significant differences on MMSE, FAB, Clock drawing test, Speech tests in follow-up.
Conclusions: In the first 10-12 days of acute ischemic stroke period cognitive functions are restored spontaneously. It is probably connected with decreasing of brain edema and penumbra reperfusion.
The computer cognitive training in patients with cognitive impairments in acute ischemic stroke has shown the effectiveness starting from 8-10 days after stroke onset. The computer complex of neuropsychological programs can be recommended to this category of patients as an accessible and simple approach for early cognitive rehabilitation in stroke departments.
Improvements after computer cognitive correction in acute period of stroke were intact in recovery period during 6-8 months at least.
Discussions: Also we have a hypothesis that stimulation of sensor areas of brain, particularly, parietal occipital areas which provide optical spatial gnosis, can improve other cognitive domains, for example frontal subcortical deficit. A computer complex for stimulation visual-perceptual recognition was developed. It presents images of two- and three-dimensional objects frequently encountered in daily life, which can be turned in different planes. At the present time clinical studies is carrying out in group of post stroke patients.
