CT improved functional deficits after visual field loss compared with standard OT and may be the intervention of choice during inpatient rehabilitation. A larger trial that includes lesion location in the analysis is recommended.
Objectives. Memory training in combination with practice in semantic structuring and word fluency has been shown to improve memory performance. This study investigated the efficacy of a working memory training combined with exercises in semantic structuring and word fluency and examined whether training effects generalize to other cognitive tasks. Methods. In this double-blind randomized control study, 36 patients with memory impairments following brain damage were allocated to either the experimental or the active control condition, with both groups receiving 9 hours of therapy. The experimental group received a computer-based working memory training and exercises in word fluency and semantic structuring. The control group received the standard memory therapy provided in the rehabilitation center. Patients were tested on a neuropsychological test battery before and after therapy, resulting in composite scores for working memory; immediate, delayed, and prospective memory; word fluency; and attention. Results. The experimental group improved significantly in working memory and word fluency. The training effects also generalized to prospective memory tasks. No specific effect on episodic memory could be demonstrated. Conclusion. Combined treatment of working memory training with exercises in semantic structuring is an effective method for cognitive rehabilitation of organic memory impairment.
Neuropsychological rehabilitation of memory performance is still a controversial topic, and rehabilitation studies have not analyzed to which stage of memory processing (encoding, consolidation, or retrieval) enhancement may be attributed. We first examined the efficacy of a computer training program for stroke patients, based on a previous study (Hildebrandt, Clausing, Janssen, & Modden, 2007a) for memory-impaired patients of a rehabilitation unit and compared it with the standard group treatment. In a second randomized controlled experiment, we trained two groups of 15 patients with mild to moderate memory disorders, caused by organic brain lesions, with the same two treatment approaches. We used several standard tests to analyze improvement of memory functions, focusing on separate parameters for encoding, consolidation, and retrieval. We developed for that purpose a new word-list learning test, which allowed assessment of response to novelty and a systematic comparison of free recall after learning of semantically structured and nonstructured word lists. The first treatment experiment showed significant improvement of verbal learning for patients treated with the computer software program. The second experiment showed that memory improvement was based exclusively on retrieval processes, whereas no specific change was found for encoding and consolidation. However, the two groups of the second experiment showed no significant differences for the treatment, although the absolute scores pointed in the same direction as in the first experiment.
Significant recovery in impaired cognitive domains can be expected during neuropsychological rehabilitation. It depends more or less exclusively on improvement in the specific functions itself, and there was no evidence for generalization between cognitive domains.
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