Combined cognitive and motor training improves the outcome in the early phase after stroke and prevents a decline of executive functions: A pilot study

Abstract

BACKGROUND: The negative impact of cognitive dysfunction on motor rehabilitation as a relearning-process is well known in stroke patients. However, evidence for combined cognitive and motor training (CMT) is lacking. OBJECTIVE: To evaluate the effects of combined CMT in early stroke rehabilitation. METHODS: In a controlled pilot study, 29 moderately affected stroke patients with low-level motor performance and cognitive impairment received motor therapy plus either cognitive (experimental group, EG) or low-frequency ergometer training (control group, CG) for eight days. RESULTS: Both groups improved their motor functioning significantly. After training, between-group comparison revealed significant differences for cognitive flexibility and trends for set-shifting, working memory, and reaction control in favor of the EG. Within-group effects showed improvement across all cognitive domains in the EG, which correlated with gains in bed-mobility, while the CG showed no significant improvement in cognition. Rather, a trend towards reaction control decline was observed, which correlated with less functional progression and recovery. Furthermore, a decline in cognitive flexibility, set-shifting, and working memory was descriptively observed. CONCLUSIONS: Combined CMT may enhance cognition and motor relearning early after stroke and is superior to single motor training. Further studies are needed to replicate these results and investigate long-term benefits.

Intervention and assessment of executive dysfunction in patients with stroke: A scoping review

“…The range of time since stroke was 6 d to 5 years. Three (11.1%) [ 37 , 40 , 45 ], four, 13, and four articles included the acute (< 1 month), subacute (18.5%) [ 22 , 26 , 30 , 43 , 44 ], chronic (48.1%) [ 24 , 27 – 29 , 31 – 34 , 36 , 38 , 39 , 42 , 47 , 48 ], and subacute to chronic (14.8%) phases [ 23 , 25 , 35 , 46 ], respectively.…”

“…Interventions were cognitive rehabilitation (6/27 articles, 22.2%) [ 27 , 35 , 39 , 45 , 47 , 48 ], VR (6/27 articles, 22.2%) [ 23 , 26 , 29 , 31 , 32 , 38 ], NIBS (4/27 articles, 14.8%) [ 25 , 26 , 28 , 40 ], DT training (3/27 articles, 11.1%) [ 22 , 33 , 34 ], and other various training methods (8/27 articles, 29.6%) [ 24 , 30 , 37 , 41 – 44 , 46 ]. The intervention period was at least twice a week, and the duration varied from 2 weeks to 3 months and was not consistent.…”

“…The intervention period was at least twice a week, and the duration varied from 2 weeks to 3 months and was not consistent. Cognitive rehabilitation included executive function, memory, and working memory training using computers [ 27 , 35 , 39 , 45 , 47 , 48 ]. VR was used in a variety of ways, including tasks to practice the components of each executive and other (memory, decision making) function, systems to solve tasks through games, and systems to carry out training based on ADL [ 23 , 26 , 29 , 31 , 32 , 38 ].…”

“…Of the 27 articles, 22 (81.5%) , 3 (11.1%) [44][45][46], and 2 (7.4%) [47,48] articles were RCTs, pilot studies, and feasibility studies, respectively. The range of the sample sizes was 7-225 participants (mean 22.2 ± 13.0), with 599 participants in total.…”

Increased brain activation and functional connectivity after working memory training in patients with ischemic stroke: an fMRI study

“…It has been suggested that WMT is an effective cognitive rehabilitation strategy in stroke patients for improving individual WM capacity, as well as the performance of untrained WM tasks and tasks that show far-transfer effect (Peers et al, 2020;Eschweiler et al, 2021;Nikravesh et al, 2021). However, the neural effects following WMT in stroke patients remain largely unclear and have been poorly studied.…”