Computer-Based Cognitive Training for Executive Functions after Stroke: A Systematic Review

Abstract

Background: Stroke commonly results in cognitive impairments in working memory, attention, and executive function, which may be restored with appropriate training programs. Our aim was to systematically review the evidence for computer-based cognitive training of executive dysfunctions.Methods: Studies were included if they concerned adults who had suffered stroke or other types of acquired brain injury, if the intervention was computer training of executive functions, and if the outcome was related to executive functioning. We searched in MEDLINE, PsycINFO, Web of Science, and The Cochrane Library. Study quality was evaluated based on the CONSORT Statement. Treatment effect was evaluated based on differences compared to pre-treatment and/or to a control group.Results: Twenty studies were included. Two were randomized controlled trials that used an active control group. The other studies included multiple baselines, a passive control group, or were uncontrolled. Improvements were observed in tasks similar to the training (near transfer) and in tasks dissimilar to the training (far transfer). However, these effects were not larger in trained than in active control groups. Two studies evaluated neural effects and found changes in both functional and structural connectivity. Most studies suffered from methodological limitations (e.g., lack of an active control group and no adjustment for multiple testing) hampering differentiation of training effects from spontaneous recovery, retest effects, and placebo effects.Conclusions: The positive findings of most studies, including neural changes, warrant continuation of research in this field, but only if its methodological limitations are addressed.

A longitudinal study of computerized cognitive training in stroke patients – effects on cognitive function and white matter

“…No transfer effect was detected, which in part corresponds to, and in part is discrepant, with previous findings. Computerized, implicit working memory training has been reported to generate generalized cognitive gains for children with ADHD 51 and for adults following brain injury, including stroke 8,13,52 . However, the current absence of evidence of improvement adds to a number of studies and meta-analyses observing no transfer effect of computerized working memory training 5,53,54 .…”

“…As no improvement was detected in the untrained tests, neither could we find any correlating or non-correlating changes in white matter integrity. In a systematic review from 2016 of computer-based cognitive training for executive functions in stroke patients only two of twenty studies included brain parameters as measurements of effects 8 . Only one case study used DTI, in which working memory was found to fluctuate in accordance with training phases and rest phases, with corresponding changes in white matter microstructure 24 .…”

“…Several rehabilitation interventions to alleviate cognitive impairment have been studied 5-7 , including Computerized Cognitive Training (CCT) 8 , with diverging results, and little is known about the possible mechanisms behind potential improvement. CCT has in recent years been argued to be a good alternative or supplement to traditional cognitive rehabilitation, though studies have been conflicting to whether it boosts the capacity of cognitive functions or not 9,10 .…”

“…CCT has in recent years been argued to be a good alternative or supplement to traditional cognitive rehabilitation, though studies have been conflicting to whether it boosts the capacity of cognitive functions or not 9,10 . Cogmed QM (Cogmed Systems AB, Stockholm, Sweden) is currently one of the most commonly used computerized working memory training systems, and preliminary evidence has shown that it can both improve objective working memory and attention 8 .…”

A comparative clinical study of the effectiveness of computer cognitive training in patients with post-stroke cognitive impairments without dementia

“…Up until now, the generalization of these improvements from the games to activities of the patient's daily life has not been proven (Van de Ven, Murre, Veltman, & Schmand, 2016;Zucchella, Capone et al, 2014).…”