Evolution of Cognitive Rehabilitation After Stroke From Traditional Techniques to Smart and Personalized Home-Based Information and Communication Technology Systems: Literature Review

Abstract

BackgroundNeurological patients after stroke usually present cognitive deficits that cause dependencies in their daily living. These deficits mainly affect the performance of some of their daily activities. For that reason, stroke patients need long-term processes for their cognitive rehabilitation. Considering that classical techniques are focused on acting as guides and are dependent on help from therapists, significant efforts are being made to improve current methodologies and to use eHealth and Web-based architectures to implement information and communication technology (ICT) systems that achieve reliable, personalized, and home-based platforms to increase efficiency and level of attractiveness for patients and carers.ObjectiveThe goal of this work was to provide an overview of the practices implemented for the assessment of stroke patients and cognitive rehabilitation. This study puts together traditional methods and the most recent personalized platforms based on ICT technologies and Internet of Things.MethodsA literature review has been distributed to a multidisciplinary team of researchers from engineering, psychology, and sport science fields. The systematic review has been focused on published scientific research, other European projects, and the most current innovative large-scale initiatives in the area. A total of 3469 results were retrieved from Web of Science, 284 studies from Journal of Medical Internet Research, and 15 European research projects from Community Research and Development Information Service from the last 15 years were reviewed for classification and selection regarding their relevance.ResultsA total of 7 relevant studies on the screening of stroke patients have been presented with 6 additional methods for the analysis of kinematics and 9 studies on the execution of goal-oriented activities. Meanwhile, the classical methods to provide cognitive rehabilitation have been classified in the 5 main techniques implemented. Finally, the review has been finalized with the selection of 8 different ICT–based approaches found in scientific-technical studies, 9 European projects funded by the European Commission that offer eHealth architectures, and other large-scale activities such as smart houses and the initiative City4Age.ConclusionsStroke is one of the main causes that most negatively affect countries in the socioeconomic aspect. The design of new ICT-based systems should provide 4 main features for an efficient and personalized cognitive rehabilitation: support in the execution of complex daily tasks, automatic error detection, home-based performance, and accessibility. Only 33% of the European projects presented fulfilled those requirements at the same time. For this reason, current and future large-scale initiatives focused on eHealth and smart environments should try to solve this situation by providing more complete and sophisticated platforms.

Physiotherapists’ and occupational therapists’ perspectives on information and communication technology in stroke rehabilitation

“…However, a recent qualitative study has shown that health professionals perceive ICT integration in the rehabilitation process to potentially increase sharing and communication between health professionals and patients, thus facilitating transparency during the rehabilitation process [23]. Recommended areas for future research include continuing to identify gaps along the continuum of the rehabilitation process and to develop new person-centred ICT-supported solutions to fill these gaps and support the rehabilitation process [22] simultaneously involving end-users in all phases of the developments to maximize the usability and usefulness of the ICT-solutions [36,38].…”

Improvement of Apraxia With Augmented Reality: Influencing Pantomime of Tool Use via Holographic Cues

“…Based on our findings, we envision HMD-based AR systems to assist patients in their ADLs in the future, thus maintaining autonomy. The advantages of wearable cognitive support systems over existing screenbased approaches (66,67) are having both hands available for interactions with the physical environment while still being able to move flexibly from one place to another. In this regard, we see two main application areas where AR can be used: (1) as a supportive training tool to facilitate performance improvement and (2) as a (well-controllable) diagnostic research tool to further examine the role and importance of different modes and types of visual cues and to identify predicting variables.…”

Healthcare Professionals’ Acceptance of Digital Cognitive Rehabilitation

“…A number of methods have been available for longer, but have not been able to show clear positive results as they often focus on restoration of isolated cognitive functions. In contrast, newer methods use a more holistic approach, in which participation and blended care are focused on (e.g., Van Heugten et al, 2016;Cogollor et al, 2018). Only a limited number of studies are currently available for effective cognitive digital cognitive rehabilitation due to its novelty and the need of follow-up study (e.g., Larson et al, 2014;Mansbach et al, 2015).…”

“…One factor that could affect health care provider attitude is a critical evaluation of earlier methods of digital cognitive rehabilitation, which often focus on restoration of isolated cognitive functions. However, newer methods are currently introduced, which use a more holistic approach, aimed at increasing participation and offering blended care (e.g., Van Heugten et al, 2016;Cogollor et al, 2018). Therefore, the current study is aimed at identifying the attitude of healthcare providers toward digital cognitive rehabilitation, in order to gain insight in this important factor for success of implementing digital cognitive rehabilitation techniques and to pinpoint potential obstacles toward its implementation.…”