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Webb SS, Demeyere N. Comparing the Oxford Digital Multiple Errands Test (OxMET) to a real-life version: Convergence, feasibility, and acceptability. Neuropsychol Rehabil 2024:1-26. [PMID: 38733612 DOI: 10.1080/09602011.2024.2344326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/23/2023] [Indexed: 05/13/2024]
Abstract
We aimed to assess the convergence, feasibility, and acceptability of the Oxford Digital Multiple Errands Test (OxMET) and the in-person Multiple Errands Test-Home version (MET-Home). Participants completed OxMET, MET-Home, Montreal Cognitive Assessment (MoCA), and questionnaires on activities of daily living, depression, technology usage, mobility, and disability. Forty-eight stroke survivors (mean age 69.61, 41.67% female, and average 16.5 months post-stroke) and 50 controls (mean age 71.46, 56.00% female) took part. No performance differences were found for healthy and stroke participants for MET-Home, and only found below p = .05 for OxMET but not below the corrected p = .006. Convergent validity was found between MET-Home and OxMET metrics (most r ≥ .30, p < .006). MET-Home accuracy was related to age (B = -.04, p = .03), sex (B = -.98, p = .03), disability (B = -0.63, p = .04), and MoCA (B = .26, p < .001), whereas OxMET accuracy was predicted by MoCA score (B = .40, p < .001). Feedback indicated that the OxMET was easy and fun and more acceptable than the MET-Home. The MET-Home was more stressful and interesting. The MET tasks demonstrated good convergent validity, with the OxMET digital administration providing a more feasible, inclusive, and acceptable assessment, especially to people with mobility restrictions and more severe stroke.
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Affiliation(s)
- Sam S Webb
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Nele Demeyere
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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2
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Moore MJ, Byrne J, Gibson EC, Ford L, Robinson GA. Hayling and stroop tests tap dissociable deficits and network-level neural correlates. Brain Struct Funct 2024; 229:879-896. [PMID: 38478051 PMCID: PMC11004053 DOI: 10.1007/s00429-024-02767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 01/24/2024] [Indexed: 04/10/2024]
Abstract
Although many executive function screens have been developed, it is not yet clear whether these assessments are equally effective in detecting post-stroke deficits of initiation and inhibition. This study presents a comparative analysis of the Stroop and Hayling tests aiming to evaluate whether these tests measure the same underlying cognitive functions and to identify the neural correlates of the deficits detected by both tasks. Sixty six stroke survivors and 70 healthy ageing controls completed the Hayling and Stroop tests. Stroke patients were found to exhibit qualitative performance differences across analogous Stroop and Hayling Test metrics intended to tap initiation and inhibition. The Stroop test was found to have high specificity to abnormal performance, but low sensitivity relative to the Hayling Test. Minimal overlap was present between the network-level correlates of analogous Stroop and Hayling Test metrics. Hayling Task strategy use metrics were significantly associated with distinct patterns of disconnection in stroke survivors, providing novel insight into the neural correlates of fine-grained behavioural patterns. Overall, these findings strongly suggest that the functions tapped by the Stroop and Hayling Test are both behaviourally and anatomically dissociable. The Hayling Test was found to offer improved sensitivity and detail relative to the Stroop test. This novel demonstration of the Hayling Test within the stroke population suggests that this task represents an effective measure for quantifying post-stroke initiation and inhibition deficits.
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Affiliation(s)
- Margaret Jane Moore
- Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Australia
| | - Jessica Byrne
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
| | - Emily C Gibson
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
| | - Lucy Ford
- Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Australia
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
| | - Gail A Robinson
- Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Australia.
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia.
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3
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Jaywant A, Keenan A. Pathophysiology, Assessment, and Management of Post-Stroke Cognitive Impairment, Depression, and Fatigue. Phys Med Rehabil Clin N Am 2024; 35:463-478. [PMID: 38514230 DOI: 10.1016/j.pmr.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Post-stroke cognitive impairment, depression, and fatigue are common, persistent, and disabling. This review summarizes current knowledge on the pathophysiology, assessment, and management of these debilitating neuropsychiatric sequelae of stroke. We briefly review evolving knowledge on the neural mechanisms and risk factors for each condition. We describe patient-reported outcome measures and clinician rating techniques that can be used to assist in screening and comprehensive assessment. We then discuss behavioral and pharmacologic management strategies. Heterogeneity of stroke remains a challenge in management and new research is still needed to optimize and personalize treatments for stroke survivors.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA; Department of Rehabilitation Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA; NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA.
| | - Alexandra Keenan
- Department of Rehabilitation Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
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Milosevich E, Kusec A, Pendlebury ST, Demeyere N. Domain-specific cognitive impairments, mood and quality of life 6 months after stroke. Disabil Rehabil 2024:1-10. [PMID: 38623852 DOI: 10.1080/09638288.2024.2340121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To identify which acute and 6-month domain-specific cognitive impairments impact mood, participation, and stroke-related quality of life 6 months post-stroke. MATERIALS AND METHODS A prospective cohort of 430 stroke survivors completed the Oxford Cognitive Screen (OCS) acutely and 6 months post-stroke. Participants completed the Stroke Impact Scale (SIS) and Hospital Depression and Anxiety Scale (HADS) at 6 months. Multivariable regression analyses assessed whether severity of, and domain-specific, cognitive impairment acutely and at 6 months was associated with composite 6-month SIS scores, each SIS subscale, and HADS scores. RESULTS Increased severity of acute and 6-month cognitive impairment was associated with lower 6-month SIS composite scores independent of age, sex, education years, and stroke severity (both p < 0.001). Domain-specific impairments in memory (p < 0.001) and attention (p = 0.002) acutely, and language (p < 0.001), memory (p = 0.001) and number processing (p = 0.006) at 6 months showed the strongest associations with worse SIS composite scores. Severity of acute and 6-month cognitive impairment was associated with poorer functioning in each SIS subscale, and greater levels of depression (acute p = 0.021, 6-months p < 0.001), but not anxiety (p = 0.174, p = 0.129). CONCLUSIONS Both acute and 6-month domain-specific cognitive impairments, particularly in memory, were found to negatively impact overall functional and mood outcomes 6 months post-stroke.
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Affiliation(s)
| | - Andrea Kusec
- Department of Experimental Psychology, University of Oxford, UK
| | - Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
- NIHR Oxford Biomedical Research Centre and Departments of General Medicine and Geratology, John Radcliffe Hospital, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, UK
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
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Gong C, Wang R, Wang N. Validity of the Chinese version of the weekly calendar planning activity (WCPA) on assessing executive function in adults with stroke. Neuropsychol Rehabil 2024:1-20. [PMID: 38593026 DOI: 10.1080/09602011.2024.2338638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
The weekly calendar planning activity (WCPA) is a performance-based assessment of executive function (EF) via a cognitively-based instrumental activity of daily life (C-IADL). This study aimed to examine the validity of the Chinese version of the WCPA in adults with stroke and to explore the characteristics of cognitive strategy use among the population. Fifty-eight hospitalized patients with stroke aged 26-82 years and 53 controls completed the WCPA, two neuropsychological tests and instrumental activity of daily life (IADL) scale. Participants with stroke were subdivided into a stroke cognitive impaired group (Stroke-CI) and a general stroke group (Stroke-NCI) based on the Montreal Cognitive Assessment. Results showed that the WCPA was able to discriminate between Stroke-CI with controls and the Stroke-NCI group with controls. We found significant limitations in stroke patients' ability to use strategies. Concurrent and ecological validities were demonstrated through correlations between the neuropsychological test scores, IADL and the WCPA performance. This study provides initial evidence for the validity of the Chinese version of the WCPA-10 for adults with stroke and suggests the need to use performance-based tests even in patients with normal cognitive screening test results. The WCPA could provide useful information for strategy-based interventions for adults with stroke.
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Affiliation(s)
- Chen Gong
- Department of Rehabilitation Medicine, Peking University First Hospital, Beijing, People's Republic of China
| | - Rongli Wang
- Department of Rehabilitation Medicine, Peking University First Hospital, Beijing, People's Republic of China
| | - Ninghua Wang
- Department of Rehabilitation Medicine, Peking University First Hospital, Beijing, People's Republic of China
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Niering M, Seifert J. The effects of visual skills training on cognitive and executive functions in stroke patients: a systematic review with meta-analysis. J Neuroeng Rehabil 2024; 21:41. [PMID: 38532485 PMCID: PMC10967170 DOI: 10.1186/s12984-024-01338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
The visual system and associated skills are of particular importance in stroke rehabilitation. The process of neuroplasticity involved in restoring cognitive function during this period is mainly based on anatomical and physiological mechanisms. However, there is little evidence-based knowledge about the effects of visual skills training that could be used to improve therapeutic outcomes in cognitive rehabilitation. A computerized systematic literature search was conducted in the PubMed, Medline, and Web of Science databases from 1 January 1960 to 11 Febuary 2024. 1,787 articles were identified, of which 24 articles were used for the calculation of weighted standardized mean differences (SMD) after screening and eligibility verification. The findings revealed moderate effects for global cognitive function (SMD = 0.62) and activities of daily living (SMD = 0.55) as well as small effects for executive function (SMD = 0.20) - all in favor of the intervention group. The analyses indicate that the results may not be entirely robust, and should therefore be treated with caution when applied in practice. Visual skills training shows positive effects in improving cognitive and executive functions, especially in combination with high cognitive load and in an early phase of rehabilitation. An improvement in activities of daily living can also be observed with this type of intervention. The high heterogeneity of the studies and different treatment conditions require the identification of a relationship between certain visual skills and executive functions in future research.
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Affiliation(s)
- Marc Niering
- Institute of Biomechanics and Neurosciences, Nordic Science, Hannover, Germany
| | - Johanna Seifert
- Institute of Biomechanics and Neurosciences, Nordic Science, Hannover, Germany.
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
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Dawson DR, Anderson ND, Binns M, Bar Y, Chui A, Gill N, Linkewich E, McEwen S, Nalder E, Skidmore E. Strategy-training post-stroke via tele-rehabilitation: a pilot randomized controlled trial. Disabil Rehabil 2024; 46:67-76. [PMID: 36524387 DOI: 10.1080/09638288.2022.2154397] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Long-term limitations in social participation are common after stroke. Whether these can be attenuated through a tele-rehabilitation approach is unknown. We were particularly interested in examining transfer of learning effects which could result in broader improvements in social participation. METHODS We adapted a strategy training rehabilitation approach (tele-CO-OP) for remote delivery. Participants with chronic stroke were randomized to receive the intervention (EXPT) or to a wait list (Control). Feasibility and acceptability were measured via attendance scores, satisfaction with the training and therapist evaluation of engagement with the training. The primary outcome measure was the Canadian Occupational Performance Measure (COPM), a standardized semi-structured interview which elicits difficulties in day-to-day life. RESULTS Seventeen participants were randomized. Tele-CO-OP was found to be feasible and acceptable: participants reported high satisfaction and engagement, and missed few sessions. Large effect sizes for transfer of learning effects were observed in favor of receiving tele-CO-OP vs being waitlisted. Significant benefits were also conferred to the Control group following receipt of tele-CO-OP. The intervention also appeared to improve mood. CONCLUSIONS This exploratory study demonstrates the feasibility and acceptability of tele-CO-OP and provides preliminary evidence for transfer of learning effects to untrained everyday social participation activities. Trial registration number: NCT02724813.
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Affiliation(s)
- Deirdre R Dawson
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, Management & Evaluation University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Management & Evaluation University of Toronto, Toronto, Canada
| | - Nicole D Anderson
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
- Psychology, Management & Evaluation University of Toronto, Toronto, Canada
- Psychiatry, Management & Evaluation University of Toronto, Toronto, Canada
| | - Malcolm Binns
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
- Public Health Sciences, Management & Evaluation University of Toronto, Toronto, Canada
| | - Yael Bar
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
| | - Adora Chui
- Institute of Health Policy, Management & Evaluation University of Toronto, Toronto, Canada
| | - Natasha Gill
- Mental Health & Additions, William Osler Health System, Brampton, Canada
| | - Elizabeth Linkewich
- Department of Occupational Science & Occupational Therapy, Management & Evaluation University of Toronto, Toronto, Canada
- North & East GTA Stroke Network, Sunnybrook Health Sciences Centre, Toronto, Canada
- Practice-Based Research, Sunnybrook Research Institute, Toronto, Canada
| | - Sara McEwen
- Rural Pre-Medicine, Selkirk College, Castlegar, Canada
| | - Emily Nalder
- Department of Occupational Science & Occupational Therapy, Management & Evaluation University of Toronto, Toronto, Canada
- Public Health Sciences, Management & Evaluation University of Toronto, Toronto, Canada
| | - Elizabeth Skidmore
- Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, USA
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8
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Giles GM, Marks TS, Edwards DF. Loss-of-Set and Strategy Application on the Menu Task: An Exploratory Study. Can J Occup Ther 2023; 90:413-422. [PMID: 37218122 DOI: 10.1177/00084174231175018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background. The Menu Task (MT) is an occupational therapy screening measure designed to identify people in need of functional cognitive (FC) assessment. Purpose. To explore whether test-taker strategy selection on the MT is clinically informative. Methods. Using a cross-sectional design we administered assessments of FC including the MT and the After MT interview, cognitive screening measures, and self-report instrumental activities of daily living assessment to a convenience sample of 55 community-dwelling adults. After MT interviews responses were qualitatively characterized as (a) loss of set (e.g., not recognizing that food preferences are irrelevant to task performance), (b) calorie counting, or (c) planning. Findings. Loss of set was associated with poorer performance on most study measures, calorie counting was associated with superior performance on most study measures, and no differences were observed relating to planning. Implications. Determining the test-takers approach to the MT adds information to that provided by the MT itself.
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9
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Zhang T, Liu W, Bai Q, Gao S. Virtual reality technology in the rehabilitation of post-stroke cognitive impairment: an opinion article on recent findings. Front Psychol 2023; 14:1271458. [PMID: 37849482 PMCID: PMC10577207 DOI: 10.3389/fpsyg.2023.1271458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Ting Zhang
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
- Department of Traditional Chinese Medicine, University Hospital, Zhejiang Normal University, Jinhua, China
| | - Wei Liu
- Physical Education College, Guangxi University of Science and Technology, Liuzhou, China
| | - Qingping Bai
- Physical Education College, Guangxi University of Science and Technology, Liuzhou, China
| | - Song Gao
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
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10
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Wang R, Muresanu D, Hösl K, Hilz MJ. Cardiovascular autonomic regulation correlates with cognitive performance in patients with a history of traumatic brain injury. Neurol Sci 2023; 44:3535-3544. [PMID: 37227563 PMCID: PMC10495484 DOI: 10.1007/s10072-023-06857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/14/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Traumatic brain injury (TBI) may afflict brain areas contributing to both cardiovascular autonomic regulation and cognitive performance. To evaluate possible associations between both functions in patients with a history of TBI (post-TBI-patients), we determined correlations between cardiovascular autonomic regulation and cognitive function in post-TBI-patients. METHODS In 86 post-TBI-patients (33.1 ± 10.8 years old, 22 women, 36.8 ± 28.9 months after injury), we monitored RR intervals (RRI), systolic and diastolic blood pressures (BPsys, BPdia), and respiration (RESP) at rest. We calculated parameters of total cardiovascular autonomic modulation (RRI-standard-deviation (RRI-SD), RRI-coefficient-of-variation (RRI-CV), RRI-total-powers), sympathetic (RRI-low-frequency-powers (RRI-LF), normalized (nu) RRI-LF-powers, BPsys-LF-powers) and parasympathetic modulation (root-mean-square-of-successive-RRI-differences (RMSSD), RRI-high-frequency-powers (RRI-HF), RRI-HFnu-powers), sympathetic-parasympathetic balance (RRI-LF/HF-ratios), and baroreflex sensitivity (BRS). We used the Mini-Mental State Examination and Clock Drawing Test (CDT) to screen the general global and visuospatial cognitive function, and applied the standardized Trail Making Test (TMT)-A assessing visuospatial abilities and TMT-B assessing executive function. We calculated correlations between autonomic and cognitive parameters (Spearman's rank correlation test; significance: P < 0.05). RESULTS CDT values positively correlated with age (P = 0.013). TMT-A values inversely correlated with RRI-HF-powers (P = 0.033) and BRS (P = 0.043), TMT-B values positively correlated with RRI-LFnu-powers (P = 0.015), RRI-LF/HF-ratios (P = 0.036), and BPsys-LF-powers (P = 0.030), but negatively with RRI-HFnu-powers (P = 0.015). CONCLUSIONS In patients with a history of TBI, there is an association between decreased visuospatial and executive cognitive performance and reduced parasympathetic cardiac modulation and baroreflex sensitivity with relatively increased sympathetic activity. Altered autonomic control bears an increased cardiovascular risk; cognitive impairment compromises quality of life and living conditions. Thus, both functions should be monitored in post-TBI-patients.
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Affiliation(s)
- Ruihao Wang
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Dafin Muresanu
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca-Napoca, Romania
| | - Katharina Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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11
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Jaywant A, Mautner L, Waldman R, O’Dell MW, Gunning FM, Toglia J. Feasibility and Acceptability of a Remotely Delivered Executive Function Intervention That Combines Computerized Cognitive Training and Metacognitive Strategy Training in Chronic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5714. [PMID: 37174232 PMCID: PMC10178100 DOI: 10.3390/ijerph20095714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/24/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
Executive dysfunction after stroke is associated with limitations in daily activities and disability. Existing interventions for executive dysfunction show inconsistent transfer to everyday activities and require frequent clinic visits that can be difficult for patients with chronic mobility challenges to access. To address this barrier, we developed a telehealth-based executive function intervention that combines computerized cognitive training and metacognitive strategy. The goal of this study was to describe intervention development and to provide preliminary evidence of feasibility and acceptability in three individuals who completed the treatment protocol. The three study participants were living in the community and had experienced a stroke >6 months prior. We assessed satisfaction (Client Satisfaction Questionnaire-8 [CSQ-8]), credibility (Credibility and Expectancy Questionnaire), and feasibility (percent of sessions completed). All three subjects rated the treatment in the highest satisfaction category on the CSQ-8, found the treatment to be credible, and expected improvement. Participants completed a median of 96% of computerized cognitive training sessions and 100% of telehealth-delivered metacognitive strategy training sessions. Individuals with chronic stroke may find a remotely delivered intervention that combines computerized cognitive training and metacognitive strategy training to be feasible and acceptable. Further evaluation with larger samples in controlled trials is warranted.
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Affiliation(s)
- Abhishek Jaywant
- Departments of Psychiatry & Rehabilitation Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Leah Mautner
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Rachel Waldman
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA
| | - Michael W. O’Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Faith M. Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY 10065, USA
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY 10522, USA
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12
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Chen J, Hong J, Li C, Zeng Y, Xie M, Zhang X, Wen H. Changes in gene expression and neuroinflammation in the hippocampus of rats with poststroke cognitive impairment. Exp Biol Med (Maywood) 2023; 248:883-896. [PMID: 37012665 PMCID: PMC10484197 DOI: 10.1177/15353702231157922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/13/2023] [Indexed: 04/05/2023] Open
Abstract
Poststroke cognitive impairment (PSCI) often occurs during the stroke recovery period and greatly increases the difficulty of rehabilitation. Activation of neuroinflammation and long-term changes in gene expression patterns in the hippocampus could be essential in the development of PSCI. Therefore, this study aimed to identify neuroinflammation and changes in gene expression patterns in the hippocampus in rats with PSCI. Rats underwent transient middle cerebral artery occlusion (tMCAO) or sham surgery. The infarct volume was measured on day 3 after surgery. The Morris water maze (MWM) test was used to assess cognitive function. Microglial activation and white matter (WM) lesions in the hippocampus were evaluated on day 28 after surgery. In addition, we compared differentially expressed genes (DEGs) in the hippocampus between tMCAO group rats and sham group rats by RNA sequencing. Then, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and protein-protein interaction (PPI) network analyses were conducted to investigate these DEGs. The results showed that the tMCAO group rats showed extensive infarction and cognitive dysfunction compared with the sham group rats. Microglial activation and WM damage were obvious in the hippocampus of tMCAO group rats. We found 43 DEGs by RNA sequencing: 29 genes with upregulated expression and 14 genes with downregulated expression. The GO analysis indicated that DEGs were mainly involved in cell proliferation and differentiation, cholesterol synthesis, and metabolism. The KEGG pathway analysis suggested that the DEGs were significantly enriched in intestinal immune network for IgA production and steroid biosynthesis. Acta2, Calb2, and Cxcl12 were notable in the PPI analysis. Our results suggest that microglial activation and WM damage are maintained in rats with PSCI. The mechanism may be related to the regulation of steroid biosynthesis, intestinal immunity, and potential key genes such as Acta2, Calb2, and Cxcl12 in the hippocampus.
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Affiliation(s)
| | | | - Chao Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Yan Zeng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Mengshu Xie
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Xue Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Hongmei Wen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
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13
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Sakai K, Hosoi Y, Harada Y. Walking Ability Associated with Executive Dysfunction in Patients with Stroke: A Cross-Sectional Study. Brain Sci 2023; 13:brainsci13040627. [PMID: 37190592 DOI: 10.3390/brainsci13040627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
Previous studies have shown an association between executive dysfunction and walking ability. However, it remains unclear whether the degree of executive dysfunction is associated with differences in walking ability in patients with stroke. The aim of this study was to investigate whether there are differences in walking ability according to executive dysfunction in patients with stroke. A total of 51 patients with stroke were enrolled in this study. Executive function was measured using the Trail Making Test (TMT) Part B, and walking ability was assessed using the 10 m walk test and the Timed Up and Go Test (TUGT). Cluster analysis was performed using the TMT Part B and compared within each cluster. TMT Part B was categorized into three groups (cluster 1: n = 20, cluster 2: n = 24, and cluster 3: n = 7). Cluster 1 was significantly better than clusters 2 and 3, and cluster 2 was significantly better than cluster 3. The 10 m walk time and TUGT of cluster 1 were significantly better than those of cluster 3. However, the 10 m walk time and TUGT of clusters 1 and 2 did not differ significantly. In conclusion, these findings may indicate differences in walking ability according to executive dysfunction.
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Affiliation(s)
- Katsuya Sakai
- Department of Physical Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Tokyo 116-8551, Japan
| | - Yuichiro Hosoi
- Department of Rehabilitation of Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Sports Health Sciences, Ritsumeikan University, Kusatsu 525-3760, Japan
| | - Yusuke Harada
- Department of Rehabilitation, Reiwa Rehabilitation Hospital, Chiba 260-0026, Japan
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo 116-8551, Japan
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14
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Quality of life after epilepsy surgery: How domain-specific cognitive changes impact QOL within the context of seizure outcome. Epilepsy Behav 2022; 137:108948. [PMID: 36283290 DOI: 10.1016/j.yebeh.2022.108948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/27/2022] [Accepted: 10/06/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Neurosurgery is an effective treatment option for pharmacoresistant epilepsy. Although post-surgical seizure freedom is considered the primary goal of epilepsy surgery, other factors that impact Quality of Life (QOL) are also important to consider, including post-surgical cognitive changes. This study aimed to examine the impact of post-surgical cognitive changes on QOL in the context of seizure outcomes. METHODS Participants were 196 adults with focal epilepsy who underwent either frontal (n = 27) or temporal (n = 169) lobe resection. Each participant completed pre- and post-surgical neuropsychological evaluations, and cognitive composites were constructed for the following domains: language, attention/processing speed, memory, executive function, and visuospatial skill. The Quality of Life in Epilepsy (QOLIE-10) questionnaire was used to assess QOL. Seizure outcome was determined by seizure status six months post-surgery. RESULTS Eighty-one percent of patients were seizure-free post-surgery and generally reported improved QOL. While a significant portion of patient's demonstrated declines in language and verbal memory following surgery, only a decline in verbal memory was associated with worse QOL; however, this relationship was no longer significant after controlling for seizure outcome. Instead, reduced post-surgical QOL was primarily observed in those who experienced both seizure recurrence and a decline in executive function. Notably, depression was a significant covariate in all of the models. CONCLUSIONS The findings from this study improve our ability to counsel patients about the trade-off between cognitive decline and seizure remittance in the greater context of overall QOL. Reassuringly, it appears that QOL is improved regardless of cognitive changes when patients have good seizure outcomes. However, for those that experience a "double hit" (i.e., cognitive decline without seizure remission), post-surgical QOL may be reduced. Changes in depression also appear to play a crucial role in QOL outcomes.
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15
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Liu X, Li F, Song W. Impact of cognition on test-retest reliability and concurrent validity of n-back for Chinese stroke patients. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 36152340 DOI: 10.1080/23279095.2022.2121211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The objective of this study was the measurement of the test-retest reliability of n-back in Chinese stroke patients. METHODS Seventy-five sub-acute stroke patients performed n-back twice in three days. The test-retest reliability of n-back was analyzed by correlation coefficient. RESULTS The n-back had excellent test-retest reliability in stroke patients. Pearson or Spearman coefficients ranged from 0.81 to 0.88. The intra-class correlation coefficients ranged from 0.72 to 0.87. The Chinese version of Montreal Cognitive Assessment-Basic (MoCA-BC) score was significantly correlated with the performance of n-back. MoCA-BC and n-back accuracy were significantly related in the Mild Cognitive Impairment (MCI) group (r = 0.60 in 1-back, p = .002; r = 0.43 in 2-back, p = .040). However, MoCA-BC was correlated with reaction time (RT) in the Cognitively Normal (CN) group (r = -0.44 in 1-back, p = .003; r = -0.36 in 2-back, p = .018). The test-retest reliability of CN group was mostly higher than that of MCI group RT: 0.71-0.76 in MCI, 0.80-0.88 in CN; accuracy: 0.80-0.85 in MCI, 0.75-0.86 in CN). The practice effect was observed in the CN group instead of the MCI group. CONCLUSIONS This study indicated that the test-retest reliability of n-back was high in stroke patients. N-back was correlated with cognition. It was preferable to conduct subgroup analyses according to the level of cognitive assessment of patients with stroke.
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Affiliation(s)
- Xiuzhen Liu
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Fang Li
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Weiqun Song
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
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16
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Ianni C, Magee L, Dagli C, Nicholas ML, Connor LT. Self-reported emotional health and social support but not executive function are associated with participation after stroke. Top Stroke Rehabil 2022:1-10. [PMID: 36073603 DOI: 10.1080/10749357.2022.2110192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Participation restrictions continue to be prevalent for community-dwelling stroke survivors. Research is needed to understand the associated post-stroke factors that limit or facilitate optimal participation and quality of life. OBJECTIVES To investigate emotional health, executive functioning (EF), and social support as predictors of participation restrictions post-stroke. METHODS Cross-sectional data collected from participants ≥ 6 months after mild stroke with and without aphasia (N = 114) were analyzed using three participation outcome measures: Reintegration to Normal Living Index (RNL), Activity Card Sort (ACS), and the Stroke Impact Scale (SIS) Version 2.0 Participation/Role Function domain. Predictor variables investigated were emotional health (SIS Emotion domain scores), EF (Delis Kaplan Executive Function System Trail Making Condition 4: DKEFS), social support (Medical Outcomes Study Social Support Survey: MOS-SSS), stroke severity (National Institutes of Health Stroke Scale: NIHSS), and education level. RESULTS Using multiple regression, these predictors accounted for 26.4% to 40% of the variance for the three participation outcomes. Emotional health was a significant independent predictor across all three measures. Social support was a significant predictor of participation as measured on the RNL. Executive function was not a significant predictor of participation when controlling for the other predictor variables. CONCLUSIONS Emotional health and social support should be considered as modifiable factors that could optimize meaningful participation and quality of life.
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Affiliation(s)
- Corinne Ianni
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Laura Magee
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Chaitali Dagli
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Marjorie L Nicholas
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, USA
| | - Lisa Tabor Connor
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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17
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The Prognostic Value of Domain-Specific Cognitive Abilities Assessed by Chinese Version of Oxford Cognitive Screen on Determining ADLs Recovery in Patients with Post-Stroke Cognitive Impairment. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1084901. [PMID: 36110193 PMCID: PMC9470312 DOI: 10.1155/2022/1084901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
Background Poststroke cognitive impairment (PSCI) has been increasingly recognized in patients. However, it remains unclear whether ADLs recovery is more susceptible to domain-specific cognitive abilities after a stroke. Therefore, the study was designed to investigate the cognitive functions of patients with PSCI at admission by using the Chinese (Putonghua) Version of the Oxford Cognitive Screen (OCS-P) as well as to identify the prognostic value of domain-specific cognitive abilities on the recovery of ADLs when discharged. Methods A total of 153 hospitalized stroke patients were included in this prospective study. Cognitive function was assessed by OCS-P when participants were admitted to the hospital. The ADLs were measured at admission and discharge, and recovery was estimated by the improvement between admission and discharge. A diagnostic model using logistic regression was constructed to identify the prognostic value of domain-specific cognitive abilities for ADLs. The efficacy and accuracy of the diagnostic model were assessed by receiver operating characteristic (ROC) and Hosmer-Lemeshow's goodness of fit test. The diagnostic model was validated by 10-fold cross-validation and presented as a nomogram. Results The score of OCS-P was 60(49.75, 69). The most frequently impaired cognitive domain was number writing (60.8%), followed by verbal memory (52.9%). Multivariate logistic regression showed executive dysfunction was a risk prognostic factor of ADLs recovery (P < 0.001, OR = 3.176 [95% CI, 1.218∼8.278]). The ROC curve of the diagnostic model was 0.839, with a good diagnostic efficacy. Hosmer–Lemeshow test showed diagnostic model had good calibration ability (χ2 = 8.939.3, P=0.347 > 0.05). The average error rate after adjustment of 10-fold cross-validation was 20.93%, within the acceptable range. Conclusions Post-stroke patients generally suffered from multidimensional cognitive impairments. Executive dysfunction screened with OCS-P at clinical admission was a reliable and accessible predictive factor ADLs recovery in patients with PSCI. Early targeted rehabilitation programs are suggested to make them as earlier as possible, especially for those having executive dysfunction while hospitalized.
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18
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Leng Y, Lo WLA, Mao YR, Bian R, Zhao JL, Xu Z, Li L, Huang DF. The Impact of Cognitive Function on Virtual Reality Intervention for Upper Extremity Rehabilitation of Patients With Subacute Stroke: Prospective Randomized Controlled Trial With 6-Month Follow-up. JMIR Serious Games 2022; 10:e33755. [PMID: 35802415 PMCID: PMC9308068 DOI: 10.2196/33755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/28/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Stroke is among the leading causes of long-term disability worldwide. Motor impairments after stroke not only impact the individuals quality of life but also lay substantial burdens on the society. Motor planning is a key component of cognitive function that impacts motor control. Hand movements such as grasping or reaching to grasp require the application of correct force and the coordination of multiple limb segments. Successful completion of hand motor task requires a certain degree of cognitive function to anticipate the requirement of the task. Cognitive function may thus be a confounding factor to rehabilitation outcomes. Objective This study aims to explore the impact of cognitive function on functional outcomes in people with subacute stroke after VR intervention. Methods Patients with stroke were first stratified into cognitively normal (CN) and cognitively impaired (CI), followed by allocation to the VR or control group (CG). Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Barthel Index (BI), and Instrumental Activities of Daily Living (IADL) were recorded at baseline, 3 weeks after the intervention, and 3 and 6 months after the intervention. The between-group and within-group differences were assessed by repeated-measures analysis of variance (ANOVA). Results The between-group comparison indicated that FMA-UE, BI, and IADL (time effect P<.001 for all) scores improved significantly in both groups after the intervention. Repeated-measures ANOVA indicated that FMA-UE, BI, and IADL (time effect P<.001 for all) were significantly different in each subgroup after the intervention. For BI score, the ANOVA results showed obvious interaction effects (treatment × time × cognitive effect, P=.04). Conclusions VR intervention was as effective as traditional conventional therapy in improving upper limb function regardless of the cognitive functional level. Patients with stroke with impaired cognitive function may gain more improvement in upper limb function and independency in performing activities of daily living after a VR-based intervention. Trial Registration Chinese Clinical Trial Registry ChiCTR-IOC-15006064; https://tinyurl.com/4c9vkrrn
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Affiliation(s)
- Yan Leng
- Department of Rehabilitation Medicine, First Affiliated Hospital Sun Yat-sen University, Guangzhou, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, First Affiliated Hospital Sun Yat-sen University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Sun Yat-sen University, Guangzhou, China
| | - Yu Rong Mao
- Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Sun Yat-sen University, Guangzhou, China.,Department of Rehabilitation Medicine, Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, China
| | - Ruihao Bian
- Department of Rehabilitation Medicine, First Affiliated Hospital Sun Yat-sen University, Guangzhou, China
| | - Jiang Li Zhao
- Department of Rehabilitation Medicine, First Affiliated Hospital Sun Yat-sen University, Guangzhou, China
| | - Zhiqin Xu
- Department of Rehabilitation Medicine, First Affiliated Hospital Sun Yat-sen University, Guangzhou, China
| | - Le Li
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
| | - Dong Feng Huang
- Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Sun Yat-sen University, Guangzhou, China.,Department of Rehabilitation Medicine, Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, China
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19
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Dorman DB, Sampson AL, Sacre P, Stuphorn V, Niebur E, Sarma SV. Decomposing Executive Function into Distinct Processes Underlying Human Decision Making. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:807-811. [PMID: 36086558 PMCID: PMC10044438 DOI: 10.1109/embc48229.2022.9871849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Executive function (EF) consists of higher level cognitive processes including working memory, cognitive flexibility, and inhibition which together enable goal-directed behaviors. Many neurological disorders are associated with EF dysfunctions which can lead to suboptimal behavior. To assess the roles of these processes, we introduce a novel behavioral task and modeling approach. The gamble-like task, with sub-tasks targeting different EF capabilities, allows for quantitative assessment of the main components of EF. We demonstrate that human participants exhibit dissociable variability in the component processes of EF. These results will allow us to map behavioral outcomes to EEG recordings in future work in order to map brain networks associated with EF deficits. Clinical relevance- This work will allow us to quantify EF deficits and corresponding brain activity in patient populations in future work.
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20
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Yu Q, Huang X, Zhang B, Li Z, Zhang T, Hu Z, Ding M, Liang Z, Lo WLA. A Novel Perspective on the Proactive and Reactive Controls of Executive Function in Chronic Stroke Patients. Front Neurol 2022; 13:766622. [PMID: 35295836 PMCID: PMC8918511 DOI: 10.3389/fneur.2022.766622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/06/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives To investigate the proactive and reactive control process when executing a complex task in patients with stroke. Proactive control is the preparatory process before the target stimulus, whereas reactive control is an imperative resolution of interference after the target stimulus. Methods In total, 17 patients with chronic stroke and 17 healthy individuals were recruited. The proactive and reactive control of executive function was assessed by the task-switching paradigm and the AX version of the Continuous Performance Task (AX-CPT). The general executive function was assessed by Color Trial Test (CTT) and Stroop Test. The behavioral data of the task-switching paradigm were analyzed by a three-way repeated-measures ANOVA, and the AX-CPT data were analyzed by two-way repeated-measures ANOVA. Results For efficiency scores in the task-switching paradigm, trial (repeat vs. switch) × group (stroke or control group) interaction effect was significant. Post-hoc analysis on trial × group effect showed a significant between-trial difference in accuracy rates in the repeat trial in the control group regardless of 100 or 50% validity. For the AX-CPT, the main effects of condition and group on response time were statistically significant. The interaction effect of condition (AY or BX) × group (stroke or control group) was also significant. Post-hoc analysis for condition × group indicated that the stroke group had a significantly longer response time in the BX condition than the control group and longer completion time in CTT2 and larger word interference for completion time in the Stroop test than the control cohort. Conclusions Post-stroke survivors showed deficits in the performance of proactive control but not in the performance of reactive control. Deficits in proactive control may be related to the impairment of working memory. Interventions that focus on proactive control may result in improved clinical outcomes.
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Affiliation(s)
- Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaomin Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Baofeng Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhicheng Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tao Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ziwei Hu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Minghui Ding
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhenwen Liang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Zhenwen Liang
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Wai Leung Ambrose Lo
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21
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Rice J, Corp DT, Swarowsky A, Cahalin LP, Cabral D, Nunez C, Koch S, Rundek T, Gomes-Osman J. Greater Cognitive-Motor Interference in Individuals Post-Stroke During More Complex Motor Tasks. J Neurol Phys Ther 2022; 46:26-33. [PMID: 34628438 PMCID: PMC8692424 DOI: 10.1097/npt.0000000000000379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Dual-task (DT) walking assessments allow for the simultaneous evaluation of cognitive and motor performance. During DT walking, individuals may experience interference in one or both tasks, known as cognitive-motor interference (CMI). The primary purpose of this study was to compare CMI between individuals post-stroke and healthy persons group during single- and dual-motor and cognitive tasks, using 2 distinct walking tasks. METHODS Motor performance was quantified as the total time for the Timed Up and Go (TUG) and gait speed for the 90-second walk (90W). Cognitive performance was measured as the correct response rate (CRR) during serial 7 subtractions. Participants performed the motor and cognitive tasks in isolation for the single-task (ST) and simultaneously for DT conditions, TUG-DT and 90W-DT. A repeated-measures analysis of variance assessed group (poststroke and healthy) by condition (ST and DT) interactions for the TUG, 90W, and CRR. RESULTS There were significant main effects of group and condition for both the TUG and the 90W (P < 0.05). There was also an interaction effect for the TUG, with individuals post-stroke demonstrating a larger decrement in TUG-DT performance compared with healthy persons (P < 0.05). Furthermore, a significant interaction effect was observed for the CRR, in which healthy individuals exhibited a greater decrement in performance from the ST to the 90W-DT (P < 0.05). DISCUSSION AND CONCLUSIONS Individuals post-stroke were susceptible to greater motor interference during the more complex motor task, the TUG-DT. However, the only decrements observed in cognitive performance from the ST to DT occurred in healthy individuals during the 90W-DT.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A367).
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Affiliation(s)
- Jordyn Rice
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel T Corp
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | | | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Danylo Cabral
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christina Nunez
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sebastian Koch
- Department of Neurology, University Miami Miller School of Medicine, Miami, FL, USA
| | - Tatjana Rundek
- Department of Neurology, University Miami Miller School of Medicine, Miami, FL, USA
- Evelyn F. McKnight Brain Institute, University Miami Miller School of Medicine, Miami, FL, USA
| | - Joyce Gomes-Osman
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurology, University Miami Miller School of Medicine, Miami, FL, USA
- Evelyn F. McKnight Brain Institute, University Miami Miller School of Medicine, Miami, FL, USA
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22
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Effect of Executive Dysfunction on Posture Control and Gait after Stroke. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3051750. [PMID: 34675982 PMCID: PMC8526208 DOI: 10.1155/2021/3051750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022]
Abstract
Objective The purpose of the study was to observe the effects of executive dysfunction (ED) on gait and postural control during walking after stroke. Methods In this study, 34 subjects with stroke and ED (8 women and 26 men; age, 55.41 ± 7.89 years; time since stroke onset, 1.3 ± 0.12 months) were recruited. Stroop color-word test (SCWT), 10-meter walk test (10MWT), timed-up-and-go test (TUGT), and gait analysis were evaluated. The correlation among the correct number of Stroop tasks (SCWT-C), the number of time-consuming tasks (SCWT-T), the amount of interference (SIE-M and SIE-T) and posture control, and gait-related parameters was analyzed. Results The results indicated that SCWT-C was negatively correlated with 10MWT, TUGT, and bilateral symmetry (P < 0.05). However, there was no significant correlation between SCWT-C and stride (P > 0.05). A significant negative correlation was seen between SCWT-C and bilateral symmetry (P < 0.05). There was no significant correlation between SCWT-T and stride (P > 0.05). SCWT-T was positively correlated with TUGT, 10MWT, and bilateral symmetry (P < 0.05). SIE-T was positively correlated with TUGT and bilateral symmetry (P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride (P > 0.05). SIE-M was positively correlated with TUGT and bilateral symmetry (P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride (P > 0.05). Conclusions ED is closely related to the decline in postural control and the occurrence of falls. In the early phases of stroke rehabilitation, physiotherapists should focus on the patients' executive function to accelerate the recovery of postural control.
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23
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Yao YY, Wei ZJ, Zhang YC, Li X, Gong L, Zhou JW, Wang Y, Zhang YY, Wang RP. Functional Disability After Ischemic Stroke: A Community-Based Cross-Sectional Study in Shanghai, China. Front Neurol 2021; 12:649088. [PMID: 34512499 PMCID: PMC8427524 DOI: 10.3389/fneur.2021.649088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023] Open
Abstract
Objective: This study aimed to understand the demographics, functional disabilities, cognitive impairment, and depressive mood among stroke patients and to explore the correlation between functional disability and the other health conditions so as to provide some data for community rehabilitation among stroke patients. Methods: A cross-sectional study was conducted to investigate the functional status of ischemic stroke patients with stroke history between 1 month and 2 years by applying the modified Rankin Scale (mRS). Data were collected during October 2016 and January 2017 from 11 communities in two districts of Shanghai, China. We used face-to-face questionnaire interviews to collect information on sociodemographics, vascular risks associated with stroke, cognitive function [Mini-Mental State Examination (MMSE)], and depression [Patient Health Questionnaire-9 (PHQ-9)]; and we applied SPSS 24.0 for data analysis. Results: In this study, 305 patients with ischemic stroke were finally recruited, including 189 (61.97%) men, with an average age of 67 years. According to the mRS score, ischemic stroke patients were divided into patients without symptoms (controls, mRS = 0), patients without obvious disability (mRS = 1), and patients with mild to severe disability (mRS = 2-5). Ischemic stroke patients with different mRS levels demonstrated significant differences in age, tobacco smoke exposure, previous stroke history, cognitive function, and depression status. Compared with patients without symptoms (mRS = 0), patients with mRS = 1 had a lower MMSE score [odds ratio (OR): 0.48, 95% confidence interval (CI): 0.26-0.90]; and patients with mRS = 2-5 had a lower MMSE score [OR = 0.16, 95% CI: 0.08-0.33], had a higher PHQ-9 score [OR = 5.36, 95% CI: 2.19-13.11], and were more likely to have previous stroke history [OR = 2.18, 95% CI: 1.01-4.79]. Conclusion: Lower degrees of functional independence are related to cognitive impairment, as well as the previous stroke history and depression status.
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Affiliation(s)
- Ying-Ye Yao
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zi-Jun Wei
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yue-Chan Zhang
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang Li
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liu Gong
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Neurology, Shanghai Baoshan Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, China
| | - Jia-Wei Zhou
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Wang
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yun-Yun Zhang
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rui-Ping Wang
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
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24
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Nagelkop ND, Rosselló M, Aranguren I, Lado V, Ron M, Toglia J. Using Multicontext Approach to Improve Instrumental Activities of Daily Living Performance after a Stroke: A Case Report. Occup Ther Health Care 2021; 35:249-267. [PMID: 34039245 DOI: 10.1080/07380577.2021.1919954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cognitive deficits constitute one of the greatest challenges for independence achievement after a stroke. This paper provides an in depth view of the application of the Multicontext approach within routine Occupational Therapy care for a 41-year-old who demonstrated limited participation in activities of daily living as a consequence of executive function impairments and limited self-awareness. Results indicated improved online self-awareness, strategy use and functional performance, however, no changes were observed on a standard Awareness Questionnaire. This suggests that awareness within activities may be more important in contributing to effective strategy use and functional performance compared to verbal acknowledgment in an interview. Results also support the feasibility of the Multicontext approach within inpatient settings in Argentina.
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Affiliation(s)
| | | | | | | | | | - Joan Toglia
- Mercy College, School of Health and Natural Science, Dobbs Ferry, New York, USA
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25
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Stolwyk RJ, Mihaljcic T, Wong DK, Chapman JE, Rogers JM. Poststroke Cognitive Impairment Negatively Impacts Activity and Participation Outcomes: A Systematic Review and Meta-Analysis. Stroke 2021; 52:748-760. [PMID: 33493048 DOI: 10.1161/strokeaha.120.032215] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This systematic review and meta-analysis aimed to investigate whether cognition is associated with activity and participation outcomes in adult stroke survivors. Five databases were systematically searched for studies investigating the relationship between general- and domain-specific cognition and longer-term (>3 months) basic activities of daily living (ADL), instrumental ADLs, and participation outcomes. Eligibility for inclusion, data extraction, and study quality was evaluated by 2 reviewers using a standardized protocol. Effect sizes (r) were estimated using a random-effects model. Sixty-two publications were retained for review, comprising 7817 stroke survivors (median age 63.57 years, range:18-96 years). Median length of follow-up was 12 months (range: 3 months-11 years). Cognition (all domains combined) demonstrated a significant medium association with all 3 functional outcomes combined, r=0.37 (95% CI, 0.33-0.41), P<0.001. Moderator analyses revealed these effects persisted regardless of study quality, order in which outcomes were collected (sequential versus concurrent), age, sample size, or follow-up period. Small to medium associations were also identified between each individual cognitive domain and the separate ADL, instrumental ADL, and participation outcomes. In conclusion, poststroke cognitive impairment is associated with early and enduring activity limitations and participation restrictions, and the association is robust to study design factors, such as sample size, participant age, follow-up period, or study quality. Cognitive assessment early poststroke is recommended to facilitate early detection of disability, prediction of functional outcomes, and to inform tailored rehabilitation therapies.
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Affiliation(s)
- Renerus J Stolwyk
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (R.J.S., T.M., J.E.C.)
| | - Tijana Mihaljcic
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (R.J.S., T.M., J.E.C.)
| | - Dana K Wong
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia (D.K.W.)
| | - Jodie E Chapman
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (R.J.S., T.M., J.E.C.)
| | - Jeffrey M Rogers
- Faculty of Medicine and Health, The University of Sydney, Australia (J.M.R.)
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Predictors of Anxiety and Depression Symptom Improvement in CBT Adapted for Traumatic Brain Injury: Pre/Post-Injury and Therapy Process Factors. J Int Neuropsychol Soc 2020; 26:97-107. [PMID: 31983372 DOI: 10.1017/s1355617719000791] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The current study examined the association of demographic/preinjury, injury-related, and cognitive behavior therapy (CBT) process variables, with anxiety and depression symptom change in traumatic brain injury (TBI)-adapted CBT (CBT-ABI). METHODS The audio recordings of 177 CBT-ABI sessions representing 31 therapist-client dyads were assessed from the independent observer perspective on measures of working alliance, homework engagement, and therapist competency in using homework. RESULTS Linear regressions showed that older client age, longer post-TBI recovery period, better executive functioning, higher levels of client homework engagement, as well as higher levels of therapist competence in reviewing homework were associated with greater improvement in anxiety and/or depression symptoms. CONCLUSIONS CBT-ABI is a promising treatment for post-TBI depression and anxiety. The current study highlights how therapists can enhance CBT-ABI effectiveness, specifically: comprehensive facilitation of client homework engagement with emphasis on homework review, and accommodation of executive deficits. The current study also suggests that the role of client age and the length of post-TBI recovery period require further investigation.
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