ABSTRACT

Cognitive difficulties are common following stroke and can have widespread impacts on everyday functioning. Technological advances offer the possibility of individualized cognitive training for patients at home, potentially providing a low-cost, low-intensity adjunct to rehabilitation services. Using this approach, we have previously demonstrated post-training improvements in attention and everyday functioning in fronto-parietal stroke patients. Here we examine whether these benefits are observed more broadly in a community stroke sample. Eighty patients were randomized to either 4 weeks of online adaptive attention training (SAT), working memory training (WMT) or waitlist (WL). Cognitive and everyday function measures were collected before and after the intervention, and after 3 months. During training, weekly measures of patients’ subjective functioning were collected. The training was well received and compliance good. No differences in our primary end-point, spatial bias, or other cognitive functions were observed. However, on patient-reported outcomes, SAT participants showed greater levels of improvement in everyday functioning than WMT or WL participants. In line with our previous work, everyday functioning improvements were greatest for patients with spatial impairments and those who received SAT training. Whether attention training can be recommended for stroke survivors depends on whether cognitive test performance or everyday functioning is considered more relevant.

摘要

认知困难在中风后很常见，并且可能对日常功能产生广泛影响。技术进步为患者在家中进行个性化认知训练提供了可能性，有可能为康复服务提供低成本、低强度的辅助手段。使用这种方法，我们之前已经证明额顶中风患者的注意力和日常功能在训练后有所改善。在这里，我们检查这些益处是否在社区中风样本中得到更广泛的观察。80 名患者被随机分配接受为期 4 周的在线适应性注意力训练 (SAT)、工作记忆训练 (WMT) 或候补名单 (WL)。在干预前后以及 3 个月后收集认知和日常功能测量。在训练期间，每周收集患者主观功能的测量结果。培训活动反响良好，合规性良好。我们的主要终点、空间偏差或其他认知功能没有观察到差异。然而，根据患者报告的结果，SAT 参与者的日常功能改善程度高于 WMT 或 WL 参与者。与我们之前的工作一致，患有空间障碍的患者和接受 SAT 训练的患者的日常功能改善最为明显。是否可以建议中风幸存者进行注意力训练取决于认知测试表现或日常功能是否更相关。