Rehabilitation Program Improves Working Memory After Stroke

2006 ◽  
2020 ◽  
Vol 34 (6) ◽  
pp. 754-763
Author(s):  
Helene Brissart ◽  
Abdou Y Omorou ◽  
Natacha Forthoffer ◽  
Eric Berger ◽  
Thibault Moreau ◽  
...  

Objective: The aim of this study is to determine the effectiveness of an extended cognitive rehabilitation program in group’s sessions in multiple sclerosis. Design: Double-blind multicenter randomized trial. Participants: People with multiple sclerosis of 18 to 60 years, Expanded Disability Status Scale ⩽6.0, mild to moderate cognitive impairment. Interventions: They were randomized into cognitive rehabilitation program (ProCog-SEP) or in a placebo program. ProCog-SEP comprises 13 group’s sessions over 6 months and includes psychoeducational advices and cognitive exercises. Placebo program included non-cognitive exercises. No strategy and no cognitive advice were provided. Main measures: The primary endpoint was the percentage of verbal memory learning measured by the Selective Reminding Test. A comprehensive neuropsychological assessment is carried out before and after interventions by a neuropsychologist blinded to intervention. Effectiveness of the ProCog-SEP versus Placebo has been verified using linear regression models. Results: In total, 128 participants were randomized and 110 were included in the study after planning session in groups; 101 completed this trial (77.2% females); mean age: 46.1 years (±9.6); disease duration: 11.8 years (±7.5). ProCog-SEP was more effective in increasing in learning index (9.21 (95% confidence interval (CI): 1.43, 16.99); p = 0.02) and in working memory on manipulation (0.63 (95% CI: 0.17, 1.09); p = 0.01), and updating capacities (–1.1 (95% CI: –2.13, –0.06); p = 0.04). No difference was observed for other neuropsychological outcomes. Regarding quality of life outcomes, no change was observed between the two groups. Conclusion: These findings suggest that ProCog-SEP could improve verbal learning abilities and working memory in people with multiple sclerosis. These improvements were observed with 13 group sessions over 6 months.


10.2196/15344 ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. e15344 ◽  
Author(s):  
Andrea Tacchino ◽  
Renee Veldkamp ◽  
Karin Coninx ◽  
Jens Brulmans ◽  
Steven Palmaers ◽  
...  

Background Interest toward dual-task training (DTT) is increasing as traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These usually involve simultaneous cognitive and motor tasks, and they often show a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but limited evidence is present for people with multiple sclerosis (MS). The use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols and easier implementation of multicenter and multilanguage studies. Objective To describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based app, and to present the preliminary results of a multicenter pilot study involving people with MS performed in several European centers for evaluating the feasibility of and adherence to a rehabilitation program based on CMI-APP. Methods CMI-APP includes user-friendly interfaces for personal data input and management, assessment of CMI, and DTT. A dedicated team developed CMI-APP for Android tablets above API level 14 (version 4.0), using C# as the programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, and sustained attention and four motor assessment tests for walking at different difficulty levels were implemented. Dual cognitive-motor tasks were performed by combining single cognitive and motor tasks. CMI-APP implements exercises for DTT involving the following 12 cognitive functions: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, and visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen people with MS (mean age 52.6, SD 8.6 years; mean disease duration 9.4, SD 8.4 years; mean Expanded Disability Status Scale score 3.6, SD 1.1) underwent DTT (20 sessions). Adherence to the rehabilitation program was evaluated according to the percentage of performed sessions, perceived exertion during the training (Borg 15-point Ratings of Perceived Exertion [RPE] Scale), and subjective experience of the training (Intrinsic Motivation Inventory [IMI]). Results The adherence rate was 91%. DTT was perceived as “somewhat difficult” (mean RPE Scale score 12.6, SD 1.9). IMI revealed that participants enjoyed the training and felt that it was valuable and, to some extent, important, without feelings of pressure. They felt competent, although they did not always feel they could choose the exercises, probably because the therapist chose the exercises and many exercises had few difficulty levels. Conclusions CMI-APP is safe, highly usable, motivating, and well accepted for DTT by people with MS. The findings are fundamental for the preparation of future large-sample studies examining CMI and the effectiveness of DTT interventions with CMI-APP in people with MS.


2019 ◽  
Author(s):  
Andrea Tacchino ◽  
Renee Veldkamp ◽  
Karin Coninx ◽  
Jens Brulmans ◽  
Steven Palmaers ◽  
...  

BACKGROUND Interest toward dual-task training (DTT) is increasing as traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These usually involve simultaneous cognitive and motor tasks, and they often show a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but limited evidence is present for people with multiple sclerosis (MS). The use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols and easier implementation of multicenter and multilanguage studies. OBJECTIVE To describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based app, and to present the preliminary results of a multicenter pilot study involving people with MS performed in several European centers for evaluating the feasibility of and adherence to a rehabilitation program based on CMI-APP. METHODS CMI-APP includes user-friendly interfaces for personal data input and management, assessment of CMI, and DTT. A dedicated team developed CMI-APP for Android tablets above API level 14 (version 4.0), using C# as the programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, and sustained attention and four motor assessment tests for walking at different difficulty levels were implemented. Dual cognitive-motor tasks were performed by combining single cognitive and motor tasks. CMI-APP implements exercises for DTT involving the following 12 cognitive functions: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, and visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen people with MS (mean age 52.6, SD 8.6 years; mean disease duration 9.4, SD 8.4 years; mean Expanded Disability Status Scale score 3.6, SD 1.1) underwent DTT (20 sessions). Adherence to the rehabilitation program was evaluated according to the percentage of performed sessions, perceived exertion during the training (Borg 15-point Ratings of Perceived Exertion [RPE] Scale), and subjective experience of the training (Intrinsic Motivation Inventory [IMI]). RESULTS The adherence rate was 91%. DTT was perceived as “somewhat difficult” (mean RPE Scale score 12.6, SD 1.9). IMI revealed that participants enjoyed the training and felt that it was valuable and, to some extent, important, without feelings of pressure. They felt competent, although they did not always feel they could choose the exercises, probably because the therapist chose the exercises and many exercises had few difficulty levels. CONCLUSIONS CMI-APP is safe, highly usable, motivating, and well accepted for DTT by people with MS. The findings are fundamental for the preparation of future large-sample studies examining CMI and the effectiveness of DTT interventions with CMI-APP in people with MS.


2016 ◽  
Vol 39 ◽  
Author(s):  
Mary C. Potter

AbstractRapid serial visual presentation (RSVP) of words or pictured scenes provides evidence for a large-capacity conceptual short-term memory (CSTM) that momentarily provides rich associated material from long-term memory, permitting rapid chunking (Potter 1993; 2009; 2012). In perception of scenes as well as language comprehension, we make use of knowledge that briefly exceeds the supposed limits of working memory.


2016 ◽  
Vol 39 ◽  
Author(s):  
Arnon Lotem ◽  
Oren Kolodny ◽  
Joseph Y. Halpern ◽  
Luca Onnis ◽  
Shimon Edelman

AbstractAs a highly consequential biological trait, a memory “bottleneck” cannot escape selection pressures. It must therefore co-evolve with other cognitive mechanisms rather than act as an independent constraint. Recent theory and an implemented model of language acquisition suggest that a limit on working memory may evolve to help learning. Furthermore, it need not hamper the use of language for communication.


2020 ◽  
Vol 63 (9) ◽  
pp. 3036-3050
Author(s):  
Elma Blom ◽  
Tessel Boerma

Purpose Many children with developmental language disorder (DLD) have weaknesses in executive functioning (EF), specifically in tasks testing interference control and working memory. It is unknown how EF develops in children with DLD, if EF abilities are related to DLD severity and persistence, and if EF weaknesses expand to selective attention. This study aimed to address these gaps. Method Data from 78 children with DLD and 39 typically developing (TD) children were collected at three times with 1-year intervals. At Time 1, the children were 5 or 6 years old. Flanker, Dot Matrix, and Sky Search tasks tested interference control, visuospatial working memory, and selective attention, respectively. DLD severity was based on children's language ability. DLD persistence was based on stability of the DLD diagnosis. Results Performance on all tasks improved in both groups. TD children outperformed children with DLD on interference control. No differences were found for visuospatial working memory and selective attention. An interference control gap between the DLD and TD groups emerged between Time 1 and Time 2. Severity and persistence of DLD were related to interference control and working memory; the impact on working memory was stronger. Selective attention was unrelated to DLD severity and persistence. Conclusions Age and DLD severity and persistence determine whether or not children with DLD show EF weaknesses. Interference control is most clearly impaired in children with DLD who are 6 years and older. Visuospatial working memory is impaired in children with severe and persistent DLD. Selective attention is spared.


2020 ◽  
Vol 63 (12) ◽  
pp. 4162-4178
Author(s):  
Emily Jackson ◽  
Suze Leitão ◽  
Mary Claessen ◽  
Mark Boyes

Purpose Previous research into the working, declarative, and procedural memory systems in children with developmental language disorder (DLD) has yielded inconsistent results. The purpose of this research was to profile these memory systems in children with DLD and their typically developing peers. Method One hundred four 5- to 8-year-old children participated in the study. Fifty had DLD, and 54 were typically developing. Aspects of the working memory system (verbal short-term memory, verbal working memory, and visual–spatial short-term memory) were assessed using a nonword repetition test and subtests from the Working Memory Test Battery for Children. Verbal and visual–spatial declarative memory were measured using the Children's Memory Scale, and an audiovisual serial reaction time task was used to evaluate procedural memory. Results The children with DLD demonstrated significant impairments in verbal short-term and working memory, visual–spatial short-term memory, verbal declarative memory, and procedural memory. However, verbal declarative memory and procedural memory were no longer impaired after controlling for working memory and nonverbal IQ. Declarative memory for visual–spatial information was unimpaired. Conclusions These findings indicate that children with DLD have deficits in the working memory system. While verbal declarative memory and procedural memory also appear to be impaired, these deficits could largely be accounted for by working memory skills. The results have implications for our understanding of the cognitive processes underlying language impairment in the DLD population; however, further investigation of the relationships between the memory systems is required using tasks that measure learning over long-term intervals. Supplemental Material https://doi.org/10.23641/asha.13250180


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