The Effects of Computer Based Cognitive Rehabilitation in Stroke Patients with Working Memory Impairment: A Systematic Review

Miriam Niemeijer; Katrine Wordenskjold Sværke; Hanne Krarup Christensen

doi:10.1016/j.jstrokecerebrovasdis.2020.105265

The Effects of Computer Based Cognitive Rehabilitation in Stroke Patients with Working Memory Impairment: A Systematic Review

J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105265. doi: 10.1016/j.jstrokecerebrovasdis.2020.105265. Epub 2020 Sep 11.

Authors

Miriam Niemeijer¹, Katrine Wordenskjold Sværke², Hanne Krarup Christensen²

Affiliations

¹ Bispebjerg Hospital, Department of Neurology, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark. Electronic address: miriamniemeijer@gmail.com.
² Bispebjerg Hospital, Department of Neurology, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.

PMID: 32992171
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105265

Abstract

Objectives: To evaluate benefits and harms for computer based cognitive rehabilitation (CBCR) on working memory impairment after stroke.

Methods: PRISMA guidelines were followed. Four electronic databases were systematically searched: Embase, Pubmed/Medline, PsycInfo and Cochrane Library. Authors of relevant studies were contacted to detect unpublished data or articles not found by searching databases.

Selection criteria: Studies were eligible for inclusion in the systematic review if they 1) investigated the effects of CBCR on working memory after acquired brain injury in a patient sample which consisted of at least 50% stroke-patients, 2) it was possible to isolate the effects of CBCR-training by comparison to passive or active control groups, and 3) if the outcome assessment included a quantitative working memory outcome measure either isolated or as part of a general outcome measure. Included studies were further eligible for the meta-analysis if 1) they were conducted as a randomized controlled trial, 2) they included only stroke patients, and 3) the effects of CBCR on working memory could be isolated.

Results: Literature is limited and reported effects of CBCR on working memory after stroke are very heterogeneous. A meta-analysis was not performed as all studies used different measures of working memory. An additional analysis was performed in order to cautiously estimate the difference between the control interventions (whether passive or active) and CBCR interventions. The analysis revealed no meaningful differences in increase of working memory measures between control conditions and intervention conditions. However, this additional analysis should be interpreted with caution as it does not take the heterogeneity of outcome measures or the differences in sample sizes between studies into account. No harms were observed.

Conclusion: There is insufficient evidence to conclude if CBCR is beneficial for patients with working memory deficits after stroke.

Systematic review number: This systematic review is registered in Prospero with registration ID: CRD42018087437.

Keywords: Cognitive deficits; Computer-based cognitive rehabilitation; Executive functions; Stroke; working memory.

Publication types

Systematic Review

MeSH terms

Adult
Cognition*
Executive Function
Female
Humans
Male
Memory Disorders / diagnosis
Memory Disorders / psychology
Memory Disorders / rehabilitation*
Memory, Short-Term*
Middle Aged
Stroke / diagnosis
Stroke / psychology
Stroke / therapy*
Stroke Rehabilitation*
Therapy, Computer-Assisted*
Treatment Outcome