Objectives: Memory deficits are common after stroke, yet remain a high unmet need within the community. The aim of this phase II randomized controlled trial was to determine whether group compensatory or computerized cognitive training approaches were effective in rehabilitating memory following stroke.
Methods: A parallel, 3-group, single-blind, randomized controlled trial was used to compare the effectiveness of a compensatory memory skills group with restorative computerized training on functional goal attainment. Secondary outcomes explored change in neuropsychological measures of memory, subjective ratings of prospective and everyday memory failures and ratings of internal and external strategy use.
Results: A total of 65 community dwelling survivors of stroke were randomized (24: memory group, 22: computerized cognitive training, and 19: wait-list control). Participants allocated to the memory group reported significantly greater attainment of memory goals and internal strategy use at 6-week follow-up relative to participants in computerized training and wait-list control conditions. However, groups did not differ significantly on any subjective or objective secondary outcomes.
Conclusion: Preliminary evidence shows that memory skills groups, but not computerized training, may facilitate achievement of functional memory goals for community dwelling survivors of stroke. These findings require further replication, given the modest sample size, subjective nature of the outcomes and the absence of objective eligibility for inclusion.
Memory problems are commonly reported following stroke but receiving help for these difficulties remains a high unmet need among survivors. Two different approaches to memory rehabilitation are available: memory skills group training and computerised cognitive training; however, it is unclear which approach is more effective. This study compared these two approaches in 65 stroke survivors who all reported memory difficulties. We found that participants who received memory group training were more likely to achieve their memory improvement goals than those who received computerised cognitive training. It was concluded that memory skills group training may be a more effective approach to improve memory function in daily life following stroke, but more research is required.
Memory impairment is one of the most commonly reported cognitive consequences of stroke (1) and can compromise rehabilitation engagement (2). Despite this, support for memory problems remains a high unmet need within the community (3) and has been identified by patients, researchers and clinicians as a high-priority research area (4).
Memory skills group (MSG) training and computerized cognitive training (CCT) are commonly used approaches to rehabilitate memory. Although both share the fundamental goal of improving everyday memory outcomes (5), there are a number of key differences between these interventions. CCT adopts a restorative approach to rehabilitation, with the theoretical goal of restoring underlying impairment through cognitive exercises (6). Repetitive drill and practice style activities are purported to result in everyday functional gains, although there remains no robust evidence of this transfer (6). By contrast, MSG interventions take a compensatory approach to rehabilitation with a theoretical aim of lessening the disabling impact of impairment (7). In addition, the format of delivery differs. CCT training tasks are generally completed individually, with associated well-recognized advantages of low cost, wide availability and potential for at personalized use at home (8). MSG intervention is facilitated by a trained clinician and is delivered face-to-face in a group format, due, in part, to increased recognition of the multifaceted nature of memory dysfunction and limited economic resources (9).
While a number of comprehensive reviews have explored best-practice recommendations for cognitive impairment following acquired brain injury (10, 11), only a minority of studies included in these reviews were conducted in stroke-only samples. Consequently, the long-held view that MSG training is the treatment of choice in rehabilitating memory has been largely speculative post-stroke and appears to have been based on an absence of evidence, rather than evidence of absence for the effectiveness of CCT (5). The aim of this study was to compare the effectiveness of CCT and MSG training in community dwelling survivors of stroke in achieving individualized, functional memory goals. A further aim was to explore the effect of training on secondary measures of objective, neuropsychological memory tasks and subjective memory ratings. In addressing these aims, we intended to maintain ecological validity by evaluating the interventions as they are clinically implemented (rather than transforming them to be experimentally matched with each other on characteristics such as group vs individual format), with the goal of facilitating clinical translation. We hypothesized that intervention participants (i.e. CCT and MSG) would show greater improvement in performance on outcome measures than waitlist control participants (WC). Given the proposed mechanism of action of each approach, we also hypothesized participants in the CCT group would show greater improvement on neuropsychological tests of memory, while participants in the MSG would show greater improvement on functional measures of memory and strategy use.[…]
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