Posts Tagged Cognitive Rehabilitation

[Abstract + References] Virtual and Augmented Reality Platform for Cognitive Tele-Rehabilitation Based System – Conference paper


Virtual and Augmented Reality systems have been increasingly studied, becoming an important complement to traditional therapy as they can provide high-intensity, repetitive and interactive treatments. Several systems have been developed in research projects and some of these have become products mainly for being used at hospitals and care centers. After the initial cognitive rehabilitation performed at rehabilitation centers, patients are obliged to go to the centers, with many consequences, as costs, loss of time, discomfort and demotivation. However, it has been demonstrated that patients recovering at home heal faster because surrounded by the love of their relatives and with the community support.


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[ARTICLE] The Use of Therapeutic Music Training to Remediate Cognitive Impairment Following an Acquired Brain Injury: The Theoretical Basis and a Case Study – Full Text


Cognitive impairment is the most common sequelae following an acquired brain injury (ABI) and can have profound impact on the life and rehabilitation potential for the individual. The literature demonstrates that music training results in a musician’s increased cognitive control, attention, and executive functioning when compared to non-musicians. Therapeutic Music Training (TMT) is a music therapy model which uses the learning to play an instrument, specifically the piano, to engage and place demands on cognitive networks in order to remediate and improve these processes following an acquired brain injury. The underlying theory for the efficacy of TMT as a cognitive rehabilitation intervention is grounded in the literature of cognition, neuroplasticity, and of the increased attention and cognitive control of musicians. This single-subject case study is an investigation into the potential cognitive benefit of TMT and can be used to inform a future more rigorous study. The participant was an adult male diagnosed with cognitive impairment as a result of a severe brain injury following an automobile accident. Pre- and post-tests used standardized neuropsychological measures of attention: Trail Making A and B, Digit Symbol, and the Brown– Peterson Task. The treatment period was twelve months. The results of Trail Making Test reveal improved attention with a large decrease in test time on both Trail Making A (−26.88 s) and Trail Making B (−20.33 s) when compared to normative data on Trail Making A (−0.96 s) and Trail Making B (−3.86 s). Digit Symbol results did not reveal any gains and indicated a reduction (−2) in free recall of symbols. The results of the Brown–Peterson Task reveal improved attention with large increases in the correct number of responses in the 18-s delay (+6) and the 36-s delay (+7) when compared with normative data for the 18-s delay (+0.44) and the 36-s delay (−0.1). There is sparse literature regarding music based cognitive rehabilitation and a gap in the literature between experimental research and clinical work. The purpose of this paper is to present the theory for Therapeutic Music Training (TMT) and to provide a pilot case study investigating the potential efficacy of TMT to remediate cognitive impairment following an ABI.

1. Introduction

An acquired brain injury (ABI) can result in impairment in a variety of domains including motor, speech, emotional, and cognitive. Cognitive impairment is the most common sequelae following an ABI [1,2,3,4] and is a result of deficit in one or more areas of cognition such as the various forms of attention, working memory, memory, executive function, or processing speed [5,6,7,8,9,10,11]. An individual with cognitive impairment may experience challenge to suppress distraction, remain on task, shift between tasks, follow directions, organize and initiate a response, or have difficulties with memory. Cognitive impairment can impact participation and progress in rehabilitation therapies for any of the above domains due to reduced attention, poor executive functioning, or impaired memory. The inability to attend to instructions of the therapist, to cognitively plan and organize a response, or to remember rehabilitation objectives outside the therapy session can potentially disqualify an individual from participation in rehabilitative programs or may impede progress in them. Furthermore, cognitive impairment is reported by family and caregivers as a significant source of stress [8,12,13,14]. Addressing cognitive impairment should be a priority in patient treatment following an acquired brain injury. Therefore, it is important to have on-going research into potentially effective cognitive rehabilitation tools.Music training has been noted in the literature to impact areas of non-musical functioning including phonological awareness [15], speech processing [16], listening skills [17], perceiving speech in noise [18] and reading [19,20]. Of significance to the theory of Therapeutic Music Training, the literature demonstrates the impact of music training on cognitive abilities including attention and executive functioning [21,22,23,24,25,26,27].Therapeutic Music Training (TMT) is a music therapy model in which the use of music training, specifically learning to play the piano, is used to address and remediate cognitive impairment following an acquired brain injury [28]. TMT is informed by clinical work and is grounded in literature. The hypothesis of the efficacy of TMT to remediate cognitive impairment is supported by literature regarding the influence of music training on cognition [23,24,25,29], musician’s enhanced abilities in attention, working memory, and cognitive control [26], theories of attention [30,31,32,33,34,35] and the neuroplasticity of the brain, including following injury [36,37,38,39,40]. Because of the engagement of the prefrontal cortex and the demands placed on working memory and attention during TMT, it can be an effective tool to address cognitive impairment. Although functionally interconnected, specific aspects of cognition such as working memory, attention, executive function, and memory are targeted in TMT tasks. TMT is a remedial approach to cognitive rehabilitation, that is, the goal is to drive, strengthen, and improve the underlying neural processes involved in the target cognitive areas. This is in contrast to a compensatory approach to cognitive rehabilitation, in which the goal is to provide the individual with strategies and accommodations to deal with the outcomes of cognitive impairment. The tangible outcome of producing a song provides motivation for the client to engage in cognitive rehabilitation and to remain in the rehabilitative process for an extended period of time as is required to stimulate a neuroplastic response and for the remediation of neural processing to take place.TMT is distinct from modified music education in that the goal of TMT is the remediation of cognitive processes rather than music performance. Tasks involved in learning to play the piano are designed with the goal of placing demands on the various components of cognition. The sequencing and pacing of tasks are determined by the cognitive goals with consideration to target cognitive processes and the time required to drive and strengthen the networks involved. Novelty and the gradual increase in complexity of tasks are utilized to place on-going demands on attention networks and to gradually benefit higher cognitive processes. This is in contrast to modified music education, in which the primary goal is the acquisition of musical abilities and performance.TMT is distinct from other models of music therapy in that it uses music training as the intervention for rehabilitative purposes. TMT contrasts from other music therapy models which use music primarily for expressive purposes, lack corrective feedback from the therapist, or use isolated music tasks which are not intended as music training. TMT is distinct from Neurologic Music Therapy (NMT) [41] in addressing cognitive goals as NMT does not use music training in its music-based rehabilitative interventions. Bruscia highlighted the importance of the music therapist’s “non-judgemental acceptance of what the client does musically” [42] (p. 3). While the TMT therapist would express empathy and support to the client, s/he would also provide constructive and corrective feedback as required in the learning to play an instrument. As in other models of music therapy, the therapist’s use-of-self and the role of the client–therapist relationship are important contributors to the success of the therapy.Remarkably, much of cognitive rehabilitation is not grounded in the literature [36,43,44,45]. This may be due in part to the fact that rehabilitation therapy used to address cognitive impairment is most often based on a compensatory approach, accommodating or supporting the impairment, rather than attempting to remediate the cognitive processes that have been impaired. While the use of music and instrument playing for motor rehabilitation has been widely investigated [41,46,47,48], there is sparse literature investigating the potential efficacy of music-based cognitive rehabilitation interventions. This paper provides a brief introduction to the theory for TMT. This case study investigates the hypothesis of the potential effectiveness of therapeutic music training, TMT, to remediate cognitive impairment and serves as a pilot project to inform future, more rigorous studies. This investigation can contribute to the literature regarding music-based cognitive rehabilitation and inform clinical practice. There is a gap between cognitive experimental research and treatment applications [49]. The hypothesis for TMT has been informed by clinical work and this study can help fill in the gap between experimental research and clinical application. […]

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[Abstract] How brain imaging provides predictive biomarkers for therapeutic success in the context of virtual reality cognitive training


VR environments help improve rehabilitation of impaired complex cognitive functions

Combining neuroimaging and VR boosts ecological validity, generates practical gains

These are the first neurofunctional predictive biomarkers of VR cognitive training


As Virtual reality (VR) is increasingly used in neurological disorders such as stroke, traumatic brain injury, or attention deficit disorder, the question of how it impacts the brain’s neuronal activity and function becomes essential. VR can be combined with neuroimaging to offer invaluable insight into how the targeted brain areas respond to stimulation during neurorehabilitation training. That, in turn, could eventually serve as a predictive marker for therapeutic success. Functional magnetic resonance imaging (fMRI) identified neuronal activity related to blood flow to reveal with a high spatial resolution how activation patterns change, and restructuring occurs after VR training. Portable and quiet, electroencephalography (EEG) conveniently allows the clinician to track spontaneous electrical brain activity in high temporal resolution. Then, functional near-infrared spectroscopy (fNIRS) combines the spatial precision level of fMRIs with the portability and high temporal resolution of EEG to constitute an ideal measuring tool in virtual environments (VEs). This narrative review explores the role of VR and concurrent neuroimaging in cognitive rehabilitation.


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[Abstract] Computerized cognitive training using virtual reality on everyday life activities for patients recovering from stroke

Purpose: Recent studies argue that the use of virtual reality tasks depicting activities daily living may be effective means for cognitive rehabilitation. The aim of this study was to test an ecologically oriented approach in virtual reality resembling the demands of everyday life activities for cognitive rehabilitation following stroke.

Materials and Methods: The sample comprised 30 sub-acute stroke patients recovering from stroke in a rehabilitation hospital. They were assessed in a single-arm pre-post intervention study on global cognition, executive functions, memory and attention abilities. The intervention consisted of virtual reality in a multidomain cognitive training approach depicting everyday life tasks (preparing food, choosing clothes, shopping, etc.).

Results: Improvements were found in the assessed cognitive domains at 6 to 10 post-treatment sessions. In-depth analysis through reliable change scores has suggested larger treatment effects on global cognition.

Conclusions: Overall results suggest that the use of virtual reality-based exercises on everyday life activities may be a useful cognitive rehabilitation approach to provide short-term gains in cognition following stroke.

  • Implications for rehabilitation
  • Virtual reality-based cognitive rehabilitation resembling everyday life activities may provide short-term gains in cognition of stroke patients;

  • Consistent improvements in executive functions may require higher treatment dosage than for improvements in global cognition.

via Computerized cognitive training using virtual reality on everyday life activities for patients recovering from stroke: Disability and Rehabilitation: Assistive Technology: Vol 0, No 0

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[Abstract] Computer-Based Cognitive Rehabilitation in Patients with Visuospatial Neglect or Homonymous Hemianopia after Stroke


Objectives: The purpose of this pilot study was to investigate the feasibility and effects of computer-based cognitive rehabilitation (CBCR) in patients with symptoms of visuospatial neglect or homonymous hemianopia in the subacute phase following stroke.

Method: A randomized, controlled, unblinded cross-over design was completed with early versus late CBCR including 7 patients in the early intervention group (EI) and 7 patients in the late intervention group (LI). EI received CBCR training immediately after inclusion (m = 19 days after stroke onset) for 3 weeks and LI waited for 3 weeks after inclusion before receiving CBCR training for 3 weeks (m = 44 days after stroke onset).

Results: CBCR improved visuospatial symptoms after stroke significantly when administered early in the subacute phase after stroke. The same significant effect was not found when CBCR was administered later in the rehabilitation. The difference in the development of the EI and LI groups during the first 3 weeks was not significant, which could be due to a lack of statistical power. CBCR did not impact mental well-being negatively in any of the groups. In the LI group, the anticipation of CBCR seemed to have a positive impact of mental well-being.

Conclusion: CBCR is feasible and has a positive effect on symptoms in patients with visuospatial symptoms in the subacute phase after stroke. The study was small and confirmation in larger samples with blinded outcome assessors is needed.

via Computer-Based Cognitive Rehabilitation in Patients with Visuospatial Neglect or Homonymous Hemianopia after Stroke – ScienceDirect

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[Abstract] Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014 – Archives of Physical Medicine and Rehabilitation

Η εικόνα ίσως περιέχει: κείμενο



To conduct an updated, systematic review of the clinical literature, classify studies based on the strength of research design, and derive consensual, evidence-based clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) or stroke.

Data Sources

Online PubMed and print journal searches identified citations for 250 articles published from 2009 through 2014.

Study Selection

Selected for inclusion were 186 articles after initial screening. Fifty articles were initially excluded (24 focusing on patients without neurologic diagnoses, pediatric patients, or other patients with neurologic diagnoses, 10 noncognitive interventions, 13 descriptive protocols or studies, 3 nontreatment studies). Fifteen articles were excluded after complete review (1 other neurologic diagnosis, 2 nontreatment studies, 1 qualitative study, 4 descriptive articles, 7 secondary analyses). 121 studies were fully reviewed.

Data Extraction

Articles were reviewed by the Cognitive Rehabilitation Task Force (CRTF) members according to specific criteria for study design and quality, and classified as providing class I, class II, or class III evidence. Articles were assigned to 1 of 6 possible categories (based on interventions for attention, vision and neglect, language and communication skills, memory, executive function, or comprehensive-integrated interventions).

Data Synthesis

Of 121 studies, 41 were rated as class I, 3 as class Ia, 14 as class II, and 63 as class III. Recommendations were derived by CRTF consensus from the relative strengths of the evidence, based on the decision rules applied in prior reviews.


CRTF has now evaluated 491 articles (109 class I or Ia, 68 class II, and 314 class III) and makes 29 recommendations for evidence-based practice of cognitive rehabilitation (9 Practice Standards, 9 Practice Guidelines, 11 Practice Options). Evidence supports Practice Standards for (1) attention deficits after TBI or stroke; (2) visual scanning for neglect after right-hemisphere stroke; (3) compensatory strategies for mild memory deficits; (4) language deficits after left-hemisphere stroke; (5) social-communication deficits after TBI; (6) metacognitive strategy training for deficits in executive functioning; and (7) comprehensive-holistic neuropsychological rehabilitation to reduce cognitive and functional disability after TBI or stroke.

via Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014 – Archives of Physical Medicine and Rehabilitation

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[Abstract] Virtual Reality Environment for the Cognitive Rehabilitation of Stroke Patients


We present ongoing work to develop a virtual reality environment for the cognitive rehabilitation of patients as a part of their recovery from a stroke. A stroke causes damage to the brain and problem solving, memory and task sequencing are commonly affected. The brain can recover to some extent, however, and stroke patients have to relearn to carry out activities of daily learning. We have created an application called VIRTUE to enable such activities to be practiced using immersive virtual reality. Gamification techniques enhance the motivation of patients such as by making the level of difficulty of a task increase over time. The design and implementation of VIRTUE is presented together with the results of a small acceptability study.

via Virtual Reality Environment for the Cognitive Rehabilitation of Stroke Patients

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[Abstract] Difficulty Factors for VR Cognitive Rehabilitation Training – Crossing a Virtual Road


Immersive VR environment for the training of safe road crossing decisions.

Relevant Lanes and Traffic Speed have a clear influence on task difficulty.

No clear influence could be found for the Gap Size.

The Number of Vehicles had almost no effect on the perceived task difficulty.

Two neuropsychologists stated that the system is ready for a study on patients.



Patients with cognitive or visual impairments have problems in dealing with complex situations. During the rehabilitation process, it is important to confront the patient with (everyday) tasks that have increasing degrees of difficulty to improve their performance. Immersive virtual reality training offers the potential to create a better transfer to daily life than non-immersive computer training. In cooperation with two neuropsychologists, an immersive virtual environment (VE) was developed in which cognitive training in the form of safe road crossing decisions can be performed. We present the experimental exploration and evaluation of difficulty factors within such a VR-based cognitive rehabilitation program. Four difficulty factors were identified and compared (number of relevant traffic lanes, speed of vehicles, distance between vehicles, and number of vehicles). The combination of these difficulty factors resulted in 36 training scenarios. The impact of the factors on participant performance and subjective perception of scenario difficulty were evaluated with 60 healthy participants to estimate the impact of the four factors to a situation’s difficulty level. For the factors Relevant Lanes and Traffic Speed a clear influence on the perceived task difficulty could be determined. No clear influence could be found for the Gap Size. The Number of Vehicles had almost no effect on the perceived task difficulty. Finally, we asked two experienced neuropsychologists about the applicability of our developed system to patients, and they stated that the system is ready for a study on patients.

via Difficulty Factors for VR Cognitive Rehabilitation Training – Crossing a Virtual Road – ScienceDirect

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[Abstract] The Effect of Noninvasive Brain Stimulation on Poststroke Cognitive Function: A Systematic Review


Introduction. Cognitive impairment after stroke has been associated with lower quality of life and independence in the long run, stressing the need for methods that target impairment for cognitive rehabilitation. The use of noninvasive brain stimulation (NIBS) on recovery of language functions is well documented, yet the effects of NIBS on other cognitive domains remain largely unknown. Therefore, we conducted a systematic review that evaluates the effects of different stimulation techniques on domain-specific (long-term) cognitive recovery after stroke. 

Methods. Three databases (PubMed, EMBASE, and PsycINFO) were searched for articles (in English) on the effects of NIBS on cognitive domains, published up to January 2018. 

Results. A total of 40 articles were included: randomized controlled trials (n = 21), studies with a crossover design (n = 9), case studies (n = 6), and studies with a mixed design (n = 4). Most studies tested effects on neglect (n = 25). The majority of the studies revealed treatment effects on at least 1 time point poststroke, in at least 1 cognitive domain. Studies varied highly on the factors time poststroke, number of treatment sessions, and stimulation protocols. Outcome measures were generally limited to a few cognitive tests. 

Conclusion. Our review suggests that NIBS is able to alleviate neglect after stroke. However, the results are still inconclusive and preliminary for the effect of NIBS on other cognitive domains. A standardized core set of outcome measures of cognition, also at the level of daily life activities and participation, and international agreement on treatment protocols, could lead to better evaluation of the efficacy of NIBS and comparisons between studies.

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[ARTICLE] Technology-based cognitive training and rehabilitation interventions for individuals with mild cognitive impairment: a systematic review



Individuals with mild cognitive impairment (MCI) are at heightened risk of developing dementia. Rapid advances in computing technology have enabled researchers to conduct cognitive training and rehabilitation interventions with the assistance of technology. This systematic review aims to evaluate the effects of technology-based cognitive training or rehabilitation interventions to improve cognitive function among individuals with MCI.


We conducted a systematic review using the following criteria: individuals with MCI, empirical studies, and evaluated a technology-based cognitive training or rehabilitation intervention. Twenty-six articles met the criteria.


Studies were characterized by considerable variation in study design, intervention content, and technologies applied. The major types of technologies applied included computerized software, tablets, gaming consoles, and virtual reality. Use of technology to adjust the difficulties of tasks based on participants’ performance was an important feature. Technology-based cognitive training and rehabilitation interventions had significant effect on global cognitive function in 8 out of 22 studies; 8 out of 18 studies found positive effects on attention, 9 out of 16 studies on executive function, and 16 out of 19 studies on memory. Some cognitive interventions improved non-cognitive symptoms such as anxiety, depression, and ADLs.


Technology-based cognitive training and rehabilitation interventions show promise, but the findings were inconsistent due to the variations in study design. Future studies should consider using more consistent methodologies. Appropriate control groups should be designed to understand the additional benefits of cognitive training and rehabilitation delivered with the assistance of technology.


Due to the aging of the world’s population, the number of people who live with dementia is projected to triple to 131 million by the year 2050 []. Development of preventative strategies for individuals at higher risk of developing dementia is an international priority []. Mild cognitive impairment (MCI) is regarded as an intermediate stage between normal cognition and dementia []. Individuals with MCI usually suffer with significant cognitive complaints, yet do not exhibit the functional impairments required for a diagnosis of dementia. These people typically have a faster rate of progression to dementia than those without MCI [], but the cognitive decline among MCI subjects has the potential of being improved []. Previous systematic reviews of cognitive intervention studies, both cognitive training and cognitive rehabilitation, have demonstrated promising effects on improving cognitive function among subjects with MCI [].

Recently, rapid advances in computing technology have enabled researchers to conduct cognitive training and rehabilitation interventions with the assistance of technology. A variety of technologies, including virtual reality (VR), interactive video gaming, and mobile technology, have been used to implement cognitive training and rehabilitation programs. Potential advantages to using technology-based interventions include enhanced accessibility and cost-effectiveness, providing a user experience that is immersive and comprehensive, as well as providing adaptive responses based on individual performance. Many computerized cognitive intervention programs are easily accessed through a computer or tablet, and the technology can objectively collect data during the intervention to provide real-time feedback to participants or therapists. Importantly, interventions delivered using technology have shown better effects compared to traditional cognitive training and rehabilitation programs in improving cognitive function and quality of life []. The reasons for this superiority are not well-understood but could be related to the usability and motivational factors related to the real-time interaction and feedback received from the training system [].

Three recent reviews of cognitive training and rehabilitation for use with individuals with MCI and dementia suggest that technology holds promise to improve both cognitive and non-cognitive outcomes []. The reviews conducted by Coyle, et al. [] and Chandler, et al. [] were limited by accessing articles from only two databases, and did not comprehensively cover available technologies. Hill, et al. [] limited their review to papers published until July 2016 and included only older adults aged 60 and above. More technology-based intervention studies have been conducted since then, and only including studies with older adults 60 and above could limit the scope of the review given that adults can develop early-onset MCI in their 40s []. Therefore, the purpose of this review is to 1) capture more studies using technology-based cognitive interventions by conducting a more comprehensive search using additional databases 2) understand the effect of technology-based cognitive interventions on improving abilities among individuals with MCI; and 3) examine the effects of multimodal technology-based interventions and their potential superiority compared to single component interventions.[…]


Continue —-> Technology-based cognitive training and rehabilitation interventions for individuals with mild cognitive impairment: a systematic review

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