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The efficacy of computerized cognitive rehabilitation in improving attention and executive functions in acquired brain injury patients, in acute and postacute phase

Authors
 Ha Seong Kim  ;  Kil-Byung Lim  ;  Jeehyun Yoo  ;  Yong Wook Kim  ;  Sang Wan Lee  ;  Sungsik Son  ;  Changgyu Kim  ;  Jiyong Kim 
Citation
 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE, Vol.57(4) : 551-559, 2021-08 
Journal Title
EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ISSN
 1973-9087 
Issue Date
2021-08
MeSH
Adult ; Aged ; Aged, 80 and over ; Attention / physiology* ; Brain Injuries / physiopathology ; Brain Injuries / rehabilitation* ; Cognition Disorders / physiopathology ; Cognition Disorders / rehabilitation* ; Cognitive Behavioral Therapy / methods* ; Executive Function / physiology* ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Single-Blind Method ; Therapy, Computer-Assisted / methods* ; Young Adult
Abstract
Background: Cognitive deficits, particularly executive dysfunction is common following acquired brain injury (ABI) and has detrimental effect on functional status and autonomy in daily life. Among various cognitive training methods, computerized cognitive rehabilitation (CCR) has been investigated as an alternative method to therapist-driven cognitive rehabilitation (TCR). However, previous studies have shown conflicting results on the superiority or inferiority of CCR and TCR. Aim: To investigate the efficacy of TCR and CCR in improving executive function in patients with acute-to-subacute ABI. Design: A prospective, assessor-blinded randomized controlled trial. Setting: Hospitalized care setting in the department of rehabilitation in a university hospital. Population: Thirty-two acute-to-subacute (less than 3 months after onset) ABI patients with executive dysfunctions were included in this study. The mean time after injury was 25.1±18.1 days. Methods: Participants were assigned to the TCR group (N.=14) or the CCR group (N.=18). Each group performed TCR or CCR for 30 minutes each day for two weeks in addition to routine rehabilitation. Neurocognitive function tests to assess complex attention, executive function, general cognitive function (mini-mental status examination [MMSE] and Montreal Cognitive Assessment [MoCA]), and functional evaluations [modified Barthel Index, MBI]) were performed at baseline (T0) and at the end of treatment (T1). Results: The TCR and CCR groups showed significant improvements in the MMSE (P=0.004, 0.000), MoCA (P=0.003, 0.006), and MBI (P=0.000, 0.000) scores. TCR and CCR groups both showed significant improvements in some of the complex attention tests (trail-making test A, P=0.002, 0.005) and executive function tests (trail-making test B, P=0.016, 0.016). The TCR group showed significant improvements in the additional executive function tests (phonemic fluency test, P=0.004, semantic fluency test, P=0.001), while the CCR group showed significant improvements in the additional complex attention tests (symbol search, P=0.02, digit symbol coding, P=0.002). In the intergroup comparison of the changes from pre- to postintervention, only the TCR group showed a significant improvement in the phonemic fluency test (P=0.013). Conclusions: TCR might be more effective than CCR in improving frontal lobe-related executive function in ABI patients. CCR might be beneficial for improving psychomotor speed and working memory. Clinical rehabilitation impact: TCR or CCR should be chosen according to the targeted domain of cognitive dysfunction in acute-to-subacute ABI patients.
Files in This Item:
T202104410.pdf Download
DOI
10.23736/S1973-9087.21.06497-2
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Wook(김용욱) ORCID logo https://orcid.org/0000-0002-5234-2454
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/185946
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