Authors (including presenting author) :
Mok WS, Leung CF, Chen CY, Chan KK, Lee HS, Hui N
Affiliation :
Occupational Therapy (OT) Department, United Christian Hospital (UCH)
Introduction :
Post stroke cognitive impairment is a common yet often overlooked consequence of stroke, significantly affecting the quality of life of survivors and their families. Aiming to provide comprehensive stroke rehabilitation and following “SMART Hospital” strategic development, OT department UCH designed “Brain-Smart” cognitive rehabilitation program with smart training device for subacute stroke patients. This smart cognitive rehabilitation offers three main advantages, including personalization, engagement and data tracking. Early detection of post stroke cognitive impairment allows occupational therapists to personalize and tailor training that address specific deficits. Incorporation of interactive elements in smart training motivates and engages patients in stroke rehabilitation while it also provides real-time feedback and progress tracking, helping both patients and therapists to monitor improvement and adjust strategies accordingly.
Objectives :
To investigate the effectiveness of “Brain-Smart” cognitive rehabilitation program with smart training devices, in conjunction with conventional OT therapy, on improving the cognitive function of subacute stroke patients.
Methodology :
Recruitment of patients commenced in the rehabilitation ward from March to November 2024. Patients with first episode of stroke and Hong Kong version of Montreal Cognitive Assessment (HK-MoCA) result within two to sixteen percentile received 10 sessions of stroke cognitive rehabilitation (five days a week for two weeks) and each session lasted for 45 minutes. Two smart interactive training devices (Pablo and tablets with cognitive training software) were employed. During the program, patients also received conventional cognitive training to further promote their cognition. HK-MoCA and Digit Span Test Backward were adopted to measure the pre and post cognitive function whereas Modified Barthel Index (MBI) and Lawton Instrumental Activities of Daily Living (Chinese Version) were used to measure the functional performance. Wilcoxon signed rank test was utilized in data analysis.
Result & Outcome :
A total of 23 stroke patients with mean age 73.2 completed the “Brain-Smart” program. The recruited patients had statistically significant improvement in HK-MoCA total score by 1.92 (p=0.013) and Digit Span Test Backward score by 0.61 (p=0.003). In particular, patients’ delayed recall (p=0.04) and orientation sub score (p=0.009) improved significantly. In addition to HK-MoCA total score, there was also significant improvement in HK-MoCA indication from mild cognitive impairment level at baseline to mild neurocognitive disorder level after training (p=0.004). In functional aspect, significant improvement was found in both mean MBI by 18.31 score (p<0.001) and mean Lawton by 1.95 score (p=0.01). 53.8% of recruited patients continued stroke cognitive rehabilitation in geriatric day hospital while 11.5% and 7.7% of patients continued rehabilitation at home under medical-social collaboration (MSC) and out-patient setting respectively upon their discharge.
“Brain-Smart” cognitive rehabilitation program brought benefits on patients’ global cognition and functional performance through enhancing neuroplasticity. Furthermore, timely in-patient cognitive rehabilitation and health education can empower patients and caregivers to navigate the challenges of recovery from stroke and lead to improved functional independence and higher engagement in rehabilitation journey. A larger sample size with control group will provide more insight for future studies.
