Combined cognitive and motor training improves the outcome in the early phase after stroke and prevents a decline of executive functions: A pilot study

Article type: Research Article

Authors: Eschweiler, Mareike^{a; b; c; d} | Bohr, Lara^{b; c} | Kessler, Josef^b | Fink, Gereon R.^{b; e} | Kalbe, Elke^{a; *} | Onur, Oezguer A.^{b; e}

Affiliations: [a] Medical Faculty and University Hospital Cologne, Department of Medical Psychology, Neuropsychology & Gender Studies and Center for Neuropsychological Diagnostic and Intervention (CeNDI), Kerpener Str. 62, Cologne, Germany | [b] Medical Faculty and University Hospital Cologne, Department of Neurology, Kerpener Str. 62, Cologne, Germany | [c] University Cologne, Medical Faculty, study program clinical and experimental neuroscience, Josef-Stelzmann-Str. 20, Germany | [d] Neurological Rehabilitation Center Godeshoehe e.V., Department of Therapeutic Science, Waldstr. 2-10, Bonn, Germany | [e] Research Center Jülich, Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Leo-Brandt-Straße, Jülich, Germany

Correspondence: [*] Address for correspondence: Elke Kalbe, PhD, Medical Faculty and University Hospital Cologne, Medical Psychology, Neuropsychology & Gender Studies Center for Neuropsychological Diagnostics und Intervention (CeNDI), Kerpener Str. 62, 50937 Cologne, Germany. Tel.: +49 221 478 6669; Fax: +49 221 478 3420; E-mail: elke.kalbe@uk-koeln.de.

Abstract: BACKGROUND:The negative impact of cognitive dysfunction on motor rehabilitation as a relearning-process is well known in stroke patients. However, evidence for combined cognitive and motor training (CMT) is lacking. OBJECTIVE:To evaluate the effects of combined CMT in early stroke rehabilitation. METHODS:In a controlled pilot study, 29 moderately affected stroke patients with low-level motor performance and cognitive impairment received motor therapy plus either cognitive (experimental group, EG) or low-frequency ergometer training (control group, CG) for eight days. RESULTS:Both groups improved their motor functioning significantly. After training, between-group comparison revealed significant differences for cognitive flexibility and trends for set-shifting, working memory, and reaction control in favor of the EG. Within-group effects showed improvement across all cognitive domains in the EG, which correlated with gains in bed-mobility, while the CG showed no significant improvement in cognition. Rather, a trend towards reaction control decline was observed, which correlated with less functional progression and recovery. Furthermore, a decline in cognitive flexibility, set-shifting, and working memory was descriptively observed. CONCLUSIONS:Combined CMT may enhance cognition and motor relearning early after stroke and is superior to single motor training. Further studies are needed to replicate these results and investigate long-term benefits.

Keywords: Cerebrovascular event, rehabilitation, physiotherapy, cognition recovery of function

DOI: 10.3233/NRE-201583

Journal: NeuroRehabilitation, vol. 48, no. 1, pp. 97-108, 2021