A randomized control trial of the effects of home-based online attention training and working memory training on cognition and everyday function in a community stroke sample

ABSTRACT

Cognitive difficulties are common following stroke and can have widespread impacts on everyday functioning. Technological advances offer the possibility of individualized cognitive training for patients at home, potentially providing a low-cost, low-intensity adjunct to rehabilitation services. Using this approach, we have previously demonstrated post-training improvements in attention and everyday functioning in fronto-parietal stroke patients. Here we examine whether these benefits are observed more broadly in a community stroke sample. Eighty patients were randomized to either 4 weeks of online adaptive attention training (SAT), working memory training (WMT) or waitlist (WL). Cognitive and everyday function measures were collected before and after the intervention, and after 3 months. During training, weekly measures of patients’ subjective functioning were collected. The training was well received and compliance good. No differences in our primary end-point, spatial bias, or other cognitive functions were observed. However, on patient-reported outcomes, SAT participants showed greater levels of improvement in everyday functioning than WMT or WL participants. In line with our previous work, everyday functioning improvements were greatest for patients with spatial impairments and those who received SAT training. Whether attention training can be recommended for stroke survivors depends on whether cognitive test performance or everyday functioning is considered more relevant.

KEYWORDS:

• Stroke
• Rehabilitation
• Cognitive training
• Attention
• Everyday-functioning

Acknowledgements

This work could not have been carried out without the willingness and effort of our patients and their families. Clinical trials registry number: ISRCTN59754564; Ethics approval: NRES 14/EE/0149; HRA approval: IRAS no 150538.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data are freely available at https://doi.org/10.17863/CAM.66310.

Additional information

Funding

This work was supported by The Stroke Association under Grant TSA 2013/06 and Medical Research Council (MRC) UK grants SUAG/ 003/RG91365 and SUAG/049.G101400.