Methods The current study was conducted to examine the influence of task oriented
training on cognitive functions in post Elderly stroke patients. All patients were
diagnosed clinically and radiologically and referred from their neurological consultants
as having post stroke cognitive impairment (PSCI). The patients were chosen, and the
study was carried- out in outpatient clinics of Faculty of physical therapy, Horus
University, this study was conducted at the period from ============== to==============.
True experimental research design study (one factorial RCT, pre-test and post-test
control group design) was utilized. One trained research assistant assessed all patients
and collected all data to reduce inter-investigator error. Patients were randomized
according to the treatment procedure into two equal groups.
Randomization method: Patients who met the study's inclusion criteria were randomized
into two groups (A and B) utilizing a secure opaque closed envelope allocation mechanism.
Group A (study group): consisted of twenty hemiparetic patients received task oriented
training in addition to traditional physical therapy program, 3 times per week for 3
month, every session for 1 hour (30 minutes task oriented training followed by 30 minutes
traditional physical therapy program). Group B (control group): consisted of twenty
hemiparetic patients received the traditional physical therapy program, 3 sessions/week
for 3 month, each session for 1hour.
Blinding: All patients were assessed and referred by the same physician and physical
therapy evaluation before beginning and at the end of the treatment program. Treatment
allocations were kept secret from both the researcher and the participants.
Inclusion criteria: Forty right-handed hemiparetic patients from both genders aged from
60 to 70 years old. They are complaining from a single ischemic stroke diagnosed by
Neurologist and confirmed radiologically by MRI of the brain. Duration of illness ranged
from three to twelve months. Spasticity grade (1 to 1+) based on the Modified Ashworth
Scale (MAS). Medically as well as psychologically stable patients. All patients had
normal and stable vital signs (heart rate, blood pressure, temperature as well as
respiratory rate). All patients had a good educational level and the body mass index
ranged from 20-30 Kg/m2.
Exclusion criteria: Patients with Recurrent stroke or hemiparesis due to other
neurological causes rather than stroke. Patients with severe cardiovascular issues that
have not been adequately treated. Visual, auditory and other neurological disorders.
Patients receiving medications that may affect cognition.
Data collection and intervention Assessment methods After being informed of the study's
goals, methods, potential benefits, privacy, as well as data use, all participants signed
a written consent form. Pre-treatment and post-treatment assessments were conducted on
all patients.
Measurement procedures:
Assessment of cognitive function by Reha-com device The computerized Reha-Com device
containing the (attention and concentration) program was utilized as the patient is
asked to concentrate on every detail in the separately presented picture and select
the one that resembles it in every detail from the matrix, as the assessment screen
is splitted into two parts. One portion represents the matrix that involves:
according to (24) levels of difficulty: 3 pictures (1 by 3 matrix), 6 pictures (2 by
3 matrix) as well as 9 pictures (3 by 3 matrix), and the other part represents the
separated picture.
Addenbrooke's Cognitive Examination Revised (ACE-R) test It consists of 26 tasks,
divided into five domains. It takes about 15 minutes to administer. The maximum
possible score is 100, and questions are asked in the sequence stated, with scores
calculated immediately based on the addition of point values for each correctly
answered question (10).
Montreal Cognitive Assessment Scale (MoCA):
The test is commonly used to screen for cognitive impairment. It was designed to detect
mild cognitive Impairment. It takes approximately 10 minutes to complete, 30-point
cognitive screening instrument. It is utilized to evaluate multiple aspects of cognition,
including: short-term memory; visual-spatial skills; executive function; concentration;
attention; memory for work; language; as well as time-and-place awareness. The possible
range of MoCA scores is 0-30. If you scored 26 or more, you're in the normal range.
Scores below 25 indicate mild cognitive impairment (MCI) in individuals who have suffered
a stroke, and the score has a high sensitivity (77%) as well as specificity (83%) (11).
Intervention methods Task-oriented training program: [For study group] Rocker board
training The subject was asked to control anteroposterior then mediolateral rolling
movement of the rocking board, first placing both feet then one foot, first with eyes
opened then with eyes closed, from sitting then standing position.
Wobble board training The subject was asked to try to stop the multidirectional rolling
wobble board movement, first with eyes opened then with eyes closed, from sitting then
standing position, repeat 10 times.
Sit to stand The patient was instructed to lean forward then press on heel then stand up.
Both hands should be on the thigh and push against it to stand. This progress to be
performed with opened eyes then with closed eyes firstly on a firm surface then on foam
surface with repetitions 10 times.
Walk five steps forward From standing position, the patient was asked to walk five steps
forward firstly on a firm surface, then on foam surface and repeat 10 times.
Upstairs and downstairs three steps The patient was asked to perform upstairs five steps
and downstairs with hand supported then without hand supported, repeat 10 times.
Traditional physical therapy program: [For both groups] Range of motion exercises Range
of motion exercises was performed for the foot. The patient was asked to sit in a chair,
lift the affected foot and circle in a clockwise, then a counterclockwise motion. Repeat
this cycling five and ten times in each direction.
Strengthing exercises:
Graduate active exercise was used through strengthing of ankle dorsiflexors,
planterflexor, invertors and evertors. Proprioceptive neuromuscular facilitation was also
applied to strength distal muscles in the form of repeated contraction for dorsiflexors
of ankle joint for ten minutes.
Sensory re-education:
Tactile stimulation for both superficial and deep sensation was applied. Gait Training
Walking within parallel bar with hand supported then without hand support was
participated for ten minutes. Obstacles also were used with hand support then without
hand support.
