Telehealth Delivery of Memory Rehabilitation Following Stroke

Abstract

Objective:Rehabilitation of memory after stroke remains an unmet need. Telehealth delivery may overcome barriers to accessing rehabilitation services.Method:We conducted a non-randomized intervention trial to investigate feasibility and effectiveness of individual telehealth (internet videoconferencing) and face-to-face delivery methods for a six-week compensatory memory rehabilitation program. Supplementary analyses investigated non-inferiority to an existing group-based intervention, and the role of booster sessions in maintaining functional gains. The primary outcome measure was functional attainment of participants’ goals. Secondary measures included subjective reports of lapses in everyday memory and prospective memory, reported use of internal and external memory strategies, and objective measures of memory functioning.Results:Forty-six stroke survivors were allocated to telehealth and face-to-face intervention delivery conditions. Feasibility of delivery methods was supported, and participants in both conditions demonstrated treatment-related improvements in goal attainment, and key subjective outcomes of everyday memory, and prospective memory. Gains on these measures were maintained at six-week follow-up. Short-term gains in use of internal strategies were also seen. Non-inferiority to group-based delivery was established only on the primary measure for the telehealth delivery condition. Booster sessions were associated with greater maintenance of gains on subjective measures of everyday memory and prospective memory.Conclusions:This exploratory study supports the feasibility and potential effectiveness of telehealth options for remote delivery of compensatory memory skills training after a stroke. These results are also encouraging of a role for booster sessions in prolonging functional gains over time.

Behavioral and Neural Correlates of Cognitive Training and Transfer Effects in Stroke Patients

“…In this particular word-list we had four categories, namely Body Parts, Land Animals, Cleaning Supplies, and Water Animals. A more detailed description of the word-lists can be found in our previous studies (12)(13)(14)(15).…”

“…Recent studies demonstrated that patients with vascular lesions can benefit from different cognitive interventions including face-name training to remember people's names and repetition-lag memory training, developed to increase recollection as opposed to familiarity in recognition memory tasks (9,10). There is also recent evidence of memory and attention improvement after computerized cognitive training and telehealth options for remote delivery of compensatory memory skills training after stroke (11,12).…”

Feasibility of an integrated multidisciplinary geriatric rehabilitation programme for older stroke patients: a process evaluation

“…Although, home therapy is valued for its effect to enhance the functional activity and participation level of stroke patients after discharge [44], results of our study indicate that there is still a time and/or travel problem for care professionals which makes it is still rather difficult, in current practice, to organize home therapy. To tackle time and travel difficulties, telemonitoring could be a feasible and effective alternative to improve recovery, and maintaining the benefits reached during inpatient rehabilitation [45][46][47]. Finally, we also observed that the attendance of the education module by the patients and informal caregivers was rather low.…”

Feasibility of an integrated multidisciplinary geriatric rehabilitation programme for older stroke patients: a process evaluation

“…Despite our intensive collaboration with the stroke care field in developing the program, the results of our process evaluation show that the program was only partly feasible. Implementation research shows that implementing complex interventions like ours is very challenging in an older population 48 .…”

“…It seems that complex interventions such as this in clinical practice for older stroke patients require a more intensive and stepwise implementation strategy such as described by Luker and Dowding 48,49 This method could be important to increase necessary knowledge of the key elements in the treatment protocol and enhance the collaboration between members of the rehabilitation teams.…”