Journal of Rehabilitation Medicine 51-5 | Page 27

J Rehabil Med 2019; 51: 343–351
ORIGINAL REPORT
COMPARING MEMORY GROUP TRAINING AND COMPUTERIZED COGNITIVE
TRAINING FOR IMPROVING MEMORY FUNCTION FOLLOWING STROKE: A
PHASE II RANDOMIZED CONTROLLED TRIAL
Toni D. WITHIEL, DPsych 1,9 , Dana WONG, PhD 1,2,3 , Jennie L. PONSFORD, PhD 1,3 , Dominique A. CADILHAC, PhD 4,5 ,
Peter NEW, PhD 6,7,8 , Tijana MIHALJCIC, DPsych 1 and Renerus J. STOLWYK, DPsych 1,3
From the 1 Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 2 School
of Psychology and Public Health, La Trobe University, 3 Monash-Epworth Rehabilitation Research Centre, Melbourne, 4 Translational
Public Health and Evaluation Division Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash
Health, Monash University, Clayton, 5 Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne,
Heidelberg, 6 Rehabilitation and Aged Care, Medical Program, Monash Health, Melbourne, 7 Epworth-Monash Rehabilitation Medicine
Unit, Southern Medical School, 8 Department of Epidemiology and Preventive Medicine, Monash University, Victoria, and 9 Allied Health,
Royal Melbourne Hospital, Melbourne, Australia
Objectives: Memory deficits are common after stro-
ke, yet remain a high unmet need within the commu-
nity. The aim of this phase II randomized controlled
trial was to determine whether group compensatory
or computerized cognitive training approaches were
effective in rehabilitating memory following stroke.
Methods: A parallel, 3-group, single-blind, randomi-
zed controlled trial was used to compare the effecti-
veness of a compensatory memory skills group with
restorative computerized training on functional goal
attainment. Secondary outcomes explored change in
neuropsychological measures of memory, subjective
ratings of prospective and everyday memory failures
and ratings of internal and external strategy use.
Results: A total of 65 community dwelling survivors
of stroke were randomized (24: memory group, 22:
computerized cognitive training, and 19: wait-list
control). Participants allocated to the memory group
reported significantly greater attainment of memory
goals and internal strategy use at 6-week follow-up
relative to participants in computerized training and
wait-list control conditions. However, groups did not
differ significantly on any subjective or objective se-
condary outcomes.
Conclusion: Preliminary evidence shows that memo-
ry skills groups, but not computerized training, may
facilitate achievement of functional memory goals
for community dwelling survivors of stroke. These
findings require further replication, given the mo-
dest sample size, subjective nature of the outcomes
and the absence of objective eligibility for inclusion.
Key words: cognition; rehabilitation; episodic memory; me-
mory; stroke; clinical trial phase II.
Accepted Feb 6, 2019; Epub ahead of print Feb 28, 2019
J Rehabil Med 2019; 51: 343–351
Correspondence address: Renerus Stolwyk, Monash Institute of Cogni-
tive and Clinical Neurosciences, School of Psychological Sciences, Mo-
nash University, Melbourne, Australia. E-mail: rene.stolwyk@monash.
edu
M
emory impairment is one of the most commonly
reported cognitive consequences of stroke (1)
and can compromise rehabilitation engagement (2).
LAY ABSTRACT
Memory problems are commonly reported following
stroke but receiving help for these difficulties remains
a high unmet need among survivors. Two different ap-
proaches to memory rehabilitation are available: me-
mory skills group training and computerised cognitive
training; however, it is unclear which approach is more
effective. This study compared these two approaches in
65 stroke survivors who all reported memory difficul-
ties. We found that participants who received memory
group training were more likely to achieve their memory
improvement goals than those who received compute-
rised cognitive training. It was concluded that memory
skills group training may be a more effective approach
to improve memory function in daily life following stro-
ke, but more research is required.
Despite this, support for memory problems remains
a high unmet need within the community (3) and has
been identified by patients, researchers and clinicians
as a high-priority research area (4).
Memory skills group (MSG) training and compute-
rized cognitive training (CCT) are commonly used ap-
proaches to rehabilitate memory. Although both share
the fundamental goal of improving everyday memory
outcomes (5), there are a number of key differences
between these interventions. CCT adopts a restorative
approach to rehabilitation, with the theoretical goal of
restoring underlying impairment through cognitive ex-
ercises (6). Repetitive drill and practice style activities
are purported to result in everyday functional gains,
although there remains no robust evidence of this trans-
fer (6). By contrast, MSG interventions take a com-
pensatory approach to rehabilitation with a theoretical
aim of lessening the disabling impact of impairment
(7). In addition, the format of delivery differs. CCT
training tasks are generally completed individually,
with associated well-recognized advantages of low
cost, wide availability and potential for at personali-
zed use at home (8). MSG intervention is facilitated
by a trained clinician and is delivered face-to-face in
a group format, due, in part, to increased recognition
This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm
Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977
doi: 10.2340/16501977-2540