So you didn't do the research well enough that you called for further research, that is failure in my book, along with not creating any protocols.
Comparison of Rehabilitative Interventions That Ameliorate Post-stroke Working Memory Deficit: A Systematic Review
Abstract
Stroke is one of the most common causes of disability in the world. It has sensory, motor, and cognitive symptoms. Many cognitive domains might get involved in a stroke. This systematic review focuses on working memory domain deficits after stroke and their various rehabilitation methods. This review is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) guidelines. For this review, we have searched PubMed, Google Scholar, and Science Direct databases and screened thoroughly with the inclusion criteria of free full-text English papers in the last 10 years that have exclusively studied humans. The articles included in the search are randomized control trials (RCTs), observational studies, meta-analysis studies, systematic reviews, and traditional reviews. Consequent quality assessment was done using the most commonly used tools for each type of study and eight papers were selected. From these papers, full-text articles were studied, analyzed, and tabulated. We found five different rehabilitation methods: transcranial direct-current stimulation, computer-assisted cognitive rehabilitation, physical activity, goal setting, and multimodal rehabilitation. We found that goal setting, computer-assisted cognitive rehabilitation, and multimodal rehabilitation can improve working memory deficits. While transcranial direct current stimulation and physical activity were inconsistent, further studies are needed. The small sample size, no follow-up, the inclusion of only a few studies, the size of the stroke, and comorbid conditions like mild cognitive impairment, dementia, and depression were the main limitations of this study. Future reviews must include a larger number of studies with large sample sizes, including follow-up as an inclusion criterion. We need more clinical trials on these methods for better knowledge.
Introduction & Background
Stroke is the second most common cause of dementia and the third most common cause of morbidity [1]. It can occur due to ischemic (most common) or hemorrhagic causes and can decrease the blood supply of the brain. The most common involved symptoms besides physical deficits (such as complete or partial paralysis, sensory loss, and altered sensations) are dysfunction in learning, memory, and executive functions. This affects nearly 83% of post-stroke patients with cognitive dysfunction, and more than 60% of stroke survivors report cognitive dysfunction, even for up to 10 years [2]. While motor and sensory deficits can affect patients’ quality of life and economic status, memory deficit will affect patients’ daily activities, their profession, and their families. Although the motor and cognitive functions are fundamentally treated as well-defined and separate entities while treating and diagnosing, both entities play an essential role in the post-stroke assessment of behavior and disability [3]. When it comes to cognitive function, working memory has a fundamental role in performing complex behavior [4]. Damage to working memory function causes a drop in the complex cognitive function of the brain to perform everyday activities such as memorization, communication, planning, reading, and writing [5].
What is working memory? It is defined as a multi-component system involved in goal-directed behavior that involves retaining and manipulating information [6]. In simple terms, it is explained as a “sketchpad of conscious thought” [7]. for example, problem-solving in our mind and navigating to our home within our mind. Baddeley and Hitch described it as an essential model with four sub-components arranged hierarchically [6]. They are the phonological loop, visuospatial sketchpad, central executive, and episodic buffer [6]. The central executive supervises the other three subcomponents to store visual, spatial, and phonological information [8]. Working memory reaches its optimal capacity by 20 to 25 years of age. Then each subcomponent declines slowly with further aging at a different rate, which is explained by visual memory declining faster than phonological memory [9]. Many previous imaging studies found that working memory is a part of the lateral prefrontal and parietal cortex of the brain [10]. These areas are supplied by the middle and anterior cerebral artery branches and later drained into cerebral venous sinuses. The stroke affecting these regions will impair the functions.
Though post-stroke dementia, episodic memory, and long-term memory deficits after stroke have been studied abundantly, working memory deficits after stroke have less information. There is ongoing research on various methods to improve working memory skills and reduce the patient’s morbidity on the efficacy of each rehabilitation. To our knowledge, there is a lack of information on the comparison and efficacies of each intervention; such information is vital for selecting an effective intervention. This review article compares rehabilitative interventions to reduce the working memory deficit after stroke.
Review
Methods
This systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines [11].
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