Nothing here even remotely suggests how to make neuroplasticity repeatable on demand.
We don't SPECIFICALLY know why a neuron gives up its' current job and takes on a neighbors. Thus nothing on neuroplasticity is scientifically repeatable on demand. So, DEMAND your doctor give you EXACT PROTOCOLS to use. Don't allow your doctor to give you generalities or guidelines.
Enhancing Neuroplasticity Post Stroke: The Role of Cognitive–Behavioral Training
1
Department of Physical Therapy, Akhmim Hospital, Sohag 82749, Egypt
2
Department of Physical Therapy for Neurology, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
3
Department of
Rehabilitation Sciences, College of Health and Rehabilitation Sciences,
Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh
11671, Saudi Arabia
4
Physical Therapy Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia
5
Basic Science for Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
6
Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Cairo University, Giza 12613, Egypt
*
Author to whom correspondence should be addressed.
Brain Sci. 2025, 15(4), 330; https://doi.org/10.3390/brainsci15040330
Submission received: 9 February 2025
/
Revised: 13 March 2025
/
Accepted: 18 March 2025
/
Published: 22 March 2025
(This article belongs to the Special Issue Biological, Psychosocial and Behavioral Factors Affecting Cognitive Function in Older Adults)
Abstract
Background: Stroke is a primary
cause of adult disability and often causes cognitive impairment.
Rehabilitation interventions aim to enhance patients’ cognitive
abilities, thereby addressing care needs, improving quality of life, and
optimizing performance in compromised functions.
Objective: To
evaluate the impact of incorporating cognitive–behavioral training (CBT)
into a selected exercise program on cortical reorganization and
cognitive recovery in post-stroke patients.
Methods: Thirty
post-stroke patients of both sexes (27 male and 3 female) aged from 40
to 65 years were randomly divided into two groups: the study group (n =
15) received CBT combined with a selected exercise program including
weight-bearing, balance, and aerobic exercises, while the control group
(n = 15) underwent the selected exercise program only. All participants
engaged in an 8-week intervention with three sessions per week. Cortical
reorganization was measured using quantitative electroencephalography
(QEEG) at electrode sites F3, F4, T5, and T6, and cognitive function was
assessed using the Montreal Cognitive Assessment (MoCA) and RehaCom,
focusing on memory, attention, concentration, logical reasoning, and
reaction behavior. Assessments were carried out for all patients before
and after the 8-week treatment program.
Results: Improvements
were assessed through three key measures: QEEG, the MoCA, and RehaCom.
Post-intervention, the study group demonstrated a significantly higher
(alpha + beta)/(delta + theta) ratio at F3, F4, T5, and T6 (p
< 0.01), indicative of enhanced cortical reorganization. MoCA scores
increased by 16.98% in the study group compared to 7.40% in the control
group (p < 0.01). Additionally,
RehaCom assessments revealed marked improvements in memory, attention,
logical reasoning, and reaction behavior in the study group (p < 0.01).
Conclusions:
Integrating cognitive–behavioral training with a selected exercise
program significantly enhances cortical reorganization and cognitive
recovery in post-stroke patients. These findings suggest that adding CBT
to rehabilitation protocols can effectively address deficits in memory
and attention, ultimately improving functional outcomes.
1. Introduction
Because
of the rising incidence and decreased mortality associated with stroke,
post-stroke cognitive impairment (PSCI) is becoming more common in
people after stroke [1].
Cognition encompasses the brain’s core functions for processing,
storing, retrieving, and manipulating the information necessary for
problem-solving. After a stroke, up to 55% of patients experience
deficits in episodic memory, 40% experience executive function
impairment, 23% show deficits in language, and 70% suffer some cognitive
decline, all of which affect their functional abilities, work
performance, and capacity for independent living [2]. PSCI significantly affects independence and the ability to return to work [3].
Memory,
learning, and attention problems can have a substantial impact on a
stroke survivor’s functional independence, and multiple studies have
found that higher levels of cognitive impairment are linked to lower
self-reported quality of life [4].
These associations have prompted significant efforts to identify
effective treatments to improve cognitive function following a stroke [5].
Computerized cognitive training consists of organized exercises on standardized, mentally stimulating tasks [6],
offering several benefits compared to traditional drill-and-practice
approaches. These advantages include engaging visual interfaces,
efficient and scalable delivery, and the ability to continuously adjust
training content and difficulty based on individual performance [7].
The
RehaCom software package offers a comprehensive approach to cognitive
assessment and rehabilitation. This evidence-based tool integrates three
core therapeutic strategies: enhancing patients’ understanding of
cognitive processes, boosting motivational aspects, and developing
compensatory techniques and adaptive skills to manage cognitive deficits
[8].
Neurorehabilitation
aims to directly quantify brain damage healing through the use of
trustworthy, objective, and interpretable measurements of
neuroplasticity or changes in brain function [9].
Because it measures cortical activity and reflects the brain’s
spatiotemporal information, quantitative electroencephalography (QEEG)
is a popular tool for developing assistive rehabilitation devices and
evaluating neurophysiological responses to rehabilitation interventions.
QEEG is also a non-invasive and easy way to record brain activity. QEEG
signals are recorded from four standard frequency bands, alpha (8–12
Hz), beta (12–30 Hz), theta (4–8 Hz), and delta (1–4 Hz) waves,
providing valuable insights into cortical brain activity [10].
It is cheap, easy, and nearly risk-free when compared to other brain
imaging methods. It offers electrophysiological information that is not
available from other imaging modalities or clinical evaluations, and it
has a high temporal resolution. Additionally, without requiring the
patient to cooperate, QEEG allows doctors to objectively measure brain
function and conduct real-time brain evaluations [11].
Several
studies have demonstrated the efficacy of cognitive–behavioral training
(CBT) in improving cognitive functions such as memory, attention, and
executive function in stroke patients. CBT facilitates neuroplasticity
by modulating neural oscillations and strengthening synaptic
connections, thereby enhancing cortical reorganization. Research has
also shown that cognitive training interventions improve functional
brain connectivity and contribute to cognitive recovery in stroke
populations [12,13,14].
Compared to other cognitive rehabilitation approaches, CBT offers a
structured and adaptive method that targets specific cognitive domains
essential for post-stroke recovery [15,16].
Despite
promising outcomes reported in prior studies, the neurophysiological
mechanisms by which cognitive–behavioral training (CBT) enhances
cognitive recovery in post-stroke patients remain underexplored. In
particular, there is limited evidence regarding how CBT influences
cortical reorganization using objective neurophysiological measures.
This study addresses this gap by combining CBT with a selected exercise
to elucidate its impact on neural oscillatory activity and cognitive
function in chronic post-stroke patients. Based on the existing
literature, the aims of the study are to evaluate the additive effect of
CBT when integrated with a selected exercise program in improving
post-stroke cognitive impairment (PSCI) and investigate the neuroplastic
changes associated with these interventions using
electroencephalography (EEG). We hypothesize that adding
cognitive–behavioral training using computerized cognitive training to a
selected exercise program will lead to greater improvements for
post-stroke patients in terms of cortical reorganization, as evidenced
by enhanced QEEG indices, and superior cognitive recovery, as reflected
in increased MoCA and RehaCom scores, compared to the selected physical
therapy program alone.
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