Effect Of Cognitive Therapy Program To Improve Cognition In Post COVID-19 Stroke Patients

(Department Of Physiotherapy,Career Institute Of Medical Sciences Bhopal M.p

Submitted By- Stella Akansha Tambe

guide- Dr.Swadeep Shukla MPT2nd Year ,neuro

• Introduction: Strokes are defined by the World Health Organization (WHO) as an acute, focal or diffuse, dysfunction of the brain, originating from
vessels and lasting for a period longer than a day. is a neurological disorder characterized by blockage of blood vessels. Rupture of the arteries leading to the brain
during stroke results in the sudden death of brain cells owing to a lack of oxygen. Stroke can also lead to depression and dementia. One of the leading causes of morbidity
and mortality .

• Cognition According to the American Psychological Association (APA), cognition can be defined as the processes of knowing, including attending, remembering
and reasoning. It can also be defined as the content of these processes, such as concepts and memories.
• Covid-19- There is a new public health crises threatening the world with the emergence and spread of 2019
novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The
virus originated in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan,
Hubei province, China in December 2019. There have been around 96,000 reported cases of coronavirus
disease 2019 (COVID-2019.
• The incubation period varies from 2 to 14 d [median 5 d]. Studies have identified angiotensin receptor 2
(ACE2) as the receptor through which the virus enters the respiratory mucosa The COVID-19 is a single-
stranded positively sensed RNA virus, consisting of 26–32 kb-sized genome. The average diameter is 100
nm, spherical, or oval-shaped. The rate of recombination is up to 25% and is externally covered by a crown
shaped like spike (S) proteins, which also can mutate frequentle The spike proteins of the COVID-19 bind to
ACE2 receptors to invade the cell and develop the infection
• Need of the study- COVID 19became a pandamic disease and patients recovered from COVID get affected from stroke as so many studies shows and in
hamorragic stroke Cognitive impairment occure so many studies also prove this.So I use Cognitive therapy to treat such kind of patients and I compare cognitive
therapy with balancing exercise to motor relearning technique to improve ADL activities .

• Aim of the study -to improve the cognition and rememorize the memory by giving cognition behaviour therapy as well as improve motor relearning on uper
and lower extrimity In post covid stroke patient .

• Objective-
1-To determine the effectiveness of motor relearning program along with balancing exercise to improving the daily living activity
2-To compare the effectiveness of cognitive therapy program and motor relearning program when given together with balancing exercise
3-For improvement of cognitive impairment in post COVID stroke patients

Hypothesis
• Null hypothesis- There is no significant effect in cognitive therapy to improve cognition impairment and motor relearning program in post COVID stroke
patients

• Alternate hypothesis
• There is a significant effect in cognitive therapy program and motor relearning programe to improve cognition impairment in post COVID stroke patients
• 2 Review of literature
• 1-Jong Skim MAY2020 -Titled by coronavirus disease 2019 and stroke
• Concluded studies said that stroke is attributed to covid 19 .He explained pathogenesis and mechanism through renin angiotensis system.Sars-covid-2virsus deplete ACE2
through brain receptor leading to stroke.

• 2-Tissa Wijeratne et.all June2021 -Titled By Post Covid19 Neurological Syndrome

• Concluded studies explain patho biology of COVID-19 and brain involvement leading to stroke An immediate immunological cascade of cytokinin response on individual
cell and vascular system leading brian Fog, ischemic stroke.

• 3-Matthew w MC donald et.all Sep12 -2019 Titled by Cognition In Stroke Rehabilitation And Recovery research
They reveal cognitive impairment is an important target for rehabilitation as it is common following stroke especially in first 3 months after stroke they included
perceptual motor function motor coordination etc

• 4 Guohua Zheng et .al August 20,2016 volume 25Titled By -Aerobic Exercises for Cognition Rehabilitation following stroke
Studies reported that the effect of aerobic exercises on cognition performance in patients suffering from a stroke

5-SoHyun Kim March 30, 2022Titled by The Effect of Cognitive Rehabilitation Program Combined with Physical Exercise on
Cognitive Function, Depression, and Sleep in Chronic Stroke Patients- The measurement tools used in this study were further analyzed for reliability. The
reliability of each item in the normal cognitive stroke group was 0.642 in the temporal and spatial, 0.671 in the vocabulary, 0.640 in the attention, 0.679 in the sentence,
0.671 in the abstraction, 0.679 in the recall, and 0.659 in the orientation .All items realibilty was high for Cognitive Rehabilitation.

6-Olugbemi Olukolade 27 Jun 2017 Efficacy of Cognitive Rehabilitation Therapy on Poststroke patient. He choose 3, groups one is cognitive
Rehabilitation Therapy , psychoeducation (PE) control group . Result concluded the Effect of Cognitive Rehabilitation Therapy (CRT) on poststroke depression in the
study was from a score of 16 to 4.9 Others are less .
• study design and methodology
• Approach used was convenient sampling
• Study design- experimental study design With 2group A and B
• Study setting- career institute of medical sciences
• Duration -For a period of 6months

• Protocol duration -1hour 30 mint duration once in a day and 6 days included 45 mints for cognitive exercises and remaining is for balancing
exercises ..
• Sample size- 40 patients male female both suffering from post COVID hamorrahgic stroke following the inclusion and exclusion criteria
• Variables of study
• Independent variables
• Cognitive therapy program
• Motor relearning technique

• Dependent variable
• Fugal meyar scale
• Montreal cognitive assessment scale
• Inclusion criteria- age 40 to 70 years old
• Sex both male and female
• Post covid stroke period
• develop Synergy pattern in both upper and lower extremity
• decrease range of motion coordination and decrease speed
• evaluating short term and long term memory by scale and treating the problem

• Exclusion criteria covid patient

• medical unstable patient
• conscious level scale zero
• City scan demonstrating intracranial hemorrhage antihypertensive treatment
• any serious surgery
• myocardial infarction
 PROCEDURE

GROUP A for cognitive therapy program GROUP B for motor relearning technique with balancing
with balancing exercise exercise
Conventional exercise –all
the exercises were done
for 10 repetition 2set with
Conventional 5- spot the difference
6-graded task 10s hold once a day
cognitive exercise assignment

Prolonged and gradually

progressive streching of
7-balancing exercise hamstring, calf ,wrist
and coordinatiom like
1-card matching 4-alphabetise
finger to nose ,8
activities sentences
figure pattern
exercises
Bridging exercises

3-visual /spatial 9-family and social

2-aerobics exercise
processing game support activities
Balance and coordination
exercises