Rehabilitation programs for people with post-stroke cognitive impairment: integrative literature  review

Sandra Antunes; Célia Campos; Marta Barreto; Patrícia Araújo; Tânia Rodrigues

doi:10.33194/rper.2025.37668

Autores/as

Sandra Antunes Unidade Local de Saúde de São João, Porto, Portugal https://orcid.org/0000-0002-2814-583X
Célia Campos Unidade Local de Saúde de Santo António, E.P.E.
Marta Barreto Unidade Local de Saúde de Santo António, E.P.E.
Patrícia Araújo Unidade Local de Saúde de São João, E.P.E.
Tânia Rodrigues Escola Superior de Saúde Santa Maria; CINTESIS, Centro de Investigação em Tecnologias e Serviços de Saúde https://orcid.org/0000-0003-4785-3783

DOI:

https://doi.org/10.33194/rper.2025.37668

Palabras clave:

Rehabilitación Cognitiva, Deterioro Cognitivo, Accidente Cerebrovascular, Enfermería de Rehabilitación, Revisión Integrativa

Resumen

Introducción: Debido al elevado número de personas con deterioro cognitivo post-accidente cerebrovascular, cada vez es más necesario aplicar programas de rehabilitación cognitiva para que puedan recuperar la funcionalidad.

Objetivo: Identificar la evidencia disponible sobre programas de rehabilitación cognitiva para personas con accidente cerebrovascular.

Metodología: Revisión integrativa de la literatura, realizada sobre el agregador EBSCOhost, con criterios de inclusión/exclusión predefinidos.

Resultados: Se incluyeron seis estudios de un total de 2327 identificados. Los programas de rehabilitación cognitiva se categorizaron en programas de rehabilitación en fase aguda (hospitalizados, en sesiones individuales); en la fase subaguda (en régimen grupal y ambulatorio, añadiendo Terapia de Reminiscencia); y en la fase crónica (grupal y ambulatoria), únicamente dirigida a la rehabilitación de la atención (visual y auditiva).

Conclusión: No existe consenso respecto al inicio, frecuencia, duración, evaluación y tipo de intervenciones aplicadas en los programas de rehabilitación encontrados. Sin embargo, es importante examinar a la persona para detectar déficits cognitivos después de un derrame cerebral, incluso si aparentemente no existen. La mejora en la cognición es más evidente cuando la rehabilitación cognitiva se realiza en las fases aguda y subaguda mediante plasticidad neuronal, pero también en la fase crónica, por lo que debe continuar meses o años después de la lesión. El enfermero especialista en enfermería de rehabilitación dispone de habilidades que le permiten evaluar la función cognitiva y, en función de los déficits identificados, desarrollar un programa personalizado de rehabilitación cognitiva de cara a la recuperación de la persona que ha sufrido un accidente cerebrovascular.

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Citas

Sociedade Portuguesa do Acidente Vascular Cerebral [SPAVC] [Internet]. Tudo o que precisa saber sobre Acidente Vascular Cerebral. Manuel digital para jornalistas. 2016. Available from: https://static.lvengine.net/spavc2013/Imgs/pages/PUBLICACOES/manual%20digital%20jornalistas_url.pdf.

World Health Organization. Global health estimates: Leading causes of death [Internet]. World Health Organization. World Health Organization; 2020. Available from: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death.

Instituto Nacional de Estatística. Anuário Estatístico de Portugal - 2021. Instituto Nacional de Estatística. 2022.

Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, et al. Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce. International Journal of Stroke. 2017; 5:444–50. doi:10.1177/1747493017711816.

Gatens C, Musto M. Cognição e comportamento. In: Hoeman S, editor. Enfermagem de reabilitação: prevenção, intervenção e resultados esperados. Loures: Lusodidacta; 2011. p. 551-578.

Norrving B, Barrick J, Davalos A, Dichgans M, Cordonnier C, Guekht A, et al. Action Plan for Stroke in Europe 2018–2030. European Stroke Journal. 2018 Oct 29;3(4):309–36.

van Heugten CM, Wilson BA. Cognition, Emotion and Fatigue Post-stroke. In: Platz T, editor. Clinical Pathways in Stroke Rehabilitation. Springer. 2021;p. 219-242. https://doi.org/10.1007/978-3-030-58505-1_12.

O’ Donoghue M, Boland P, Leahy S, Galvin R, McManus J, Lisiecka D et al. Exploring the perspectives of key stakeholders on the design and delivery of a cognitive rehabilitation intervention for people post-stroke. Mordaunt DA, editor. PLOS ONE. 2022 Jun 16;17(6):e0269961. doi:10.1371/journal.pone.0269961.

Teasell R, Hussein N, Saikaley Bsc M, Iruthayarajah J, Longval Bsc M. Rehabilitation of Cognitive Impairment Post Stroke. In: Teasell R., Hussein N., Iruthayarajah J., Saikaley M., Longval M. & Viana R., editor. Stroke Rehabilitation clinician handbook. The Heart and Stroke Foundation Canadian Partnership for Stroke Recovery. http://www.ebrsr.com/sites/default/files/EBRSR%20Handbook%20Chapter%205_Rehab%20of%20Cognitive%20Impairment.pdf.

Abzhandadze T, Rafsten L, Lundgren-Nilsson Å, Sunnerhagen KS. Feasibility of Cognitive Functions Screened With the Montreal Cognitive Assessment in Determining ADL Dependence Early After Stroke. Frontiers in Neurology. 2018 Aug 27;9. doi:10.3389/fneur.2018.00705.

Jiang H, Li H, Wang Z, Xia X, Su Q, Ma J. Effect of Early Cognitive Training Combined with Aerobic Exercise on Quality of Life and Cognitive Function Recovery of Patients with Poststroke Cognitive Impairment. Rajakani K, editor. Journal of Healthcare Engineering. 2022 Apr 12;2022:1–7. doi:10.1155/2022/9891192.

Cheng C, Fan W, Liu C, Liu Y, Liu X. Reminiscence therapy-based care program relieves post-stroke cognitive impairment, anxiety, and depression in acute ischemic stroke patients: a randomized, controlled study. Irish journal of medical science. 2021;190(1):345-355. doi:10.1007/s11845-020-02273-9.

Quinn TJ, Richard E, Teuschl Y, et al. European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment. European journal of neurology. 2021;28(12):3883-3920. doi:10.1111/ene.15068.

Ordem dos Enfermeiros. Regulamento n.º 392/2019. Regulamento das competências específicas do enfermeiro especialista em enfermagem de reabilitação. Diário da República, 2ª série - n.º 85 - 3 maio 2019. Available from: https://files.dre.pt/2s/2019/05/085000000/1356513568.pdf.

Varanda E, Rodrigues C. Reeducação Cognitiva em Enfermagem de Reabilitação: Recuperar o Bailado da Mente. In: MarquesVieira C, Sousa L, editors. Cuidados de Enfermagem de Reabilitação à Pessoa ao Longo da Vida. 2017. Loures: Lusodidacta; 2017. p. 215-226.

Xuefang L, Guihua W, Fengru M. The effect of early cognitive training and rehabilitation for patients with cognitive dysfunction in stroke [published correction appears in Int J Methods Psychiatr Res. 2022 Dec;31(4):e1921]. Int J Methods Psychiatr Res. 2021;30(3):e1882. doi:10.1002/mpr.1882.

Winstein CJ, Stein J, Arena R, et al. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association [published correction appears in Stroke. 2017 Feb;48(2):e78] [published correction appears in Stroke. 2017 Dec;48(12 ):e369]. Stroke. 2016;47(6):e98-e169. doi:10.1161/STR.0000000000000098.

Leonardi M, Fheodoroff K. Goal setting with ICF (International Classification of Functioning, Disability and Health) and multidisciplinary team approach in stroke rehabilitation. Clinical Pathways in Stroke Rehabilitation: Evidence-based Clinical Practice Recommendations. Springer; 2021:35-56. doi: 10.1007/978-3-030-58505-1_10.

Varanda E, Rodrigues C. Avaliação da pessoa com alterações da função cognitiva: avaliar para reeducar e readaptar. Cuidados de enfermagem de reabilitação à pessoa ao longo da vida. Loures: Lusodidacta. 2016:145-57.

Platz T, Owolabi M. Clinical pathways in stroke rehabilitation: background, scope, and methods. Clinical Pathways in Stroke Rehabilitation: Evidence-based Clinical Practice Recommendations. Springer; 2021:15-34. Available from: https://link.springer.com/chapter/10.1007/978-3-030-58505-1_2.

Toronto CE. Overview of the integrative review. In: Toronto C, Remington R, editors. A step-by-step guide to conducting an integrative review. Springer; 2020:1-9. doi: 10.1007/978-3-030-37504-1.

De Sousa LM, Marques-Vieira CM, Severino SS, Antunes AV. A metodologia de revisão integrativa da literatura em enfermagem. Revista investigação em enfermagem. 2017 Nov 2;21(2):17-26.

Health Sciences Descriptors: DeCS [Internet]. 2023 ed. São Paulo (SP): BIREME / PAHO / WHO. 2022 [cited 2021, november,12]. Available from: http://decs.bvsalud.org.

Remington R. Quality appraisal. In: Toronto C, Remington R, editors. A step-by-step guide to conducting an integrative review. Springer; 2020:45-55. doi:10.1007/978-3-030-37504-1.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Moher D. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. Journal of clinical epidemiology. 2021 Jun 1;134:103-12. doi: 10.1136/bmj.n71.

Menoita EC, Sousa LM, Pão-Alvo I, Marques-Vieira C. Reabilitar a pessoa idosa com AVC: Contributos para um envelhecer resiliente. Lusociência; 2012 Jan 1.

Sousa-Uva M, Dias CM. Prevalência de Acidente Vascular Cerebral na população portuguesa: dados da amostra ECOS 2013. Boletim Epidemiológico Observações, 2014; 2ª série(9): 12-14. Available from: https://research.unl.pt/ws/portalfiles/portal/3664501/Uva_Bol_Epi_Obs_2014_9_12.pdf.

Hasanzadeh Pashang S, Zare H, Alipour A, Sharif-Alhoseini M. The effectiveness of cognitive rehabilitation in improving visual and auditory attention in ischemic stroke patients. Acta Neurologica Belgica. 2021 Aug;121:915-20. doi: 10.1007/s13760-020-01288-4.

Wang HY, Zhu CH, Liu DS, Wang Y, Zhang JB, Wang SP, Song YN. Rehabilitation training improves cognitive disorder after cerebrovascular accident by improving BDNF Bcl-2 and Bax expressions in regulating the JMK pathway. European Review for Medical & Pharmacological Sciences. 2021 May 15;25(10). doi: 10.26355/eurrev_202105_25949.

Li, Aoyang, and Yang Liu. “Reminiscence therapy serves as an optional nursing care strategy in attenuating cognitive impairment, anxiety, and depression in acute ischemic stroke patients.” Irish journal of medical science. 2022 vol. 191,2: 877-884. doi:10.1007/s11845-021-02600-8.

Nunes L. Aspetos éticos na investigação em enfermagem [Internet]. Available from: http://hdl.handle.net/10400.26/32782.

Cicerone KD, Goldin Y, Ganci K, Rosenbaum A, Wethe JV, Langenbahn DM, et al. Systematic Review of the Literature From 2009 Through 2014. Archives of Physical Medicine and Rehabilitation. 2019 Aug 100(8):1515–33. doi:10.1016/j.apmr.2019.02.011.