Stroke is a debilitating neurological condition leading to devastating motor, cognitive and functional changes, often affecting the quality of life of the patients severely. During covid-19 pandemic Cognitive retraining (CR) with patients became a major challenge. This brought a paradigm shift in healthcare, particularly in health delivery services, and necessitated the use of virtual and remote platforms to conduct cognitive assessments and rehabilitation. Previous studies on Tele Neuropsychological assessment in a remote setting has shown that findings are comparable to that of face-to-face neuropsychological evaluation (Cullum et al, 2014; Rizzi et al 2022: Marra DE et al, 2020; Sharma et al, 2022). In the current paper, we present preliminary findings from a pilot study of cognitive retraining program for patients with Post Stroke Cognitive Impairment (PSCI) delivered remotely via a video-conferencing platform (Zoom), guided by the researcher.

Fourteen patients diagnosed with Ischemic stroke recruited from the out-patient services of a tertiary care hospital in southern India were randomized to an intervention group receiving virtual cognitive retraining, along with Treatment as usual (TAU), and a control group receiving only TAU. Data of 7 completers (intervention= 4; control=3) are presented here. The intervention comprised of an established comprehensive, multidomain, multi-level, culturally appropriate cognitive training program, with modifications for stroke population and remote delivery (Kumar et al, 2020; Banerjee et al, 2020). The intervention targets the cognitive domains of attention, executive functions, and memory. Two novel tasks were developed and added to the existing package to train visuo-spatial functions. The duration of the training comprised of 18 sessions with 4-5 sessions per week. Neuropsychological assessments done using Digit Span and Spatial Span tests, Controlled Oral Word Association Test (COWAT) and Animal names test, Auditory Verbal Learning test (AVLT), and Design construction test, were administered at baseline, and second time-point asessment (post intervention for intervention group). Secondary outcome measures on quality of life, psychological symptoms, and subjective cognitive complaints were administered at baseline, second timepoint assessment and at 3-month follow-up.

Patients in the intervention group showed improvements in attention, fluency, verbal working memory, verbal learning and memory, visual memory and visuo-spatial functions on post-assessment. Subsequent improvements were also reported in quality of life, psychological symptoms, perceived cognitive deficits and subjective distress. Virtual cognitive retraining was found to be useful for bridging the gap of geographical barriers, caregiver availability, time constraints, and accessibility of treatment. However, technological usability and administration of visuo-spatial tasks were some of the barriers faced in the smooth delivery of the rehabilitation. Other challenges included access to devices, setting boundaries and supervision of tasks.

The use of information and communications technology in the delivery of interventions for cognitive impairment is a promising trend. This is one of the first attempts on remote cognitive retraining in India and is a part of an ongoing study on the same. The challenges of TeleCognitive Training in low to middle income countries are discussed.