Cognitive Reserve as a useful variable to address robotic or conventional upper limb rehabilitation treatment after stroke. A multicenter study of the Fondazione Don Carlo Gnocchi.

INTRODUCTION:Rehabilitation plays a central role in stroke recovery. Besides conventional therapy, technological treatments have become available. About technological rehabilitation, its effectiveness and appropriateness are not yet well defined, hence researches focused on different variables impacting the recovery are needed. Results from literature identified the Cognitive Reserve (CR) as a variable impacting on the cognitive outcome. In this paper we aim to evaluate whether the CR influences the motor outcome in patients after stroke treated with conventional or robotic therapy and if it may address towards one treatment rather than another.METHODS/PATIENTS:Seventy-five stroke patients were enrolled in five Italian neurological rehabilitation centres. Patients were assigned either to a Robotic Group, rehabilitation by means of robotic devices, or to a Conventional Group, where a traditional approach was used. Patients were evaluated at baseline and after rehabilitation treatment of 6 weeks through Action Research Arm Test (ARAT), Motricity Index (MI) and Barthel Index (BI). CR was assessed at baseline using the Cognitive Reserve Index (CRI) questionnaire.RESULTS:Considering all patients, a weak correlation was found between the CRI related to leisure time and MI evolution (r:0.276; p=0.02). Among the patients who performed a robotic rehabilitation a moderate correlation emerged between the CRI related to working activities and the MI evolution (r:0.422; p=0.02).CONCLUSIONS:Our results suggest that CR may influence the motor outcome. For each patient, the CR and its subcategories should be considered in the choice between conventional and robotic treatment.