Ecologically Valid Tablet-based Cognitive Training: A Case Report of a Bilateral Thalamic Stroke Patient

Bilateral thalamic infarcts are associated with severe and long-term impairments, leading to a poor functional prognosis. As a result, patients can exhibit a wide range of cognitive and behavioral deficits, including difficulties with attention, learning and memory, language, emotional processing, time perception, and loss of self-activation, manifested through apathy and indifference. Information and Communication Technology-based Cognitive Training (ICT-based CT) with more ecologically valid content may be valuable in intervening with these patients. Beyond enhancing motivation and engagement, such technologies can be equipped with several features, such as cue systems and errorless learning techniques, that assist patients with severe declarative memory deficits by minimizing errors and engaging alternative non-declarative memory routes to facilitate encoding and retrieval of new information. Herein, we present a case report of LT, a 41-yearold female patient, with 10 years of formal education, diagnosed with bilateral thalamic stroke who enrolled in a one-month tablet-based CT intervention with the prototype version of the NeuroAIreh@b platform. Prior to the intervention, LT was submitted to a neuropsychological assessment to characterize her cognitive abilities, emotional state (i.e., presence and severity of depressive symptomatology), quality of life, and functional abilities. The tablet-based CT intervention encompassed eight 45-minute sessions and involved performing four types of Reh@Apps incorporating CT tasks (i.e., cancelation, categorization, action sequencing and calculation) within daily life scenarios (i.e., the kitchen and the supermarket). After the CT intervention, LT was reassessed and demonstrated reliable increases in the Montreal Cognitive Assessment, Digit Symbol-Coding, and the Phonemic Verbal Fluency test, suggesting improvements in global cognitive functioning, processing speed and phonemic verbal fluency, respectively. Moreover, quantitative improvements in both immediate and delayed recall trials of the Free and Cued Selective Reminding Test indicated a slight improvement in verbal episodic memory. Concerning the emotional status domain, LT also reported less depressive symptomatology. Throughout the rehabilitation program, LT became progressively more autonomous when performing tasks, requiring fewer cues and verbal instructions from the therapist, which enhanced her engagement, emotional stability, and selfefficacy. A three-month follow-up reassessment revealed that her cognitive and emotional status reverted to baseline values. This case report highlights the potential of a personalized tabletbased CT, not only to improve learning and compensate for memory deficits but also to foster self-efficacy and well-being in patients with severe acquired brain injuries and poor functional prognosis. Future studies should focus on optimizing patient outcomes by exploring extended ICT-based CT within a comprehensive and multicomponent rehabilitation program delivered in community settings. These programs can be implemented life-long and can incorporate both compensatory strategies training that capitalizes on implicit learning and memory, and psychosocial interventions for caregivers (e.g., emotional support, psychoeducation) to further increase the patient's adherence and generalization of gains to everyday life.