Rehabilitation of Executive Functions: Systematic Review of Technological Stimulation Devices

Abstract

Executive functions are high-level mental abilities that are located in the frontal lobe and allow humans to regulate their behavior. These cognitive skills are initiative, working memory, problem solving ability, inhibition, monitoring, verification, planning, among others. In the processes of stimulation or rehabilitation of executive functions, we work with material based on pencil and paper, therefore, it is essential to generate technological proposals that can help in the processes of rehabilitation of executive functions. In this context, we present a research that conducted a quantitative systematic review of technological devices used for neuropsychological stimulation and rehabilitation of executive functions. The research concludes by analyzing the contribution of having technological resources to rehabilitate executive functions and the need for future research to develop new technological tools in the neuropsychological rehabilitation process.

Appendix 1

Title	Sample	Research countries	Ed. Level	Population type	Technological development	How is it used?	Limitations	Executive functions stimulation	Intervention time
Empowering Executive Functions in 5- and 6-Year-Old Typically Developing Children Through Educational Robotics: An RCT Study	187	Italy	Preschool students	Children between 5 and 6 years of age, who are studying in a school	Bee-Bot robot, bee-shaped device with boards or complementary material	It is used in an ER-lab, where children must complete goals programmed by the BEE-Bot robot. As this robot has buttons to move forward, stop, delete the memory, etc., the children must use these buttons according to the goals to be accomplished	It is important that you are in a school or classroom environment	Mamory of visuospatial work, inhibition, self-control, cognitive flexibility, sustained attention, problem solving	20 training sessions of 60 min each
CortexVR: Immersive analysis and training of cognitive executive functions of soccer players using virtual reality and machine learning	37	Germany	Don’t specify	Men and women from 21 to 35 years old	CortexVR, is an application with different virtual reality games	By means of virtual reality glasses, the CortexVR application is used, which has some game modes (player tracking, counting players, finding the ball), then, while people play, they stimulate some executive functions. Similarly, it should be complemented with the CachApp for training and analysis	The full benefits of this adaptation are not yet fully known	Inhibition, working memory, cognitive flexibility, reasoning and problem solving	It does not show an exact time, but you must play the 3 game modes in a specific order and repeat it 4 times
Smartwatch Executive Function Supports for Students With ID and ASD	3	United States	University	Patients with a diagnosis of intellectual disability and autism spectrum disorder	A smartwatch app to help support executive functions	It is an application that requires students to be digitally literate, so that they can enter the alarms of their appointments through an appointment formula and through the Smartwatch access the information. With the purpose of helping the student to have more independence	The application does not allow selecting the date of the appointment, only the day of the week. In addition, as the study sample was very limited, it is not possible to ensure that it works for other age groups	Planning, organization and independence	3 sessions per week of 50 min. Each one
Educational robotics to develop executive functions visual spatial abilities, planning and problem solving	30	Italy	5th grade of primary education	Healthy children attending school	LEGO Mindstorms EV3. It is a programmable robotic kit, created by Lego	The children have to assemble the robot, then they are given programs, which they have to program and they increase in difficulty. In addition, the children can observe the movements of the toy and what it does according to the environment in which it is	Don’t specify	Visuospatial attention, planning, problem solving, working memory, control of complex tasks	10 meetings, 2 h each and one meeting per week
Computer-based training in math and working memory improves cognitive skills and academic achievement in primary school children: Behavioral results	104	Spain	Primary Education	Children from 7 to 12 years old in rural schools in Murcia (Spain)	Computer-based training, consisting of: working memory and mathematical tasks	This training consists of 3 phases: pre-training, training and post-training. Through tasks of mathematical ability, reading, and verbal skills. In order to measure the stimulation, a test is performed before and after the training	Therefore, it is not possible to measure long-term effects because the post-training measurement is a short-term measurement	Working memory, adaptability, inhibition	17 weeks
Computer aided technology-based cognitive rehabilitation efficacy against patients’ cerebral stroke	128	China	10 a 11 years of basic education	Cardiovascular accident patients, 18 to 80 years old	Computer Aided Technology (CAT)	Doctors specialized in rehabilitation have designed a specialized training program for each patient, so in addition to the one-on-one training with the patient, CAT is applied and the respective medication for each patient	Because MOCA is used for rehabilitation assessment, there may be certain limitations and misdiagnoses	Memory, visual and spatial executive function, abstract ability, orientation and language	4 weeks, 30 min per day, 6 days per week
Use of a Brain–Computer Interface + Exoskeleton Technology in Complex Multimodal Stimulation in the Rehabilitation of Stroke Patients	44	Russia	Don’t specify	Patients with cardiovascular stroke, 61 years of age	Brain–Computer Interface + Exoskeleton Technology in Complex Multimodal Stimulation (BCNI)	The patient is seated in a chair in front of a computer with both wrists attached to an exoskeleton. Then on the screen comes out 3 mental commands: relax, imagine the state of the muscles when opening the right or left hand. The hand opens after the system recognized the correct classification of execution	Patients only have an average capacity and tolerance of 20 to 30 min	Problem solving, visuospatial thinking, attention, working memory (practice)	8 to 10 procedures, 10 min per session, with a 3 to 5 min break
Enhancing the potential of creative thinking in children with educational robots	171	Italy	4th and 5th year elementary school students	Children	Ozobot, a small educational robot	It is a robot that is coded to follow colors on a linear surface, so the children use the colors to determine the robot’s movements according to the instructions they receive	Don’t specify	Problem-solving, visuospatial thinking, attention, working memory	There is no time limit, it depends on how long the children take
“CityQuest,” A Custom-Designed Serious Game, Enhances Spatial Memory Performance in Older Adults	56	Ireland	Don’t specify	Healthy older adults 65 years of age and older	CityQuest, a virtual city game	A virtual game that through navigation of unfamiliar and crowded locations that require participants to control navigation through city spaces and avoid obstacles	Don’t specify	Spatial memory, working memory, problem-solving, sustained attention, cognitive flexibility	2 sessions per week of 60 min, for 5 weeks
Using a wearable camera to support everyday memory following brain injury: A single-case study	1	United Kingdom	Don’t specify	A 48-year-old man with Alzheimer’s disease	Handheld Camera	The use of a wearable camera to record significant events over a 6-week period to aid memory recall	It was only a case study, so we need to deepen the effectiveness with a larger sample	Working memory	6 weeks
Reading Goals and Executive Function in Autism: An Eye-Tracking Study	22	Spain	School and high school	Middle-class children and adolescents with a diagnosis of autism	Eye-tracking technology	Using a computerized and modified version of The Tower of Hanoi, they must read the instructions on the screen and solve the problem with a maximum of 15 moves per problem, moving the computer mouse to do so. While the eye tracker evaluates it	Its application cannot be generalized to the entire population with autism	Problem solving, inhibition, planning	40 min
Robotic Rehabilitation: An Opportunity to Improve Cognitive Functions in Subjects With Stroke. An Explorative Study	51	Italy	Less than 26 years of education	Persons between 35 and 85 years of age, who have had a cardiovascular accident in the last 6 months	A set of three robots and a sensor-based device for upper limb rehabilitation	The rehabilitation program focused on interactive games, carried out with the support of the assistance forces provided by the 3 robots (Amadeo, Pablo and Diego)	Lack of a control group in the application of robots	Planning, problem-solving, selective attention, cognitive flexibility	30 rehabilitation sessions, 45 min each, 5 days a week
Application of virtual environments in a multi-disciplinary day neurorehabilitation program to improve executive functioning using the Stroop task	21	United States	Don’t specify	Brain-injured patients with executive dysfunction	Bimodal VR-Stroop	It consists of two scenarios (a classroom and an apartment), then in both there are visual and auditory distractions that appear for 5 s, in intervals of 10, 15 and 25 s. The task is to say the color that comes up, not the color it is written in	Excludes patients who lack the cognitive sufficiency to participate in tasks	Sustained attention, attention to visual details, cognitive flexibility	Sessions 1 and 8 of 60 min; Sessions 2 to 7 of 30 min