Table 1.

Characteristics of included studies

Burton & O'Connell [5]
Methods	RCT
Participants	6 participants with subjective cognitive impairment (n = 4), MCI (n = 1), or dementia due to Alzheimer disease (n = 1) randomly allocated to telehealth videoconferencing (n = 3) or in-person cognitive rehabilitation (n = 3)
Intervention	1. Telehealth videoconferencing Intervention: Individually tailored cognitive rehabilitation via videoconference. Materials and procedures: all participants participated in an in-person assessment. Following the assessment, goals for cognitive rehabilitation were set collaboratively, and baseline performance and satisfaction were measured. Measurement occurred through telehealth. Following 3 weeks of baseline measurement, each participant’s first goal was addressed in the subsequent cognitive rehabilitation sessions. A new goal, or set of goals, was introduced every 3 weeks. Provided by: a senior doctoral student in clinical psychology and supervised by a neuropsychologist Delivery: via videoconference Regimen: 1-h session, once a week, for 8 weeks 2. In-person treatment Intervention: Individually tailored in-person cognitive rehabilitation. Materials and procedures: all participants participated in an in-person assessment. Following the assessment, goals for cognitive rehabilitation were set collaboratively, and baseline performance and satisfaction were measured. Measurement occurred in-person. Following 3 weeks of baseline measurement, each participant’s first goal was addressed in the subsequent cognitive rehabilitation sessions. A new goal, or set of goals, was introduced every 3 weeks. Provided by: a senior doctoral student in clinical psychology and supervised by a neuropsychologist Delivery: via videoconference Regimen: 1-h session, once a week, for 8 weeks
Outcome measures	Two sets of measures were used in this study: pre-post measures and weekly measures. Three baseline measures (B1, B2, B3) and 8 weeks of cognitive rehabilitation (CR1-CR8). Battery: Rivermead Behavioral Memory Test III (RBMT-III), Delis Kaplan Executive Function System (D-KEFS), Verbal Fluency Subtest, Test of Everyday Attention (TEA), Quality of Life in Alzheimer Disease (QoL-AD), World Health Organization Quality of Life Assessment, Short Version (WHOQOL-BREF), Zarit Burden Inventory (ZBI)
Notes
Charvet et al. [7]
Methods	RCT
Participants	135 participants with multiple sclerosis divided into two groups: ACR (n = 74) vs. active control (n = 61)
Intervention	1. Adaptive Cognitive Remediation (ACR) Intervention: ACR is an online adaptive cognitive training program with a set of 15 exercises targeting speed, attention, working memory, and executive function through the visual and auditory domains. Each exercise employed multiple stimulus sets designed to span relevant dimensions of real-world stimuli. The goal of the training exercises is to improve the speed and accuracy of brain information processing while engaging neuromodulatory systems, and allow the generalization of training to improvement cognitive performance in real-world situations. Materials and procedures: Participants were instructed to train in their assigned condition. All participants used a study-provided laptop computer, peripheral equipment including headphones, and a user guide with directions for the use of their assigned program. They had ongoing access to technical support as well as a scheduled weekly check-in phone call. Provided by: a study technician conducted the weekly check-in phone calls Delivery: computer-based Regimen: 1 h per day, 5 days per week, over 12 weeks (targeting 60 h of total program use). 2. Active control condition Intervention: The active control condition was a software gaming suite. These games served as an active placebo control, designed to account for nonspecific treatment effects including interactions with research personnel, and computer-based game-playing. Materials and procedures: Participants were provided a set gaming schedule and were instructed to play games in an arrangement that mirrored to the active condition. The games were selected for “face validity” as having cognitive benefit (e.g., word puzzles) but did not include the active condition's program design features to drive learning or maintain user challenge. All participants used a study-provided laptop computer, peripheral equipment including headphones, and a user guide with directions for the use of their assigned program. They had ongoing access to technical support as well as a scheduled weekly check-in phone call. Provided by: a study technician conducted the weekly check-in phone calls Delivery: computer-based Regimen: 1 h per day, 5 days per week, over 12 weeks (targeting 60 h of total program use).
Outcome measures	A battery of neuropsychological tests was administered at baseline and study end visits. Paced Auditory Serial Addition Test (PASAT), WAIS-IV Letter Number Sequence, WAIS-IV Digit Span Backwards, Selective Reminding Test, Brief Visuospatial Memory Test-Revised (BVMT-R), Delis-Kaplan Executive Function System Trails
Notes
Man et al. (2) [14]
Methods	RCT
Participants	109 patients with acquired brain injury, randomly assigned to one of four groups: computer-assisted training (CCRG) (n =30), therapist-administered training (TCRG) (n = 30), online interactive computer-assisted training (OCRG) (n = 29), and control group (CG) (n = 20)
Interventions	1. Computer-assisted training (CCRG) Intervention: computer-assisted, skill-training programme in solving problems using analogies. The self-paced computer-assisted training strategy was complemented with face-to-face support from a therapist if needed. For example, the trainees could clarify queries and request performance feedback from the therapist while in need. The subjects were required to perform regular problem-solving exercises in order to become habitualized in daily problem-solving skills. Materials and procedures: This programme was equipped with interactive multimedia presentations on the knowledge and concepts required for persons with ABI to function independently in daily life. Knowledge or lessons were presented in a linear format (one idea after another), supplemented by video and graphical presentations. Lessons were graded by the level of difficulty above the baseline presentation, allowed the trainees to have more control over the presentation and provided role-playing, positive feedback, and errorless learning strategies. Provided by: Therapists Delivery: computer-based, face-to-face Regimen: 20-session training (each lasted for 45 minutes) in 2 months 2. Online interactive computer-assisted training (OCRG) Intervention: The online programme mirrored the structure and content of the computer-assisted version. Materials and procedures: The treatment programme was developed by using the sharing features of Microsoft’s Net-Meeting software, which reflected the visual layout of the computer screen on the therapist’s side to a remote computer on the patient’s side. The therapist was in full command of the programme, exchanging images and audio through the broadband network to the computer on the subject’s side. High-end video-conference units were employed to achieve appealing visual and audio effects. Similar to the therapist-administered programme, the remote therapist could also demonstrate the analogical problem-solving strategy and using positive feedback and errorless learning strategies in the training. Provided by: Therapists Delivery: via videoconference Regimen: 20-session training (each lasted for 45 minutes) in 2 months 3. Therapist-administered training (TCRG) Intervention: conventional face-to-face, activity-based, cognitive rehabilitation programs, the contents of which were identical to those of the OCRG and CCRG groups. The subjects were required to perform regular problem-solving exercises in order to become habitualized in daily problem-solving skills. Materials and procedures: The TCRG provided the most intensive “human touch” in the training through adopting a similar analogical problem-solving strategy demonstration, positive feedback, and errorless learning strategies as the OCRG and CCRG. According to the respective hierarchy of the problem solving (e.g., basic to function), they were given 10 analogous sources (with solutions and strategies) and target (the trainees provide solutions according to their understanding of the respective source question) problems. The TCRG performed and submitted their homework in a pencil-and-paper answer sheet format. The trainers gave the subject’s feedback on their performance as a consolidation of their problem-solving skills learning as well. Provided by: Therapists Delivery: face-to-face Regimen: 20-session training (each lasted for 45 minutes) in 2 months 4. Control group (CG) Wait-listed group. Participants in CG did not receive any intervention in problem-solving skills during the 2-month study period.
Outcomes	Problem-solving skills and self-efficacy were assessed.
Poon et al. [18]
Methods	RCT
Participants	22 community-dwelling older subjects with mild dementia or mild cognitive impairments randomized either in a videoconference group (n = 11) and a face-to-face (FTF) group (n = 11)
Interventions	1. Videoconference Intervention: A total of 12 sessions of assessment and cognitive intervention (CI) were conducted via videoconferencing Materials and procedures: VC units were installed at a social center and Shatin Hospital where the research team was based. The VC systems was linked via broadband (1.5 Megabytes per second bandwidth). A high-resolution document camera was used to project images during assessment and intervention. Provided by: A social worker at the social center was assigned to coordinate the CI program. Delivery: via videoconferencing Regimen: A total of 12 CI sessions were conducted over 6 weeks. 2. Face-to-face Intervention: A total of 12 sessions of assessment and cognitive intervention (CI) were conducted by the face-to-face method Materials and procedures: sessions of assessment and CI conducted face-to-face Provided by: A social worker at the social center was assigned to coordinate the CI program. Delivery: Face-to-face Regimen: A total of 12 CI sessions were conducted over 6 weeks
Outcome measures	Outcome measures: Cantonese version of Mini-Mental State Examination (C-MMSE); Cantonese version of Rivermead Behavioural Memory test (C-RBMT); Hierarchic Dementia Scale (HDS); user satisfaction questionnaire towards VC was distributed to participants and staff.
Sandroff et al. [20]
Methods	RCT
Participants	82 patients with multiple sclerosis (MS) randomly allocated into physical activity behavioral intervention (n = 41) or wait-list control conditions (n = 41).
Interventions	1. Intervention condition Intervention: Participants in the intervention condition received a theory-based program for increasing physical activity behavior that was delivered via the Internet, and one-on-one video chat sessions with a behavior-change coach. Materials and procedures: For the physical activity intervention, patients visited a study website, wore a Yamax SW-401 Digiwalker pedometer, completed a log book and used Goal Tracker software, and participated in one-on-one video coaching sessions. The website provided content based on social cognitive theory (SCT) for increasing ambulatory physical activity. The behavioral intervention further involved weekly, one-on-one behavioral coaching sessions via Skype. The sessions were semi-scripted and based on principles of supportive accountability (i.e., encouraging participants to wear the pedometer daily and monitor behavioral change and goal attainment throughout the 6-month intervention). The coaching sessions each consisted of a review of goal setting and progress toward goal attainment, as well as a discussion of strategies and facilitators of behavioral change based on SCT and current website content. Provided by: laboratory personnel Delivery: via the Internet Regimen: 6-month intervention with decreased frequency 2. Wait-list control condition Intervention: Participants in this condition completed the study measures before and after the 6-month period, and then received the intervention as described above once the study reached completion.
Outcome measures	Outcome measures: Symbol Digit Modalities Test (SDMT); 6-minute walk (6MW) test; the abbreviated International Physical Activity Questionnaire (IPAQ), The patient-determined disease steps (PDDS) scale.
Jelcic et al. [12]
Methods	Pilot study
Participants	Total of 38 participants. 27 participants met the selection criteria and entered the study. They were randomly assigned to three treatment groups: seven patients received lexical-semantic stimulation (LSS) with a teleconference technology (LSS-tele); ten were treated with a face-to-face direct administration of LSS (LSS-direct), and ten control subjects underwent unstructured cognitive stimulation (UCS).
Interventions	1. Lexical-semantic stimulation–teleconference technology (LSS-tele) Intervention: The LSS protocol contained lexical tasks aimed at enhancing semantic verbal processing. The exercises focused on the interpretation of written words, sentences, and stories and were divided into eight main parts: semantic categories, syntagmatic and paradigmatic relationship, level of semantic affinity between words, adequacy of adjectives to the context of the text, part-whole relationship, recognition of nonsense sentences, identification of semantic definition, and context of a short story. In the LSS-tele treatment, the same LSS exercises were delivered through remote control based on telecommunication technology. Materials and procedures: In the LSS-tele protocol, the therapist was based at the Hospital and was connected to a group of patients placed in two elderly day care centers. One trained operator was based in the patients’ room with the aim to guarantee the correct access to the technologies and to facilitate the interaction with the treatment therapist when required. The rehabilitation protocol was provided at distance by a customized system, based on two applications run on two personal computer workstations. The therapist’s interface allowed for control of all the experimental information. The patients’ side of the interface was designed with two windows: one showing the therapist by videoconference, the other displaying the target exercise. Provided by: a neuropsychologist and a trained operator Delivery: via videoconference Regimen: two weekly sessions, lasting 1 h each in the morning, over a period of 3 months 2. Lexical-semantic stimulation–direct (LSS-direct) Intervention: Participants of the LSS-direct group received the LSS intervention by the same face-to-face modality, in the presence of the therapist during the entire session. Materials and procedures: Participants of the LSS-direct group received the LSS intervention by the same face-to-face modality, in the presence of the therapist during the entire session. Provided by: a neuropsychologist Delivery: face-to-face Regimen: two weekly sessions, lasting 1 h each in the morning, over a period of 3 months 3. Unstructured cognitive treatment (UCS) Intervention: Participants of the UCS group were engaged in face-to-face training. Materials and procedures: Exercises consisted of creative work such as practicing manual skills, stimulating fantasy and creativeness, reading the newspaper with active participation and discussion, and improving verbal communication. Provided by: a neuropsychologist Delivery: face-to-face Regimen: two weekly sessions, lasting 1 h each in the morning, over a period of 3 months
Outcome measures	Extensive neuropsychological assessment addressing multiple cognitive domains was given to each subject at study entry and postintervention after 3 months of treatments. Primary outcome measures were (a) global cognitive performance, assessed with the Mini-Mental State Examination (MMSE); (b) lexical-semantic abilities, assessed with the Verbal Naming Test and phonemic and semantic fluency; and (c) semantically related and unrelated immediate and delayed episodic verbal memory, assessed respectively with Brief Story Recall and Rey Auditory Verbal Learning (RAVL) tests. Secondary outcome measures were (a) working memory, assessed with the Forward Digit Span Test; (b) visual-spatial memory, assessed with the Rey–Osterrieth Complex Figure (ROCF) Delayed Recall Test; (c) attention and executive functions, assessed with Digit Cancellation Test and Trail Making Test (A and B); (d) visual-spatial abilities, evaluated with the ROCF Copy Test.
Meltzer et al. [16]
Methods	Randomized non-inferiority trial
Participants	Participants were randomly assigned to in-person (IP) or telerehabilitation (TR) group: IP Group: 22 participants—16 aphasic (M = 62.9 years, SD = 11.6); 6 with CLCD (M = 63.2 years, SD = 8.4) TR Group: 22 participants—17 aphasic (M = 66.8 years, SD = 11.2); 5 with CLCD (M = 60.8 years, SD = 10.4)
Interventions	In-person treatment Intervention: tablet-based homework exercises and realistic, customized treatment plans tailored to the needs of each individual client. Materials and Procedures: the study consisted of an in-person assessment before and after a 10-week treatment, with a heavy emphasis on homework exercises completed on a tablet, with weekly therapist contact conducted in-person. Communication partner received training and participated in the weekly contact sessions. The study was not limited to aphasia, but also included clients with cognitive-linguistic communication disorders (CLCD). The therapist conducted a 1-h/week treatment session; in three sessions (weeks 3, 6, and 9), 30 min of each session was devoted exclusively to the communication partner, giving training on Supported Conversation techniques and helping the partner keep the client on track with the treatment program. Provided by: speech and language therapist. Delivery: face-to-face Regimen: 1-h/week treatment for 10 weeks. 2. Telerehabilitation Intervention: tablet-based homework exercises and realistic, customized treatment plans tailored to the needs of each individual client. Materials and procedures: remote therapy sessions were conducted via teleconferencing equipment and software. Participants consulted the therapist using WebEx, a commercial teleconferencing program, except for one participant who preferred to use VSee as they were already familiar with it. Others visited a local site of MBTelehealth, a province-wide network for the provision of health-care services through videoconferencing technology. A few participants went to the therapy site itself for TR treatment, without contact with the treating therapist. The treating therapist conducted 1-h weekly treatment session; in three sessions (weeks 3, 6, and 9), 30 min of the session was devoted exclusively to the communication partner, giving training on Supported Conversation techniques and helping the partner keep the client on track with the treatment program. In some cases, a brief telephone call was conducted between therapy sessions to provide support and to monitor progress, particularly when there were concerns about homework compliance. For homework exercises, the majority of the clients used the commercial software program by TalkPath, which comprises graded exercises in speaking, listening, reading, writing, and paralinguistic cognitive skills including memory. Provided by: speech and language therapist. Delivery: remotely, via teleconferencing equipment and software. Regimen: 1h a week, for 10 weeks.
Outcome measures	Primary outcomes: Western Aphasia Battery-Revised, Part 1 (WAB-R) for people with aphasia; Cognitive-Linguistic Quick Test (CLQT) for participants with Cognitive-Linguistic Communication Disorder (CLCD); Communication Confidence Rating Scale for Aphasia to assess subjective communication confidence in the participants themselves; Communication Effectiveness Index to evaluate the functional competence of participants from a subjective but external perspective. The assessment took place during the first and the last week of intervention and was carried out by a SLP not involved in the treatment administration.
Torrisi et al. [23]
Methods	Randomized controlled trial
Participants	Forty patients (mean ± SD: age = 55.17 ± 18.37 years; 26% male) affected by cognitive disorders due to either ischemic or hemorrhagic stroke were enrolled and randomized into the control (n = 20) or the experimental (n = 20) groups, in order of recruitment.
Interventions	1. Telerehabilitation Intervention: The telerehabilitation device VRRS allows the monitoring of patient remotely in his/her home by a real-time interaction, comparable to a vis-a-vis interaction. Materials and procedures: The pictures were presented on a computer screen using customized software. The software allows a remote communication between therapist and patient using an embedded communication platform. In this study, the cognitive module with 3D scenarios was mainly used during the hospital training, whilst 2D exercises were used at home. The exercises performed by the patients included attention, memory, visuo-spatial, and reasoning tasks. The cognitive rehabilitation method chosen was the restorative method (consisting in enhancement of compromised abilities) rather than the compensatory (based on the development of alternative strategies). Provided by: Twice a week, a psychologist monitored the progress of rehabilitation at home through a videoconference. Delivery: Communication with participant based at home through internet connection. Regimen: The EG and the CG performed the same amount of treatment, i.e., five sessions a week, each session lasting about 50 min. 2. Face-to-face treatment Intervention: patients were trained with the same exercises as in telerehabilitation group, but using paper–pencil tools. Materials and procedures: Participants performed a neuropsychological assessment before entering in treatment. Evaluation at baseline (T0), after twelve weeks (T1), and at the end of the protocol, that is 12 weeks later (T2). During the first phase (T0–T1), the two groups underwent different rehabilitative training at our center: the EG patients underwent a cognitive rehabilitation training performed using the VRRS-Evo, whereas the CG patients were trained with the same exercises, but using paper–pencil tools. In the second phase (T1-T2), all the patients were discharged, and the EG continued cognitive rehabilitation using the VRRS Home Tablet including the same exercises carried out in inpatient regimen (three sessions a week, each session lasting about 50 min). Provided by: Twice a week, a psychologist monitored the progress of rehabilitation at home through a videoconference. Delivery: Face-to-face using paper–pencil tools Regimen: The EG and the CG performed the same amount of treatment, i.e., five sessions a week, each session lasting about 50 min.
Outcome measures	Outcomes recorded at baseline (T0), postintervention after 12 weeks (T1), and follow-up after 24 weeks (T2). The neuropsychological battery: (1) Montreal Overall Cognitive Assessment (MOCA); (2) Frontal Assessment Battery (FAB) and Weigl Test; (3) Attentive Matrices (AM) and Trail Making Test (TMT A, B and B-A); (4) Rey Auditory Verbal Learning Test (RAVLT; immediate and differite) and Digit Span; (5) phonemic and semantic verbal fluency; and (6) Hamilton Rating Scale for Anxiety (HRS-D) and Depression (HRS-D).
Zhou et al. [26]
Methods	RCT
Participants	Forty patients participated in the experiment. Patients were randomly assigned to each group as follows: Group 1: 10 participants, inpatient control group (ICG) Group 2: 10 participants, inpatient cognitive training group (ITG) Group 3: 10 participants, discharge control group (DCG) Group 4: 10 participants, discharge cognitive training group (DTG)
Interventions	1. In-person training Intervention: computerized intervention for aphasia that combined speech-language and cognitive training delivered on an inpatient unit. Materials and procedures: participants were randomly assigned to the combined speech-language and cognitive training group (ITG) or the control group (ICG). The ICG was provided with routine treatment, while the ITG group received computerized speech-language and cognitive training. Provided by: speech and language therapists. Delivery: one-to-one, and face-to-face. Regimen: twice a day, for 14 days. 2.Telerehabilitation Intervention: remote communication training for discharged control group (DCG), with additional computerized speech-language and cognitive training for discharged cognitive training group (DTG). Materials and procedures: for the DTG, remote communication training was adopted with additional communication speech-language and cognitive training. The telerehabilitation training program was adopted from the Wispirit Inc. (66nao.com). The training program included both a speech-language module and a cognitive training module. The training assignment was based on individual’s deficit profile. Training program included a speech-language module and a cognitive module. To enable adaptive training, each task was designed with different levels of difficulty by adjusting the number of stimuli, the size of the stimulus, and the timing of the presentation. Provided by: speech and language therapist. Delivery: one-to-one, via telerehabilitation. Regimen: The DCG group engaged in family topics communication for 30 min per session, 2 times a day for 30 days, and the DTG group engaged in family topics communication for 30 min a day, with additionally computerized speech-language and cognitive training for 30 min a day for 30 consecutive days.
Outcome measures	Western Aphasia Battery (WAB); Communicative Abilities in Daily Living (CADL). Data collection: T1 for baseline and T2 for end of treatment (after 14 days for inpatient groups and after 30 days for discharged patients)