TY - JOUR
T1 - Strategy Training Shows Promise for Addressing Disability in the First 6 Months After Stroke
AU - Skidmore, Elizabeth R.
AU - Dawson, Deirdre R.
AU - Butters, Meryl A.
AU - Grattan, Emily S.
AU - Juengst, Shannon B.
AU - Whyte, Ellen M.
AU - Begley, Amy
AU - Holm, Margo B.
AU - Becker, James T.
N1 - Funding Information:
Strategy training shows promise for addressing disability and executive cognitive impairments within the first 6 months of stroke. Valuable lessons learned in the conduct of this early phase clinical trial may be useful in the design of future confirmatory trials. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Activities within this article were funded by the National Institutes of Health (K12 HD055931, P30 MH090333), the University of Pittsburgh Medical Center Rehabilitation Institute, and the University of Pittsburgh Office of Research Health Sciences.
Publisher Copyright:
© American Society of Neurorehabilitation.
PY - 2015/8/23
Y1 - 2015/8/23
N2 - Background. Cognitive impairments occur frequently after stroke and contribute to significant disability. Strategy training shows promise but has not been examined in the acute phase of recovery. Objective. We conducted a single-blind randomized pilot study estimating the effect of strategy training, relative to reflective listening (attention control), for reducing disability and executive cognitive impairments. Methods. Thirty participants with acute stroke who were enrolled in inpatient rehabilitation and had cognitive impairments were randomized to receive strategy training (n = 15, 10 sessions as adjunct to usual inpatient rehabilitation) or reflective listening (n = 15, same dose). The Functional Independence Measure assessed disability at baseline, rehabilitation discharge, 3, and 6 months. The Color Word Interference Test of the Delis-Kaplan Executive Function System assessed selected executive cognitive impairments (inhibition, flexibility) at baseline, 3, and 6 months. Results. Changes in Functional Independence Measure scores for the 2 groups over 6 months showed significant effects of group (F1,27 = 9.25, P =.005), time (F3,74 = 96.00, P <.001), and group ∗ time interactions (F3,74 = 4.37, P <.007) after controlling for baseline differences in stroke severity (F1,27 = 6.74, P =.015). Color Word Interference Inhibition scores showed significant effects of group (F1,26 = 6.50, P =.017) and time (F2,34 = 4.74, P =.015), but the group ∗ time interaction was not significant (F2,34 = 2.55, P =.093). Color Word Interference Cognitive Flexibility scores showed significant effects of group (F1,26 = 23.41, P <.001), time (F2,34 = 12.77, P <.001), and group ∗ time interactions (F2,34 = 7.83, P <.002). Interaction effects suggested greater improvements were associated with strategy training. Conclusions. Strategy training shows promise for addressing disability in the first 6 months after stroke. Lessons from this pilot study may inform future clinical trials.
AB - Background. Cognitive impairments occur frequently after stroke and contribute to significant disability. Strategy training shows promise but has not been examined in the acute phase of recovery. Objective. We conducted a single-blind randomized pilot study estimating the effect of strategy training, relative to reflective listening (attention control), for reducing disability and executive cognitive impairments. Methods. Thirty participants with acute stroke who were enrolled in inpatient rehabilitation and had cognitive impairments were randomized to receive strategy training (n = 15, 10 sessions as adjunct to usual inpatient rehabilitation) or reflective listening (n = 15, same dose). The Functional Independence Measure assessed disability at baseline, rehabilitation discharge, 3, and 6 months. The Color Word Interference Test of the Delis-Kaplan Executive Function System assessed selected executive cognitive impairments (inhibition, flexibility) at baseline, 3, and 6 months. Results. Changes in Functional Independence Measure scores for the 2 groups over 6 months showed significant effects of group (F1,27 = 9.25, P =.005), time (F3,74 = 96.00, P <.001), and group ∗ time interactions (F3,74 = 4.37, P <.007) after controlling for baseline differences in stroke severity (F1,27 = 6.74, P =.015). Color Word Interference Inhibition scores showed significant effects of group (F1,26 = 6.50, P =.017) and time (F2,34 = 4.74, P =.015), but the group ∗ time interaction was not significant (F2,34 = 2.55, P =.093). Color Word Interference Cognitive Flexibility scores showed significant effects of group (F1,26 = 23.41, P <.001), time (F2,34 = 12.77, P <.001), and group ∗ time interactions (F2,34 = 7.83, P <.002). Interaction effects suggested greater improvements were associated with strategy training. Conclusions. Strategy training shows promise for addressing disability in the first 6 months after stroke. Lessons from this pilot study may inform future clinical trials.
KW - Cognition
KW - Intervention
KW - Rehabilitation
KW - Strategy training
KW - Stroke
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U2 - 10.1177/1545968314562113
DO - 10.1177/1545968314562113
M3 - Article
C2 - 25505221
AN - SCOPUS:84937842942
SN - 0888-4390
VL - 29
SP - 668
EP - 676
JO - Journal of Neurologic Rehabilitation
JF - Journal of Neurologic Rehabilitation
IS - 7
ER -