Cognitive Rehabilitation After Stroke: A Case Series Testing a New Method to Transfer Gains to Daily Life

Abstract

This case-series piloted a novel cognitive rehabilitation approach, i.e., Constraint-Induced Cognitive Therapy (CICT), for improving Instrumental Activities of Daily Living (IADL) in stroke survivors with chronic, mild-to-moderate, cognitive impairment. Four consecutively sampled stroke survivors (mean chronicity=18 months, SD = 10) with mild (n = 3) or moderate (n = 1) cognitive impairment received 35 h of CICT. CICT combined two empirically supported approaches: Speed of Processing Training (SOPT) and behavior change techniques from Constraint-Induced Movement Therapy (CIMT) adapted to transfer gains from in-lab cognitive training to daily life. The latter featured IADL training following shaping principles and a suite of behavioral techniques, called the Transfer Package, to promote participation in cognitively-based functional activities outside of the lab. Outcome measures assessed cognitive processing speed (Useful Field of View, UFOV) and IADL performance outside the treatment setting (Canadian Occupational Performance Measure, COPM). All three participants with valid UFOV data displayed meaningful improvements after treatment in cognitive processing speed (M = 64%, SD = 40, d'=1.6). All three with COPM data reported meaningful improvements in satisfaction with IADL performance (M = 2.87, SD = 1.5, d'=1.9). Values of d’ ≥ 0.57 are large. Per structured interviews developed for this study, the IADL improvements present after treatment lasted for at least a year. These promising findings warrant further study.