Date Presented 04/21/21
Community-dwelling individuals with chronic stroke experience participation limitations in cognitively demanding activities, which can be partially explained by apathy, executive function, and social support. Increased recognition of apathy, analysis of cognitive activity demands, and access to social support networks may further advance OTs’ ability to address participation limitations among individuals poststroke.
Primary Author and Speaker: Amy Ho
Additional Authors and Speakers: Desiree Taylor, Nicole Klans, Alexandra Reynolds, and Lucia Kissinger
Contributing Authors: Emily Skaletski, Joshua Brown
PURPOSE: Participation in complex activities requires a range of cognitive skills necessary for independent living. After stroke, retention of pre-stroke complex activities may depend on whether the client can both initiate activities and has executive function skills to perform them. Further, social support is posited as a protective, contextual factor that may promote participation in cognitively-demanding activities. The objective of this study was to understand the extent to which apathy, cognition, and social support contributes to participation in cognitively-demanding activities among individuals with chronic stroke.
DESIGN: A prospective, quantitative, correlational, cross-sectional study.
METHOD: This study enrolled 81 community-dwelling individuals post-stroke with and without aphasia recruited from outpatient treatment centers and community stroke support groups associated with Washington University School of Medicine in St. Louis and MGH Institute of Health Professions in Boston. The Activity Card Sort measured participation retention of pre-stroke activities, including those that required low-cognitive skills (low-CS) and high-cognitive skills (high-CS). The Apathy Evaluation Scale measured self-reported apathy symptomology. The Medical Outcomes Study Social Support Survey measured perceived social support. The Delis-Kaplan Executive Function System subtests of Design Fluency and Trail-Making Test measured executive function. All measures were adapted to support communication while preserving the psychometric integrity of the assessments. An independent samples t-test determined whether a difference existed for our outcome variables between persons with aphasia (PWA) and persons without aphasia (PWOA). Pearson correlations identified variables associated with participation to include in the regression models (p < .05). These select independent variables were then included in two hierarchical regression analyses to determine the proportion of variance accounted for in percent retained low-CS and high-CS activities. A post-hoc analysis compared those who met criteria for apathy (N = 23) to those who did not (N = 58) on percent retained of pre-stroke activities, perceived stroke recovery, and perceived social support.
RESULTS: There were no differences between PWA and PWOA in participation levels. Participants gave up 35% and 20% of their pre-stroke activities with low-CS and high-CS, respectively. Both regression analyses were statistically significant (p < .0001) indicating that apathy, cognition, and positive social interactions accounted for 33.4% and 39.4% of the variance in activities with low-CS and high-CS, respectively. Cognition was a significant predictor of activities with high-CS only. Those with apathy compared to those without differed in overall retained pre-stroke activities (p < .0001), perceived stroke recovery (p < .04), and perceived social support (p < .03).
CONCLUSIONS AND IMPACT: Community-dwelling individuals post-stroke continue to experience cognitive participation limitations chronically. Cognitive abilities contribute to activities with high-CS necessitating attention to the cognitive demands of activities in rehabilitation. Nearly one-third of individuals in our sample endorsed symptoms of apathy, which limits participation regardless of cognitive skill demand and impedes recovery. Although apathy was endorsed by a significant number of individuals in our study, it is not well recognized or traditionally addressed by occupational therapists. Positive social interactions is a facilitator for participation both in activities with low-CS and high-CS. Encouraging individuals to access and build their social support networks can directly facilitate participation.
References
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