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Randomized Controlled Trial
. 2015 Aug;29(7):668-76.
doi: 10.1177/1545968314562113. Epub 2014 Dec 11.

Strategy Training Shows Promise for Addressing Disability in the First 6 Months After Stroke

Elizabeth R Skidmore  1 , Deirdre R Dawson  2 , Meryl A Butters  3 , Emily S Grattan  4 , Shannon B Juengst  4 , Ellen M Whyte  3 , Amy Begley  3 , Margo B Holm  4 , James T Becker  4
Affiliations
Randomized Controlled Trial

Strategy Training Shows Promise for Addressing Disability in the First 6 Months After Stroke

Elizabeth R Skidmore et al. Neurorehabil Neural Repair. 2015 Aug.

Abstract

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.

Keywords: cognition; intervention; rehabilitation; strategy training; stroke.

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Figures

Figure 1
Figure 1
CONSORT Flow Diagram
Figure 2
Figure 2
Functional Independence Measure Total Scores, By Group
Figure 3
Figure 3
Color Word Interference Inhibition Scaled Scores, By Group
Figure 4
Figure 4
Color Word Interference Cognitive Flexibility Scaled Scores, By Group
See this image and copyright information in PMC

References

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