Combined Cognitive-Strategy and Task-Specific Training Improve Transfer to Untrained Activities in Subacute Stroke

Abstract

Purpose The purpose of this study was to estimate the effect of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach compared to usual outpatient rehabilitation on activity and participation in people less than 3 months post stroke. Methods An exploratory, single blind, randomized controlled trial with a usual care control arm was conducted. Participants referred to 2 stroke rehabilitation outpatient programs were randomized to receive either Usual Care or CO-OP. The primary outcome was actual performance of trained and untrained self-selected activities, measured using the Performance Quality Rating Scale (PQRS). Additional outcomes included the Canadian Occupational Performance Measure (COPM), the Stroke Impact Scale Participation Domain, the Community Participation Index, and the Self Efficacy Gauge. Results Thirty-five (35) eligible participants were randomized; 26 completed the intervention. Post-intervention, PQRS change scores demonstrated CO-OP had a medium effect over Usual Care on trained self-selected activities (d=0.5) and a large effect on untrained (d=1.2). At a 3 month follow-up, PQRS change scores indicated a large effect of CO-OP on both trained (d=1.6) and untrained activities (d=1.1). CO-OP had a small effect on COPM and a medium effect on the Community Participation Index perceived control and the Self-Efficacy Gauge. Conclusion CO-OP was associated with a large treatment effect on follow up performances of self-selected activities, and demonstrated transfer to untrained activities. A larger trial is warranted.

Feasibility of a home-based program to improve handwriting after stroke: a pilot study

“…However, adults with stroke who have a handwriting impairment may again need to rely on conscious cognitive processes when writing. Cognitive strategies, such as 'stop-think-plan-do' have been used with adults with stroke when training motor tasks such as handwriting McEwen et al, 2014). These cognitive strategies may be helpful to include in a handwriting retraining program.…”

“…Although the CO-OP approach is not exclusively used for motor tasks, application of these cognitive strategies is thought to be an important aspect of improving motor control . A pilot RCT investigated the use of the CO-OP approach and task-specific training to improve performance on a range of tasks (McEwen et al, 2014).…”

“…In summary, four studies (Beaudet, 2004;Henshaw et al, 2011;McEwen et al, 2014;) involving adults with stroke or traumatic brain injury included handwriting retraining or handwriting-related goals. One pilot RCT included handwriting-related goals, and reported a treatment effect for task-specific training and CO-OP approach over usual care.…”

“…Three studies used a single case experimental or quasiexperimental design, and a fourth study used a pilot randomised design with a small sample. The studies included adults with stroke (Henshaw et al, 2011;McEwen et al, 2014;) and traumatic brain injury (Beaudet, 2004). Each study provided a different number of sessions targeting handwriting (ranging from 4 to 10; unspecified by McEwan and colleagues (2014)) and different program content but all included elements of task-specific practice.…”

“…Each study provided a different number of sessions targeting handwriting (ranging from 4 to 10; unspecified by McEwan and colleagues (2014)) and different program content but all included elements of task-specific practice. Three studies (Henshaw et al, 2011;McEwen et al, 2014; focused on a single self-selected handwriting goal (e.g., writing a signature or writing neatly and precisely), in addition to addressing other non-handwriting goals, while the other study (Beaudet, 2004) focused only on handwriting, covering a broader range of handwriting elements (e.g., pen control, speed and legibility). Approaches also differed between the studies, with three (Henshaw et al, 2011;McEwen et al, 2014; …”