Neurofunctional treatment targeting participation among chronic stroke survivors: A pilot randomised controlled study

Abstract

Long-term disabilities are common among stroke survivors and are associated with reduced quality of life (QoL). Research on occupation-based intervention for chronic stroke survivors is sparse. The objective of this study was to examine the effectiveness of neurofunctional treatment (NFT), an occupation-based client-centred treatment approach, for attaining individualised goals in chronic stroke survivors. A pilot randomised control study with a crossover design was employed. The participants were randomly allocated to treatment or control groups, with the intervention replicated for the control group after three months. Twenty three community dwelling stroke survivors, at least one year post-stroke attending a community day centre participated in this study. The 12-week intervention included NFT with individualised occupational goal setting. The treatment methods included task-specific training, environmental or task adaptation, assistive devices, motivation recruitment, and advocacy. Significant differences between the groups were found on occupational performance measures, but not on QoL. These findings were replicated after crossover for the control group. The results support the efficacy of NFT for attaining occupational goals in individuals in the chronic stage after stroke, yet further research is needed to validate these findings in additional treatment settings and over time.

Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014

“…63,150,154 Finally, this review provides evidence that various cognitive rehabilitation interventions can be effectively tailored to individuals across levels of injury severity and across levels of neurocognitive impairment. 55,56,82 The our evaluation of studies for this review. We recognize that the failure to include formal assessment of study quality in this systematic review may influence the precision, applicability and confidence in our results and recommendations.…”

“…The CRTF reviewed 15 Class I [68][69][70][71][72][73][74][75][76][77][78][79][80][81][82] or Class Ia [83][84][85] studies, 3 Class II [86][87][88] Goal Management Training. We reviewed 2 Class I studies, 69,70 1 Class II study, 86 and 1 Class III study 93 addressing the remediation of executive functioning using GMT.…”

“…For patients with severe cognitive (executive) deficits, including limitations of emergent awareness and use of compensatory strategies, the use of direct, skill-specific training including errorless learning may be considered to promote performance of specifically trained functional tasks, with no expectation of transfer to untrained activities. 82 While the direct evidence for NFT is limited to participants with chronic stroke, the CRTF considered that there is a sound clinical rationale and indirect evidence for applying this recommendation to the treatment of people with severe cognitive impairments after TBI (Practice Option). There is preliminary evidence suggesting that MST as a component of training on functional activities may increase the effectiveness of acute rehabilitation for patients with cognitive impairment after stroke (Practice Option) ( Table 6).…”

Client perception of a client-centered and occupation-based intervention for at-risk youth

“…An occupation-based practice uses occupation throughout the OT therapeutic process of assessment, intervention, and measurement of outcome (6). Client-centered and occupation-based are an inter-reliant approach in OT that has yielded greater client satisfaction and success in occupational performance (7)(8)(9).…”

Social Cognition Deficits: Current Position and Future Directions for Neuropsychological Interventions in Cerebrovascular Disease

“…Consequently, due to damage in areas of the brain that subserves these functions, a significant number of patients with cerebrovascular disease often show conduct that violate social norms and conventions. They may also become socially withdrawn, disengaged, and isolated [15]. Such social isolation is associated with faster cognitive decline and higher mortality [16].…”