Rehabilitation of Poststroke Cognition

Abstract

Given the increasing rates of stroke and our aging population, it is critical that we continue to foster innovation in stroke rehabilitation. Although there is evidence supporting cognitive rehabilitation in stroke, the set of cognitive domains effectively addressed to date represents only a small subset of the problems experienced by stroke survivors. Further, a gap remains between investigational treatments and our evolving theories of brain function. These limitations present opportunities for improving the functional impact of stroke rehabilitation. The authors use a case example to encourage the reader to consider the evidence base for cognitive rehabilitation in stroke, focusing on four domains critical to daily life function: (1) speech and language, (2) functional memory, (3) executive function and skilled learned purposive movements, and (4) spatial-motor systems. Ultimately, they attempt to draw neuroscience and practice closer together by using translational reasoning to suggest possible new avenues for treating these disorders.

Memory rehabilitation: Restorative, specific knowledge acquisition, compensatory, and holistic approaches

“…This strategy involves preventing errors as much as possible during learning. Errorless learning is based on the assumption that memory for learned information will improve by reducing guessing and thus incorrect responses Clare & Jones, 2008;Shigaki et al, 2014;Wilson, 2002). Errorless learning paradigms often include an errorful condition, where participants are provided with word stems (e.g.…”

“…These strategies have been designed with the intention to capitalize on preserved implicit memory abilities of memory-impaired patients (Censori et al, 1996;Kapur et al, 2004;. Therefore, it has been suggested that these techniques could be particularly beneficial for patients with severe memory impairments, who may have marked difficulties with tasks that require explicit memory (Censori et al, 1996;Clare & Jones, 2008;Shigaki et al, 2014;Wilson, 2002). Moreover, as these strategies include some error-reduction at the learning stage, they may strengthen connections for only the correct stimulus and response associations for patients with poor error-monitoring (Clare & Jones, 2008;Piras et al, 2011).…”

“…A compensatory approach may become the focus of memory rehabilitation when restoration of function seems to be no longer possible either through spontaneous recovery or memory training (Wilson, 2000). It is held that the compensatory approach can lead to improvements as a result of a structural reorganization of neural modules (das Nair & Lincoln, 2012;Rothi & Horner, 1983;Shigaki et al, 2014). Specifically, training patients to use compensatory strategies may result in the reorganization of neural networks to recruit undamaged circuits to compensate for the lack of activity in the damaged circuits (das Nair & Lincoln, 2012;Rothi & Horner, 1983;Tate, 1997).…”

“…Memory impairment following an acquired brain injury can negatively impact daily living, quality of life, and progression to dementia (Claesson et al, 2005;Pohjasvaara et al, 1997;Tang et al, 2020;Wilson, 2002). Memory deficits are among the most common cognitive deficits and subjective complaints for acquired brain injury patients (Barman et al, 2016;Censori et al, 1996;Cumming et al, 2013;das Nair et al, 2016;Hochstenbach et al, 1998;Shigaki et al, 2014;Wade et al, 1986). Although some improvements in memory abilities can occur through spontaneous recovery, memory impairments can persist for years after the injury (Censori et al, 1996;Elliott & Parente, 2014;Rasquin et al, 2002;Schaapsmeerders et al, 2013;Zucchella et al, 2014).…”

“…The techniques are used to restore function, to provide specific information relevant to everyday life, and as supportive tools to improve daily functioning (Cumming et al, 2013;das Nair et al, 2016;das Nair & Lincoln, 2012;Rees et al, 2007;Shigaki et al, 2014). Cognitive rehabilitation that is intended to improve memory is commonly thought to involve three approaches (das Nair et al, 2016;das Nair & Lincoln, 2012;Rees et al, 2007;Tate, 1997;Wilson, 2009).…”