The feasibility of meta-cognitive strategy training in acute inpatient stroke rehabilitation: Case report

Abstract

Meta-cognitive strategy training may be used to augment inpatient rehabilitation to promote active engagement and subsequent benefit for individuals with cognitive impairments after stroke. We examined the feasibility of administering a form of meta-cognitive strategy training, Cognitive Orientation to daily Occupational Performance, during inpatient rehabilitation. We trained an individual with cognitive impairments after right hemisphere stroke to identify performance problems, set self-selected goals, develop plans to address goals, and evaluate performance improvements. To assess feasibility, we examined the number of meta-cognitive training sessions attended, the number of self-selected goals, and changes in goal-related performance. We also examined changes in rehabilitation engagement and disability. The participant used the metacognitive strategy to set 8 goals addressing physically-oriented, instrumental, and work-related activities. Mean improvement in Canadian Occupational Performance Measure Performance Scale scores was 6.1. Pittsburgh Rehabilitation Participation Scale scores (measuring rehabilitation engagement) improved from 3.2 at admission to 4.9 at discharge. Functional Independence Measure scores (measuring disability) improved from 68 at admission, to 97 at discharge. Performance Assessment of Self-care Skills scores improved from 1.1 at admission to 2.9 at discharge. The results indicate that meta-cognitive strategy training was feasible during inpatient rehabilitation and warrants further evaluation to determine its effectiveness.

Interventions to increase engagement with rehabilitation in adults with acquired brain injury: A systematic review

“…It is common in neuropsychological rehabilitation for disability scales to be used as an outcome measure rather than goal attainment; both reflect important aspects of the rehabilitation process but often there is a poor correlation between the two (Liu, McNeil & Greenwood, 2004). Only two studies in this review utilised specific (although different) measures of rehabilitation engagement (Pegg et al, 2005;Skidmore et al, 2011). The database searches revealed a validated measure of rehabilitation engagement (Chervinsky et al, 1998).…”

“…These ranged from providing clients with tailored information about their condition (Pegg et al, 2005) through to interventions targeting broader meta-cognitive processes, equipping clients with the skills to plan, execute and evaluate their own rehabilitation (Skidmore et al, 2011) or enabling client involvement in a collaborative process of identifying, working towards and evaluating rehabilitation goals Lane-Brown & Tate, 2010).…”

“…Eight studies reported interventions using predominantly behavioural modification techniques (Hegel, 1988Zencius, Wesolowski, Burke & McQuade, 1989;Yuen, 1996;Manchester, Hodgkinson, Pfaff & Nguyan, 1997;Newell, 1997;Sohlberg, Lemoncello & Lee, 2011;Hufford et al, 2012), 5 studies primarily cognitive techniques (Pegg et al, 2005;Lane-Brown & Tate, 2010;Skidmore et al, 2011;Hsieh, Ponsford, Wong, Schönberger, Taffe & Mckay, 2012;Hsieh, Ponsford, Wong, Schönberger, Mckay & Haines, 2012) and 2 studies reported a mixture of the two (Corrigan, Bogner, Lamb-Hart, Heinemann & Moore, 2005;Corrigan & Bogner, 2007).…”

An Exploratory Analysis of the Self-Reported Goals of Individuals With Chronic Upper-Extremity Paresis Following Stroke

“…Previously published research is available on general goals of individuals post-stroke [11,[24][25][26]. Given the prevalence of UE paresis, it is necessary to better understand the rehabilitation priorities of this population.…”

A review of cognitive orientation to daily occupational performance with stroke

“…CO-OP uses a meta-cognitive strategy, an approach that promotes self-direction and self-monitoring to identify one's problems by Review Article combining a cognitive strategy to detailed occupational training. Therefore, the cognitive strategy takes care of the central role in the learning process of performance of occupation and motor skills [7,8]. The client learns global problem-solving strategies [5].…”