Efficacy of executive function interventions after stroke: a systematic review

Disorders in executive functions are common post stroke and play a critical role in predicting functional recovery. To establish best practice recommendations, it is necessary to appraise the evidence regarding specific executive function interventions post stroke. This systematic review aims to determine whether executive function intervention is more effective than no or alternative intervention in improving executive functions and functional abilities in the acute, subacute, and chronic stages post stroke.

A systematic review was performed up to January 2011 of MEDLINE, CINAHL, PsychINFO, OTseeker, and Cochrane databases. Eligible studies needed to include a cognitive intervention to remediate executive function impairments post stroke or to improve functional tasks compromised by these impairments. Methodological quality of randomized trials was rated by 2 authors. The level of evidence for each intervention, according to stage of recovery, was determined.

Ten studies met inclusion criteria - 1 evaluating treatment in the subacute and 9 in the chronic stage. Limited evidence from the 1 study in the subacute stage (level 2b) and 9 studies (including 3 randomized controlled trials) in the chronic stage (level 2a) support using remedial (eg, computerized working memory training) and compensatory interventions (eg, problem-solving strategies, paging system) for improving executive functioning and, possibly, functional abilities.

These findings suggest that persons with stroke may possibly benefit from specific executive function training and learn compensatory strategies to reduce the consequences of executive impairments. Further research is needed in acute and subacute stroke, when the impact of treatment is potentially great and where few studies have been undertaken.