Comparison of two cognitive interventions for adults experiencing executive dysfunction post-stroke: a pilot study.

Area of Science:

• Neurorehabilitation
• Occupational Therapy
• Cognitive Rehabilitation

Background:

• Executive dysfunction is a common and disabling impairment following stroke.
• Effective interventions are needed to improve daily functioning and quality of life for stroke survivors with executive dysfunction.

Purpose of the Study:

• To compare the feasibility and preliminary efficacy of two interventions for post-stroke executive dysfunction: occupation-based strategy training (Cognitive Orientation to daily Occupational Performance - CO-OP) and computer-based executive function training (COMPUTER training).

Main Methods:

• A pilot partially randomized controlled trial involving 16 hours of either CO-OP or COMPUTER training.
• Feasibility, acceptability, and changes in executive function, participation, and self-efficacy were assessed.
• Outcomes measured included the Canadian Occupational Performance Measure (COPM) for performance and satisfaction.

Main Results:

• High satisfaction reported for both CO-OP and COMPUTER training.
• Both groups showed large improvements in self- and significant other-rated performance and satisfaction with goals (CO-OP: ES=1.6-3.5; COMPUTER: ES=0.9-4.0).
• COMPUTER training improved targeted EF impairments (ES=0.9-1.6); CO-OP improved self-efficacy (ES=1.5).

Conclusions:

• Both CO-OP and COMPUTER training are feasible and acceptable interventions for individuals with executive dysfunction post-stroke.
• Preliminary evidence suggests both interventions positively impact real-world outcomes.
• CO-OP may particularly enhance self-efficacy for everyday activities.