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Updated: Jan 24, 2026

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Cognitive oriented strategy training augmented rehabilitation (COSTAR) for ischemic stroke: a pilot exploratory

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Summary

This study compared cognitive strategy training plus task-specific training (COSTAR) with task-specific training (TST) alone for stroke survivors. Results showed no significant advantage of COSTAR over TST for improving activity and participation after stroke.

Keywords:
Strokeactivities of daily livingcognitionneurological rehabilitationoccupational therapystroke rehabilitation

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Area of Science:

  • Neurology
  • Rehabilitation Medicine
  • Occupational Therapy

Background:

  • Task-specific training (TST) is a cornerstone of stroke rehabilitation, improving upper extremity function but often lacking generalization to untrained activities.
  • Cognitive strategy use can enhance skill generalization in stroke survivors but is not always integrated into TST protocols.

Purpose of the Study:

  • To compare the effectiveness of Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), which adds cognitive strategy training to TST, versus TST alone.
  • To evaluate the impact on activity and participation levels in chronic stroke survivors undergoing outpatient occupational therapy.

Main Methods:

  • An exploratory, single-blind, randomized controlled trial was conducted with chronic stroke survivors.
  • Participants were randomized to either the TST group or the COSTAR group.
  • Primary outcomes included the Stroke Impact Scale (SIS), Canadian Occupational Performance Measure (COPM), and Performance Quality Rating Scale (PQRS) to assess activity and participation.

Main Results:

  • Forty-four participants were randomized; the COSTAR group experienced higher attrition (50%) and completed fewer sessions (9.8/12) compared to the TST group (25% attrition, 10.7/12 sessions).
  • Both groups demonstrated improvements across most primary and secondary outcome measures.
  • There was minimal evidence to suggest COSTAR provided a significant benefit over TST for improving activity performance or other measured outcomes.

Conclusions:

  • The study found no clear advantage of adding cognitive strategies to TST for improving trained or untrained activities in stroke survivors.
  • Potential reasons for negligible findings include inadvertent treatment group equivalency and limitations in measuring skill generalization.
  • Focusing TST on activity performance, rather than impairment reduction, may be key for enhancing participation in daily life activities, even without explicit cognitive strategies.