Integrating Functional Cognitive Rehabilitation With Activity-Based Stroke Telerehabilitation: Intervention Design and Development Study

Many stroke survivors experience chronic cognitive deficits that, together with motor impairments, negatively impact well-being and daily function. Critically, poststroke cognitive deficits can interfere with successful engagement in rehabilitation programs aimed at improving participation in home and community activities. To address this issue, we developed a new telehealth intervention that integrates brief, functional cognitive rehabilitation (COG) into an existing upper extremity-focused, activity-based occupational therapy (OT) telerehabilitation program.

To describe the development and specification of a telehealth intervention (COG+OT) that integrates functional cognitive rehabilitation into activity-based stroke telerehabilitation.

COG+OT was developed using a multi-disciplinary, theory-informed process guided by principles of functional cognitive rehabilitation. It is reported according to the Template for Intervention Description and Replication checklist for rehabilitation (TIDieR-Rehab). The intervention was developed by a team with expertise in stroke rehabilitation from the fields of OT, neuropsychology, clinical psychology, and speech-language pathology. Cognitive rehabilitation content was adapted from an evidence-based compensatory strategy program and condensed into a brief "primer" format. The COG component was iteratively integrated into an existing upper-extremity, activity-based OT telerehabilitation program to support engagement and transfer of strategies to real-world functional tasks. In this paper, we describe the intervention structure, content, delivery, and tailoring procedures.

COG+OT is an 8-week, 13-session telehealth intervention delivered in three phases: (1) cognitive strategy training ("primer"; sessions 1-4), (2) review and guided application of strategies within OT activities (sessions 5-10), and (3) integration of strategies to support generalization to everyday contexts (sessions 11-13). The intervention combines individualized, strategy-based cognitive rehabilitation with goal-oriented OT using a titrated approach. Patient-facing materials, structured session workflows, and therapist-guided metacognitive strategies support tailoring and real-world application.

COG+OT is a theory-informed, user-centered intervention that provides a structured approach for integrating functional cognitive rehabilitation into stroke telerehabilitation. This work establishes a well-specified, replicable intervention model and supports future feasibility, effectiveness, and implementation studies.