Cognitive-Behavioral Interventions for Improving Activity Outcomes After Stroke: A Narrative Review of the Literature

Abstract

The use of cognitive-behavioral interventions for the remediation of motor impairments is receiving increasing scientific attention. Previous investigators have established that interventions that incorporate an individual’s motivation and foster self-efficacy can potentiate the benefits of traditional neurological rehabilitation. The hemiparetic upper extremity may be particularly susceptible to these non-motor interventions as there is often a discrepancy between objective motor function and real-world arm use in the postacute phase after stroke. One possible explanation for this discrepancy lies within the learned nonuse phenomenon, which theorizes that decreased upper extremity use is learned and which has the potential to be reversed via behavioral techniques. Several interventions have been developed that aim to influence these behavioral contributors. However, despite having similar components and theoretical constructs, they use a distinct nomenclature and employ various methods of administration making comparison challenging. The purpose of this literature review is to examine several cognitive-behavioral interventions which have been described in the literature (motivational interviewing, individualized coaching, self-management training, and cognitive strategy training), and to investigate the current evidence supporting their use for the remediation of motor and functional impairments after stroke.