Strategy Training Shows Promise for Addressing Disability in the First 6 Months After Stroke

Abstract

Background. Cognitive impairments occur frequently after stroke and contribute to significant disability. Strategy training shows promise but has not been examined in the acute phase of recovery. Objective. We conducted a single-blind randomized pilot study estimating the effect of strategy training, relative to reflective listening (attention control), for reducing disability and executive cognitive impairments. Methods. Thirty participants with acute stroke who were enrolled in inpatient rehabilitation and had cognitive impairments were randomized to receive strategy training (n = 15, 10 sessions as adjunct to usual inpatient rehabilitation) or reflective listening (n = 15, same dose). The Functional Independence Measure assessed disability at baseline, rehabilitation discharge, 3, and 6 months. The Color Word Interference Test of the Delis–Kaplan Executive Function System assessed selected executive cognitive impairments (inhibition, flexibility) at baseline, 3, and 6 months. Results. Changes in Functional Independence Measure scores for the 2 groups over 6 months showed significant effects of group ( F1,27 = 9.25, P = .005), time ( F3,74 = 96.00, P < .001), and group * time interactions ( F3,74 = 4.37, P < .007) after controlling for baseline differences in stroke severity ( F1,27 = 6.74, P = .015). Color Word Interference Inhibition scores showed significant effects of group ( F1,26 = 6.50, P = .017) and time ( F2,34 = 4.74, P = .015), but the group * time interaction was not significant ( F2,34 = 2.55, P = .093). Color Word Interference Cognitive Flexibility scores showed significant effects of group ( F1,26 = 23.41, P < .001), time ( F2,34 = 12.77, P < .001), and group * time interactions ( F2,34 = 7.83, P < .002). Interaction effects suggested greater improvements were associated with strategy training. Conclusions. Strategy training shows promise for addressing disability in the first 6 months after stroke. Lessons from this pilot study may inform future clinical trials.