Objectives
Let’s quickly go over the objectives of what I would like to cover with you over the next hour. After this course, you should be able identify some limitations with some of the current intervention approaches that are out there for stroke related to transfer and generalization of real-world environments.
We will also look at key components of what is cognitive strategy training. We will talk about it in general and just give a really quick overview, but then I am going to specifically dive into the cognitive strategy training program that we use which is called CO-OP. You should be able to list the components of the CO-OP intervention approach. We will talk about the assessments we use to measure whether or not we are being effective in using CO-OP with these populations. Specifically those that can be applied to the CO-OP intervention which we are using or any cognitive strategy training program.
Finally I will briefly touch on some contraindications to using cognitive strategy training. Like any intervention approach, it may or may not be appropriate for certain individuals depending on what their level of impairment is.
Background
For those of you who work in this area, this is not going to be really surprising to you, but functional outcomes after stroke are poor. If we follow people longitudinally after they leave the hospital or rehab, whenever they have reached maximum recovery or in some cases when they just reach the end of their benefits, we know that at six months they are still reporting pretty significant participation limitations in everyday life.
In this one study that we have cited here, almost 2/3 of people at six months post stroke are still reporting participation restrictions. A lot of times these tend to be centered in higher-level IADL activities such as housework or shopping. My specific interest is how this impacts their work or participation in activities out in the community. However, even in individuals who may have more involved strokes, almost half of them still need some level of assistance with basic ADL which are more procedural-based tasks and should not be as difficult.
My specific focus has been with mild stroke with limited neurological impairment. This population are still reporting limitations in these complex higher-level IADL activities like work, leisure, family roles and community activities, even when they do not have the level of motor involvement, speech involvement or some of the other symptoms that we classically associate with stroke.
Task-Specific Training
When we look at current trends in stroke rehabilitation, I should not even say it is new and emerging anymore, this is almost becoming a standard of practice. Task-specific training has different names, but this is probably the most common. This is a treatment approach that is really focused on function, and it has involved out of the movement science and motor learning literature. The basic premise of this is that instead of focusing on impairment reduction exercises, this is really getting more at goal-directed practice of functional task. I put "walking and grasping" in here because those are often cited in literature. Another example would be pouring or other things along those same lines, where the target is improvement in that functional activity. They are going to do repetitive practice of that activity with the goal of hopefully improving motor recovery, but also improving their performance.
