Question
How does cognitive strategy training differ from task-specific training for individuals recovering from a stroke?
Answer
Task-specific training is a treatment approach focused on function that evolved out of the movement science and motor learning literature. The basic premise is goal-directed practice of functional tasks instead of focusing on impairment reduction exercises. Examples of tasks include grasping objects and pouring liquid, where the target is improvement in the functional activity. The client will practice the activity repeatedly with the goal of improving their task performance and hopefully improving motor recovery also. Several studies have shown that task-specific training produces cortical reorganization and improved function. However, the improvements do not generalize and transfer beyond the targeted activity. For example, the performance of a grasping activity will improve, but it does not lead to improvements in ADL function or even with similar grasping activities in a different environment.
Cognitive strategy training is a treatment approach with its roots in educational psychology. It focuses on teaching the client strategies that support early and mid-phase skill acquisition. For example, an individual might use a strategy such as mnemonics to help remember the list of ingredients for a new recipe. We use cognitive strategies every day to help organize and develop a plan for accomplishing our daily tasks. Cognitive strategies are derived from executive function abilities, such as initiation, planning, error detection and organizing behavior. They can be either general or domain specific. An example of a general cognitive strategy is Meichenbaum’s Goal-Plan-Do-Check, which can be applied to any activity. An example of a domain specific strategy is when you are learning to play the guitar and you try to hold the guitar a different way or strum the chords of a new song slowly. These strategies are specific to the activity of playing a guitar, but likely cannot be applied in a general context.
The advantage of cognitive strategy training is that clients are able to transfer and generalize what they learn to other tasks after their rehabilitation is complete. Another advantage is the decreased treatment intensity associated with it. When treatment targets performance and learning strategies instead of targeting impairments, the client is able to learn the strategy fairly quickly as opposed to re-learning a new motor-based activity. Cognitive strategy training is very goal-directed. Once the client identifies an outcome to target in therapy, you focus on teaching the client strategies to try to obtain it.
Editor’s note: This Ask the Expert was adapted from the article ‘Cognitive Strategy Training in Subacute Stroke: A Case Study’. The complete article can be accessed here.
