Combined Cognitive-Strategy and Task-Specific Training Affects Cognition and Upper-Extremity Function in Subacute Stroke: An Exploratory Randomized Controlled Trial

Abstract

The purpose of this study was to estimate the effect of Cognitive Orientation to Daily Occupational Performance (CO-OP) compared with usual occupational therapy on upper-extremity movement, cognitive flexibility, and stroke impact in people less than 3 mo after stroke. An exploratory, single-blind randomized controlled trial was conducted with people referred to outpatient occupational therapy services at two rehabilitation centers. Arm movement was measured with the Action Research Arm Test, cognitive flexibility with the Delis-Kaplan Executive Function System Trail Making subtest, and stroke impact with subscales of the Stroke Impact Scale. A total of 35 participants were randomized, and 26 completed the intervention. CO-OP demonstrated measurable effects over usual care on all measures. These data provide early support for the use of CO-OP to improve performance and remediate cognitive and arm movement impairments after stroke over usual care; however, future study is warranted to confirm the effects observed in this trial.

Copyright © 2016 by the American Occupational Therapy Association, Inc.

Figures

Figure 1.

CONSORT (CONsolidated Standards Of Reporting Trials) diagram of participant flow through the study. Note. CO–OP = Cognitive Orientation to Daily Occupational Performance; SJR = St. John’s Rehab; TRISL = The Rehabilitation Institute of St. Louis. From “Combined Cognitive-Strategy and Task-Specific Training Improve Transfer to Untrained Activities in Subacute Stroke: An Exploratory Randomized Controlled Trial,” by S. McEwen, H. Polatajko, C. Baum, J. Rios, D. Cirone, M. Doherty, & T. Wolf, 2015, Neurorehabilitation and Neural Repair, 29, 531. http://dx.doi.org/10.1177/1545968314558602. Copyright © 2015 by the American Society of Neurorehabilitation. Used with permission.