Cognitive Screening for CI Therapy after Stroke

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DESCRIPTION (provided by applicant): Stroke is the leading neurologic disorder and a major cause of chronic disability. Functional deficits following stroke can be ameliorated through rehabilitation, but until recently there has been little development of testable models of stroke therapies. Furthermore, despite the identification of several predictors of treatment outcomes, comprehensive models to account for how such variables affect therapy outcomes have not been developed. Constraint-Induced Movement Therapy (CI therapy) is a treatment for chronic stroke hemiparesis that has controlled evidence for efficacy on actual daily living tasks. The treatment was developed from basic neuroscience research that postulates that learned non-use is a major determinant of chronic hemiparesis and can be reversed through intensive practice. The intensive practice is associated with massive cortical reorganization on functional imaging studies. The PIs hypothesize that several cognitive mechanisms are essential to the therapeutic benefits of intensive practice: sustained attention, declarative memory, and emotional regulation. About one-third of patients in the CI therapy clinic demonstrate impaired cognitive regulation or memory disturbances, and they tend to have reduced treatment gains and retention of benefits after discharge. The purpose of this pilot application will be to prospectively assess CI therapy clinic patients on the above cognitive functions, and then through multivariable regression analysis determine their contributions to treatment outcomes in comparison to other predictors of general stroke rehabilitation outcomes (age, lesion findings, stroke severity, pre-treatment function, incontinence). The findings will indicate whether specific cognitive processes are importantly involved with the mechanism hypothesized to account for treatment benefit. Understanding of cognitive contributions to CI therapy benefit will help to propose treatment modifications for patients with behavioral disorders who undergo therapy, and as well to better inform prospective patients of their likely treatment benefit.