Closing Gap in Stroke Rehabilitation: Early Intervention for Cognitive Disability

描述(申请人提供)：三分之一到一半的急性中风导致新获得的认知障碍。与中风相关的认知障碍与严重的功能残疾有关，表现为无法在日常活动中恢复独立。这种独立性的丧失是代价高昂的，因为与中风相关的认知障碍患者比那些没有认知障碍的中风患者需要更多的康复和更多的资源来支持他们的生活。促进中风相关认知障碍患者的独立性的有效干预措施可以显著提高这些患者的生活质量，并减少与中风相关的医疗费用。开始康复的最佳时机是在康复的急性期。这项拟议的研究考察了一项新的创新计划的有效性，即通过中风后策略训练适应日常活动表现(ADAPTS)，该计划可以在急性康复期间提供。Adapts教授中风相关认知障碍患者识别有问题的日常活动并确定其优先顺序，识别阻碍活动表现的障碍，生成和评估解决这些障碍的策略，并通过迭代实践推广他们的学习。因此，Adapts教授的过程可以在康复完成后很长时间内应用于“现实生活”活动。这项随机对照试验的主要目的是检验适应性在接受急性康复治疗的中风相关认知障碍成年人中促进独立性的有效性。我们预测，与注意力控制参与者相比，适应性参与者将在日常活动中表现出更大的独立性改善，并且适应性参与者将表现出 6个月时的独立性得分显著高于注意力控制组。这项研究的第二个目的是探索由于适应而导致的认知操作的变化。我们预测，Adapts参与者将在更高级别的认知操作中表现出显著的改善，即认知流畅性(生成性思维)、灵活性和 抑制作用强于注意控制组。通过解决这些目标，拟议的研究将以两个重要方式解决当前康复研究中的关键差距。首先，我们将检验一种新的创新方法的有效性，该方法显示出在中风相关认知障碍患者中通过日常活动促进独立性的前景。其次，我们将考察干预对潜在认知操作的改善，以帮助澄清可以在未来研究中测试的行为和生物学变化机制。这些努力将使我们能够测试新的模型，以支持对 与中风相关的认知障碍患者，从而使与中风相关的认知障碍患者受益，他们特别容易受到长期残疾的影响。

DESCRIPTION (provided by applicant): One-third to one-half of acute strokes result in newly acquired cognitive impairments. Stroke-related cognitive impairments are associated with significant functional disability, as indicated by the inability to regain independence in daily activities. This loss of independence is costly because individuals with stroke-related cognitive impairments require more rehabilitation and more resources to support their living than individuals who sustain stroke without cognitive impairments. Efficacious interventions that promote independence in individuals with stroke-related cognitive impairments could significantly improve the quality of life among these individuals and reduce stroke-related health care expenses. The best time to initiate rehabilitation is in the acute phase of recovery. The proposed study examines the efficacy of a new and innovative program, Adapting Daily Activity Performance Through Strategy Training after Stroke (ADAPTS), that can be delivered during acute rehabilitation. ADAPTS teaches individuals with stroke-related cognitive impairments to identify and prioritize problematic daily activities, identify the barriers impeding activity performance, generate and evaluate strategies to address these barriers, and generalize their learning through iterative practice. Thus, ADAPTS teaches a process that can be applied to "real-life" activities long after rehabilitation is completed. The primary aim of this randomized controlled trial is to examine the efficacy of ADAPTS for promoting independence among adults with stroke-related cognitive impairments engaged in acute rehabilitation. We predict that ADAPTS participants will demonstrate significantly greater improvements in independence with daily activities than attention control participants, and that ADAPTS participants will demonstrate significantly higher independence scores at 6 months than attention control participants. The secondary aim of this study is to explore changes in cognitive operations attributed to ADAPTS. We predict that ADAPTS participants will demonstrate significantly greater improvements in higher order cognitive operations, namely cognitive fluency (generative thinking), flexibility, and inhibition than attention control participants. By addressing these aims, the proposed study will address critical gaps in current rehabilitation research in two important ways. First, we will examine the efficacy of a new and innovative approach that shows promise for promoting independence with daily activities among individuals with stroke-related cognitive impairments. Second, we will examine the intervention-derived improvements in underlying cognitive operations to help clarify behavioral and biological mechanisms of change that can be tested in future studies. These efforts will allow us to test new models to support optimal interventions for individuals with stroke-related cognitive impairments, thus benefitting individuals with stroke-related cognitive impairments who are particularly vulnerable to long-term disability.