Closing Gap in Stroke Rehabilitation: Early Intervention for Cognitive Disability

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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.