Closing Gap in Stroke Rehabilitation: Early Intervention for Cognitive Disability

描述（由申请人提供）：三分之一到一半的急性中风导致新获得性认知障碍。中风相关的认知障碍与显著的功能障碍相关，如无法在日常活动中重新获得独立性。这种独立性的丧失代价高昂，因为与没有认知障碍的中风患者相比，患有中风相关认知障碍的患者需要更多的康复和更多的资源来支持他们的生活。促进脑卒中相关认知障碍患者独立性的有效干预措施可以显著改善这些患者的生活质量，并减少脑卒中相关的医疗保健费用。开始康复的最佳时机是在康复的急性期。提出的研究考察了一个新的创新项目的有效性，通过卒中后策略训练调整日常活动表现（ADAPTS），可以在急性康复期间交付。ADAPTS教授中风相关认知障碍患者识别和优先处理有问题的日常活动，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，并通过反复练习来推广他们的学习。因此，ADAPTS教授的过程可以在康复完成后很长一段时间内应用于“现实生活”活动。这项随机对照试验的主要目的是检查ADAPTS在急性康复中促进中风相关认知障碍成人独立性的疗效。我们预测，与注意力控制参与者相比，ADAPTS参与者在日常活动的独立性上表现出更大的改善，并且ADAPTS参与者将表现出更大的改善

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.