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的认知障碍。中风相关的认知障碍与严重的功能障碍相关，如在日常活动中无法恢复独立性所示。这种独立性的丧失是昂贵的，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。有效的干预措施，促进中风相关的认知障碍的个人的独立性，可以显着提高这些人的生活质量，并减少中风相关的医疗保健费用。开始康复的最佳时间是在急性恢复阶段。这项拟议的研究探讨了一种新的创新计划的有效性，即通过卒中后策略训练（ADAPTS）适应日常活动表现，该计划可以在急性康复期间提供。ADAPTS教导患有中风相关认知障碍的人识别和优先考虑有问题的日常活动，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，并通过迭代实践推广他们的学习。因此，ADAPTS教导了一个可以在康复完成后很长时间内应用于“现实生活”活动的过程。这项随机对照试验的主要目的是检查ADAPTS在促进急性康复中卒中相关认知障碍成年人独立性方面的疗效。我们预测，与注意力控制参与者相比，ADAPTS参与者将在日常活动中表现出更大的独立性改善，并且ADAPTS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。本研究的第二个目的是探索归因于ADAPTS的认知操作的变化。我们预测，ADAPTS参与者将在高阶认知操作方面表现出更大的改善，即认知流畅性（生成性思维），灵活性， 注意力控制的参与者。通过实现这些目标，拟议的研究将以两种重要方式解决当前康复研究中的关键差距。首先，我们将研究一种新的创新方法的有效性，这种方法有望促进中风相关认知障碍患者的日常活动独立性。其次，我们将研究干预衍生的潜在认知操作的改善，以帮助澄清行为和生物学机制的变化，可以在未来的研究中进行测试。这些努力将使我们能够测试新的模型，以支持最佳干预措施， 患有中风相关认知障碍的个人，从而使患有中风相关认知障碍的个人受益，这些人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.