While there are many different approaches to stroke rehabilitation, most fit into one of two categories. The physical approach is the focus of many early rehabilitation programs. The cognitive approach seeks to address the underlying problems that can persist beyond the immediately visible effects of stroke. And it’s this cognitive approach that many stroke sufferers value the most. It offers benefits that can help with independence and day-to-day living in a way that purely physical rehabilitation cannot. There is, however, still much that is unknown when it comes to cognitive remediation.
Dr. Summer explains the concept of cognitive remediation in this video.
In a bid to further our understanding, a group for researchers in Australia looked at 22 studies of more than 1,000 patients. They reviewed the effects of cognitive remediation in terms of immediate and longer-term outcomes.
The results are in…
Cognitive remediation is training built around a combination of task-focused training and rehabilitation that improves the way we interact in the real world. The team concluded that it generally positively affects both the impairment level (the measurable physical limitation) and the participation level (how limiting an impairment is in the real world). However, outcomes vary based on the amount of rehabilitation, and the stage of recovery at which it is administered.
The most benefit came when cognitive remediation began in the acute phase of stroke. The greatest improvements were in visuospatial/perception and language skills. These are key elements of recovery which improve independence and daily living. But more is not necessarily better. While the level of improvement was ‘dose-dependent’, the benefit plateaued at around 20 hours per week.
Room for improvement?
So while this tells us that cognitive remediation is a valuable tool in stroke recovery, it also tells us that there might be room to further refine our approach. And by focusing on optimizing early intervention, and working towards the outcomes that mean the most to patients in real-world terms, we can ensure the greatest all-around benefit to stroke patients.
The lead author of the original article is Jeffrey M. Rogers, South Eastern Sydney Local Health District and Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.