Cognitive Rehabilitation

Introduction

Cognitive skills are characterized as basic mental abilities, including a wide variety of mental processes. For example, perception, memory, problem solving, attention, body awareness in addition to many others. Cognitive abilities can be perceived as fundamental processes since they can shape social, emotional, as well as academic learning. In individuals who have sustained a stroke, these skills may be altered resulting in deficits in several areas of functioning such as communication, self-care, productivity and leisure. Cognitive rehabilitation is based upon scientific theories that have been derived from various disciplines including cognitive neuroscience, neuropsychology, neurolinguistics, and language and cognitive development. It is a treatment that comprises both medical and therapeutic services, specifically aimed at restoring as many cognitive functions as possible while proposing different compensatory strategies to more fully cope with cognitive deficits. The aim of this module is to address the effectiveness of cognitive rehabilitation for improving attention deficits and memory in patients who have suffered a stroke.

Authors*: Adam Kagan, B.Sc.; Amy Henderson, PhD Student, Neuroscience; Dr. Nicol Korner-Bitensky PhD OT

NOTE: *The authors have no direct financial interest in any tools, tests or interventions presented in StrokEngine.

test

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

1a (Strong)	Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate)	1 RCT of high quality (PEDro ≥ 6)
2a (Limited)	At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited)	At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus)	Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting)	Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence)	No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

Patients longer than 6 months post-stroke are identified as in chronic stage of recovery.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

1a (Strong)	Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate)	1 RCT of high quality (PEDro ≥ 6)
2a (Limited)	At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited)	At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus)	Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting)	Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence)	No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

Patients longer than 6 months post-stroke are identified as in chronic stage of recovery.

1a (Strong)	Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate)	1 RCT of high quality (PEDro ≥ 6)
2a (Limited)	At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited)	At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus)	Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting)	Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence)	No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

1a (Strong)	Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate)	1 RCT of high quality (PEDro ≥ 6)
2a (Limited)	At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited)	At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus)	Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting)	Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence)	No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)