Advertisement

Cognitive Rehabilitation and Recovery After Stroke

Chapter

Abstract

As the previous chapters have described in detail, many of those fortunate to survive their stroke do so with detrimental alterations to their cognitive and psychological well-being. These impairments impact the affected individual’s ability to participate in, and benefit from, multidisciplinary stroke rehabilitation, to safely and independently carry out activities of everyday living, and to resume pre-morbid personal, social, and vocational roles [1–4]. Previously automatic and effortless tasks require exhausting levels of concentration and, despite the efforts invested, often end in perplexing and de-motivating failure. Uncertainty in one’s own abilities and reliance on others makes people with cognitive problems vulnerable to frustration, humiliation, worry, and feelings of hopelessness. These topics are covered elsewhere in this book. The current chapter focuses on cognitive rehabilitation by exploring the evidence base from the perspective of informing clinical service improvements and strives to root cognitive recovery firmly within a broader psychological context.

Keywords

Traumatic Brain Injury Cochrane Review Stroke Survivor Cognitive Problem Cognitive Rehabilitation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

We are grateful to the authors of the national clinical guidelines (Australia, Canada, Scotland, RCP London) and the NHS Improvement—Stroke program for England and to Wiley for allowing us to reprint sections of their work. Our ideas are the result of collaborative working with the RCP London’s Intercollegiate Stroke Working Party, and especially the members of the cognitive psychology subgroup: Janet Cockburn, David Gillespie, Andrew Bateman, and Peter Knapp whose input we wish to acknowledge.

Potential Conflict of Interest: Audrey Bowen is a member of the RCP London Intercollegiate Working Party for Stroke that produces the National Clinical Guideline referred to as UK (except Scotland), and author of some of the studies referred to in this chapter.

References

  1. 1.
    British Psychological Society. Psychological services for stroke survivors and their families: briefing paper no 19. Leicester: British Psychological Society; 2002.Google Scholar
  2. 2.
    Claesson L, Lindén T, Skoog I, Blomstrand C. Cognitive impairment after stroke—impact on activities of daily living and costs of care for elderly people. The Goteborg 70+ Stroke Study. Cerebrovasc Dis. 2005;19(2):102–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Patel MD, Coshall C, Rudd AG, Wolfe CD. Cognitive impairment after stroke: clinical determinants and its associations with long-term stroke outcomes. J Am Geriatr Soc. 2002;50(4):700–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Tatemichi TK, Desmond DW, Stern Y, Paik M, Sano M, Bagiella E. Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities. J Neurol Neurosurg Psychiatry. 1994;57(2):202–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Barker-Collo SL. Depression and anxiety 3 months post stroke: prevalence and correlates. Arch Clin Neuropsychol. 2007;22(4):519–31.Google Scholar
  6. 6.
    Department of Health. National stroke strategy. London: Department of Health; 2007.Google Scholar
  7. 7.
    McKevitt C. The Stroke Association: UK stroke survivors needs survey; 2010. ISBN 0901548650.Google Scholar
  8. 8.
    Pollock A, Brady M, Langhorne P. DORIS: Database of Research in Stroke—current best evidence, ongoing research and priorities for future research relating to stroke rehabilitation. Int J Stroke. 2011;6 Suppl 2:50–1.Google Scholar
  9. 9.
    Medical Research Council. A Framework for development and evaluation of RCTs for complex interventions to improve health. London: MRC; 2000. http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC003372. Accessed 6 Feb 2012.
  10. 10.
    Medical Research Council. Developing and evaluating complex interventions: new guidance. London: MRC; 2008. http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC004871. Accessed 8 Feb 2012.
  11. 11.
    Cochrane Library. http://www.thecochranelibrary.com/view/0/index.html. Accessed 6 Feb 2012.
  12. 12.
    National Stroke Foundation. Clinical guidelines for stroke management, Melbourne, Australia; 2010. http://www.strokefoundation.com.au/. Accessed 8 Feb 2012.
  13. 13.
    Lindsay MP, Gubitz G, Bayley M, Hill MD, Davies-Schinkel C, Singh S, Phillips S. Canadian Best Practice Recommendations for Stroke Care (Update 2010). Prepared by the Canadian Stroke Strategy Best Practices and Standards Writing Group, on behalf of the Canadian Stroke Strategy (a joint initiative of the Canadian Stroke Network and the Heart and Stroke Foundation of Canada). Ottawa, ON: Canadian Stroke Network; 2010. http://www.canadianstrokenetwork.ca/. Accessed 8 Feb 2012.Google Scholar
  14. 14.
    Intercollegiate Stroke Working Party. National clinical guideline for stroke. 4th ed. London: Royal College of Physicians; 2012.Google Scholar
  15. 15.
    Scottish Intercollegiate Guidelines Network (SIGN). 118. Management of patients with stroke: rehabilitation, prevention and management of complications and discharge planning. A national clinical guideline. Edinburgh: SIGN; 2010. http://www.sign.ac.uk/guidelines/published/numlist.html. Accessed 8 Feb 2012.
  16. 16.
    Cooksey, Sir David. A review of UK health research funding. London: HMSO; 2006. http://www.hm-treasury.gov.uk/pre_budget_report/prebud_pbr06/other_docs/prebud_pbr06_odcooksey.cfm. Accessed 31 Jan 2012Google Scholar
  17. 17.
    Intercollegiate Stroke Working Party. National sentinel stroke audit 2010—public report. London: Royal College of Physicians; 2011.Google Scholar
  18. 18.
    National Stroke Foundation. National Stroke Audit—acute services organisational survey report. Melbourne, Australia: National Stroke Foundation; 2011.Google Scholar
  19. 19.
    Canadian Stroke Network. The quality of stroke care in Canada 2011. http://www.canadianstrokenetwork.ca/. Accessed 6 Feb 2012Google Scholar
  20. 20.
    Lincoln NB, Kneebone II, Macniven JAB, Morris RC. Psychological management of stroke. West Sussex: Wiley-Blackwell; 2012.Google Scholar
  21. 21.
    Johnstone B, Stonnington HH, editors. Rehabilitation of neuropsychological disorders: a practical guide for rehabilitation professionals. Philadelphia, PA: Psychology Press; 2001.PubMedCrossRefGoogle Scholar
  22. 22.
    Cattelani R, Zettin M, Zoccolotti P. Rehabilitation treatments for adults with behavioral and psychosocial disorders following acquired brain injury: a systematic review. Neuropsychol Rev. 2010;20:52–85.PubMedCrossRefGoogle Scholar
  23. 23.
    Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar K, Fraas M, et al. Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Arch Phys Med Rehabil. 2011;92:519–30.Google Scholar
  24. 24.
    Lincoln N, Majid M, Weyman N. Cognitive rehabilitation for attention deficits following stroke. Cochrane Database Syst Rev. 2000;(4):CD002842. doi: 10.1002/14651858.CD002842.
  25. 25.
    Bowen A, Lincoln N. Cognitive rehabilitation for spatial neglect following stroke. Cochrane Database Syst Rev. 2007;(2):CD003586. doi: 10.1002/14651858.CD003586.pub2.
  26. 26.
    das Nair R, Lincoln N. Cognitive rehabilitation for memory deficits following stroke. Cochrane Database Syst Rev. 2007;(3):CD002293. doi: 10.1002/14651858.CD002293.pub2.
  27. 27.
    West C, Bowen A, Hesketh A, Vail A. Interventions for motor apraxia following stroke. Cochrane Database Syst Rev. 2008;(1):CD004132. doi: 10.1002/14651858.CD004132.pub2.
  28. 28.
    Brady MC, Kelly H, Godwin J, Enderby P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev. 2012;(5):CD000425. doi: 10.1002/14651858.CD000425.pub3.
  29. 29.
    Bowen A, Knapp P, Gillespie D, Nicolson DJ, Vail A. Non-pharmacological interventions for perceptual disorders following stroke and other adult-acquired, non-progressive brain injury. Cochrane Database Syst Rev. 2011;(4):CD007039. doi: 10.1002/14651858.CD007039.pub2.
  30. 30.
    Chung CSY, Pollock A, Campbell T, Durward BR, Hagen S. Cognitive rehabilitation for executive dysfunction in patients with stroke or other adult non-progressive acquired brain damage (Protocol). Cochrane Database Syst Rev. 2010;(3):CD008391. doi: 10.1002/14651858.CD008391 (The Review has now been submitted for publication).
  31. 31.
    Gillham S, Clark L. Psychological care after stroke—improving stroke services for people with cognitive and mood disorders. NHS improvement—stroke; 2011. http://www.improvement.nhs.uk/stroke/Psychologicalcareafterstroke/tabid/177/Default.aspx. Accessed 6 Feb 2012.PubMedCrossRefGoogle Scholar
  32. 32.
    Hyndman D, Pickering RM, Ashburn A. The influence of attention deficits on functional recovery post stroke during the first 12 months after discharge from hospital. J Neurol Neurosurg Psychiatry. 2008;79(6):656–63.PubMedCrossRefGoogle Scholar
  33. 33.
    Levitt T, Johnstone B. The assessment and rehabilitation of attention disorders. In: Johnstone B, Stonnington HH, editors. Rehabilitation of neuropsychological disorders: a practical guide for rehabilitation professionals. Philadelphia, PA: Psychology Press; 2001. p. 27–52.Google Scholar
  34. 34.
    Robertson IH, Ridgeway V, Greenfield E, Parr A. Motor recovery after stroke depends on intact sustained attention: a 2-year follow-up study. Neuropsychology. 1997;11(2):290–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Gray J, Robertson I, Pentland B, Anderson S. Microcomputer-based attentional retraining after brain damage: a randomised group controlled trial. Neuropsychol Rehabil. 1992;2(2):97–115.CrossRefGoogle Scholar
  36. 36.
    Schoettke H. Rehabilitation von Aufmerksamkeits storungen nach einem Schlagenfall—Effectivitat eines verhaltensmedizinisch–neuropsychologischen Aufmerksamkeitstrainings. Verhaltenstherapie. 1997;7:3.Google Scholar
  37. 37.
    Sturm W, Willmes K. Efficacy of a reaction training on various attentional and cognitive functions in stroke patients. Neuropsychol Rehabil. 1991;1:259–80.CrossRefGoogle Scholar
  38. 38.
    Fasotti L, Kovacs F, Eling PATM, Brouwer WH. Time pressure management as a compensatory strategy training after closed head injury. Neuropsychol Rehabil. 2000;10(1):47–65.CrossRefGoogle Scholar
  39. 39.
    Winkens I, Van Heugten CM, Wade DT, Habets EJ, Fasotti L. Efficacy of time pressure management in stroke patients with slowed information processing: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90(10):1672–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Barker-Collo SL, Feigin VL, Lawes CM, Parag V, Senior H, Rodgers A. Reducing attention deficits after stroke using attention process training: a randomized controlled trial. Stroke. 2009;40(10):3293–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Sohlberg MM, McLaughlin KA, Pavese A, Heidrich A, Posner MI. Evaluation of attention process training and brain injury education in persons with acquired brain injury. J Clin Exp Neuropsychol. 2000;22(5):656–76.PubMedCrossRefGoogle Scholar
  42. 42.
    Wade DT, Parker V, Langton HR. Memory disturbance after stroke: frequency and associated losses. Int Rehabil Med. 1986;8(2):60–4.PubMedGoogle Scholar
  43. 43.
    Clark PC, Dunbar SB, Shields CG, Viswanathan B, Aycock DM, Wolf SL. Influence of stroke survivor characteristics and family conflict surrounding recovery on caregivers’ mental and physical health. Nurs Res. 2004;53(6):406–13.PubMedCrossRefGoogle Scholar
  44. 44.
    Skeel R, Edwards S. The assessment and rehabilitation of memory impairments. In: Johnstone B, Stonnington HH, editors. Rehabilitation of neuropsychological disorders: a practical guide for rehabilitation professionals. Philadelphia, PA: Psychology Press; 2001. p. 27–52.Google Scholar
  45. 45.
    Appelros P, Karlsson GM, Seiger A, Nydevik I. Neglect and anosognosia after first-ever stroke: incidence and relationship to disability. J Rehabil Med. 2002;34(5):215–20.PubMedCrossRefGoogle Scholar
  46. 46.
    Teasell R, Salter K, Bitensky J, Bhogal SK, Foley N, Anita Menon A, et al. EBRSR: evidence-based review of stroke rehabilitation: perceptual disorders. http://www.ebrsr.com/uploads/Module-13_Perceptual-Disorders.pdf. Accessed 15 Oct 2011.
  47. 47.
    Ferreira HP, Leite Lopes MA, Luiz RR, Cardoso L, André C. Is visual scanning better than mental practice in hemispatial neglect? Results from a pilot study. Top Stroke Rehabil. 2011;18(2):155–61.PubMedCrossRefGoogle Scholar
  48. 48.
    Fong KN, Chan MK, Ng PP, Tsang MH, Chow KK, Lau CW, et al. The effect of voluntary trunk rotation and half-field eye-patching for patients with unilateral neglect in stroke: a randomized controlled trial. Clin Rehabil. 2007;21(8):729–41.PubMedCrossRefGoogle Scholar
  49. 49.
    Luukkainen-Markkula R, Tarkka IM, Pitkänen K, Sivenius J, Hämäläinen H. Rehabilitation of hemispatial neglect: a randomized study using either arm activation or visual scanning training. Restor Neurol Neurosci. 2009;27(6):663–72.PubMedGoogle Scholar
  50. 50.
    Nys GM, de Haan EH, Kunneman A, de Kort PL, Dijkerman HC. Acute neglect rehabilitation using repetitive prism adaptation: a randomized placebo-controlled trial. Restor Neurol Neurosci. 2008;26(1):1–12.PubMedGoogle Scholar
  51. 51.
    Polanowska K, Seniów J, Paprot E, Leśniak M, Członkowska A. Left-hand somatosensory stimulation combined with visual scanning training in rehabilitation for post-stroke hemineglect: a randomised, double-blind study. Neuropsychol Rehabil. 2009;19(3):364–82.PubMedCrossRefGoogle Scholar
  52. 52.
    Schroder A, Wist ER, Homberg V. TENS and optokinetic stimulation in neglect therapy after cerebrovascular accident: a randomized controlled study. Eur J Neurol. 2008;15(9):922–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Tsang MH, Sze KH, Fong KN. Occupational therapy treatment with right half-field eye-patching for patients with subacute stroke and unilateral neglect: a randomised controlled trial. Disabil Rehabil. 2009;31(8):630–7.PubMedCrossRefGoogle Scholar
  54. 54.
    Turton AJ, O’Leary K, Gabb J, Woodward R, Gilchrist ID. A single blinded randomised controlled pilot trial of prism adaptation for improving self-care in stroke patients with neglect. Neuropsychol Rehabil. 2010;20(2):180–96.PubMedCrossRefGoogle Scholar
  55. 55.
    Kerkhoff G, Keller I, Artinger F, Hildebrandt H, Marquardt C, Reinhart S, Ziegler W. Recovery from auditory and visual neglect after optokinetic stimulation with pursuit eye movements—transient modulation and enduring treatment effects. Neuropsychologia. 2012;50(6):1164–77.PubMedCrossRefGoogle Scholar
  56. 56.
    Mizuno K, Tsuji T, Takebayashi T, Fujiwara T, Hase K, Liu M. Prism adaptation therapy enhances rehabilitation of stroke patients with unilateral spatial neglect: a randomized, controlled trial. Neurorehabil Neural Repair. 2011;25(8):711–20.PubMedCrossRefGoogle Scholar
  57. 57.
    Welfringer A, Leifert-Fiebach G, Babinsky R, Brandt T. Visuomotor imagery as a new tool in the rehabilitation of neglect: a randomised controlled study of feasibility and efficacy. Disabil Rehabil. 2011;33:2033–43.PubMedCrossRefGoogle Scholar
  58. 58.
    Bowen A, Hesketh A, Patchick E, Young A, Davies L, Vail A, et al. Effectiveness of enhanced communication therapy in the first four months after stroke for aphasia and dysarthria: a randomised controlled trial. BMJ. 2012;345:e4407.PubMedCrossRefGoogle Scholar
  59. 59.
    Bowen A, Hesketh A, Patchick E, Young A, Davies L, Vail A, et al.; The ACT NoW investigators. Clinical effectiveness, cost effectiveness and service users’ perceptions of early, well-resourced communication therapy following a stroke, a randomised controlled trial (The ACT NoW Study). Health Technol Assess. 2012;16(26):1–160.Google Scholar
  60. 60.
    Laska AC, Kahan T, Hellblom A, Murray V, von Arbin M. A randomized controlled trial on very early speech and language therapy in acute stroke patients with aphasia. Cerebrovasc Dis. 2011;1:66–74.CrossRefGoogle Scholar
  61. 61.
    Godecke E, Hird K, Lalor EE, Rai T, Phillips MR. Very early poststroke aphasia therapy: a pilot randomized controlled efficacy trial. Int J Stroke. 2011. doi: 10.1111/j.1747-4949.2011.00631.
  62. 62.
    de Jong-Hagelstein M, van de Sandt-Koenderman WM, Prins ND, Dippel DW, Koudstaal PJ, Visch-Brink EG. Efficacy of early cognitive linguistic treatment and communicative treatment in aphasia after stroke: a randomised controlled trial (RATS-2). J Neurol Neurosurg Psychiatry. 2011;82:399–404.PubMedCrossRefGoogle Scholar
  63. 63.
    Young A, Gomersall T, Bowen A. Trial participants’ experiences of early, enhanced speech and language therapy after stroke compared with employed visitor support: a qualitative study nested within a RCT. Clin Rehabil. (Online First 26/7/12).Google Scholar
  64. 64.
    Thomas SA, Lincoln NB, Walker MF, Macniven J, Haworth H. Communication and Low Mood (CALM) study: a randomised controlled trial evaluating behaviour therapy for low mood in people with aphasia after stroke. Int J Stroke. 2011;6 Suppl 2:27–8.Google Scholar
  65. 65.
    West C, Hesketh A, Vail A, Bowen A. Interventions for apraxia of speech following stroke. Cochrane Database Syst Rev. 2005;(4):CD004298. doi: 10.1002/14651858.CD004298.pub2.
  66. 66.
    Salazar AM, Warden DL, Schwab K, Spector J, Braverman S, Walter J, et al. Cognitive rehabilitation for traumatic brain injury: a randomized trial. Defense and Veterans Head Injury Program (DVHIP) Study Group. JAMA. 2000;283(23):3075–81.PubMedCrossRefGoogle Scholar
  67. 67.
    Cicerone KD, Mott T, Azulay J, Sharlow-Galella MA, Ellmo WJ, Paradise S, et al. A randomized controlled trial of holistic neuropsychologic rehabilitation after traumatic brain injury. Arch Phys Med Rehabil. 2008;89(12):2239–49.PubMedCrossRefGoogle Scholar
  68. 68.
    The National Institute for Health and Clinical Excellence. Depression the NICE guideline on the treatment and management of depression in adults (updated edition) CG90. The British Psychological Society & The Royal College of Psychiatrists; 2010. http://guidance.nice.org.uk/CG90/Guidance. Accessed 8 Feb 2012.
  69. 69.
    National Audit Office. Reducing brain damage: faster access to better stroke care. Norwich: Stationery Office; 2005. http://www.nao.org.uk/publications/0506/reducing_brain_damage.aspx. Accessed 9 Feb 2012.

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Vascular and Stroke Research CentreUniversity of Manchester (MAHSC), Salford Royal Foundation NHS TrustSalfordUK
  2. 2.School of Psychological SciencesUniversity of ManchesterManchesterUK

Personalised recommendations