Cognition in Stroke Rehabilitation and Recovery Research: Consensus-Based Core Recommendations From the Second Stroke Recovery and Rehabilitation Roundtable

Abstract

Cognitive impairment is an important target for rehabilitation as it is common following stroke, is associated with reduced quality of life and interferes with motor and other types of recovery interventions. Cognitive function following stroke was identified as an important, but relatively neglected area during the first Stroke Recovery and Rehabilitation Roundtable (SRRR I), leading to a Cognition Working Group being convened as part of SRRR II. There is currently insufficient evidence to build consensus on specific approaches to cognitive rehabilitation. However, we present recommendations on the integration of cognitive assessments into stroke recovery studies generally and define priorities for ongoing and future research for stroke recovery and rehabilitation. A number of promising interventions are ready to be taken forward to trials to tackle the gap in evidence for cognitive rehabilitation. However, to accelerate progress requires that we coordinate efforts to tackle multiple gaps along the whole translational pathway.

Similar cognitive deficits in mice and humans in the chronic phase post-stroke identified using the touchscreen-based paired-associate learning task

“…One of the challenges in advancing research on cognitive impairment post-stroke is to establish and validate test platforms that allow for parallel cognitive assessments in humans and animals in experimental models of stroke 5 . This was recently reiterated in the core recommendations from the recent second Stroke Recovery and Rehabilitation Roundtable 6 .…”

Stroke survivors’ occupational performance and cognitive strategy use: A pilot exploration of strengths and difficulties using the Perceive Recall Plan Perform System of Task Analysis

“…This research demonstrated how the PRPP can be applied to a broad range of tasks and performed by stroke survivors receiving ESD without increasing the assessment load on patients or therapists. It is imperative that assessments are easily implemented in multiple settings, valid for a broad client base and examine executive function (McDonald et al, 2019). In this study, each tool was scored in full, suggesting that these tools have clinical utility in ESD.…”

“…Cognitive impairment is a common and significant sequela post stroke, adversely affecting independence in activities of daily living (ADL), instrumental activities of daily living (IADL) (Intercollegiate Stroke Working Party (ISWP), 2016: 53) and quality of life (McDonald et al, 2019). It is essential that stroke survivors receive screening for post-stroke cognitive impairment with standardised tools and, when indicated, a thorough cognitive assessment to guide intervention (ISWP, 2016: 59).…”

“…Literature recommends further research of poststroke cognition and standardised ecological-based assessments of cognition (McDonald et al, 2019;Pilegaard et al, 2014;Sansonetti and Hoffman, 2013) such as the PRPP. In Australia, ESD is commonly a transitional service and, for benchmarking, this particular service routinely collected global measures of occupational performance using the Functional Independence Measure (FIM) to assess ADL and the Australian modified Lawton's Instrumental Activities of Daily Living scale (Lawton's) to measure IADL (Australian Rehabilitation Outcomes Centre, 2018; Harper et al, 2019).…”

Structural and Functional Remodeling of the Brain Vasculature Following Stroke

“…Despite these setbacks, researchers are continuously developing new methods and refining models, as well as investigating novel avenues of research that hold significant promise in improving stroke outcome ( Silasi et al, 2015 ; Gouveia et al, 2017 ; Kannangara et al, 2018 ; Freitas-Andrade et al, 2019 ; Hill et al, 2020 ; Mendonca et al, 2020 ; Rayasam et al, 2020 ; Zhang et al, 2020 ). A greater appreciation for the role of physical rehabilitation and insight into the molecular mechanisms at play has led to a significant impact on the quality of life after stroke ( Fang et al, 2019 ; McDonald et al, 2019 ; Sun and Zehr, 2019 ).…”