cva case study example occupational therapy

Becoming occupation-based: a case study

Affiliation.

• 1 1Department of Occupational Therapy, Eastern Kentucky University, Camille, Richmond, USA.
• PMID: 24867352
• DOI: 10.3109/07380577.2014.921751

This descriptive case study illustrates the experiences of a 55-year-old male with a chronic disability resulting from a stroke, living in the community and a clinician's trial using occupation-based interventions predominately in a rehabilitation setting. The participant engaged in occupation-based interventions three times a week for 5 weeks guided by the Canadian Occupational Performance Measure (COPM). Data were collected through semi-structured interviews during the intervention sessions and journal entries made by the therapist. Results suggested occupation-based interventions facilitated a transformation for both the client and the therapist by enhancing the participant's occupational performance and the ability to resume previous roles. The therapist's belief in the power and value of occupation-based practice was reinforced and validated, particularly in the rehabilitation of an individual with chronic stroke.

Keywords: Client-centered; occupation-based; occupational performance.

Publication types

• Case Reports
• Research Support, Non-U.S. Gov't
• Activities of Daily Living*
• Chronic Disease
• Disabled Persons
• Interviews as Topic
• Middle Aged
• Occupational Therapy / methods*
• Occupations*
• Stroke Rehabilitation*

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Case Study: Neurological rehabilitation

by Joanna Bresi-Ando

Lucas was a 49 year old male, who ran his own business as an IT consultant. He lived with his wife and 2 adult children in their own home. Lucas was previously fully independent with all his daily activities and had no significant past medical history.

Lucas fell down the stairs at work and sustained a sub arachnoid haemorrhage, a fractured skull, facial lacerations and 2 fractured ribs. He was admitted to the nearest hospital with a trauma centre, where he underwent surgery to debride and evacuate the depressed skull fracture and debride and repair the lacerations.

As a result of the brain injury, Lucas was left with the following impairments;

• Left sided lower limb weakness
• Reduced balance
• Cognitive difficulties - particularly working memory, reduced attention and executive function skills
• Expressive and receptive language difficulties
• Increased fatigue.

Following his acute admission, Lucas was transferred to a rehab unit, however his low mood deteriorated and he was increasingly agitated. Lucas made very little progress on the unit, so it was decided in his best interests for his rehab to be continued at home.

NHS community services in his borough did not provide neuro specific rehab and Lucas’ Case Manager began the search for a neuro Occupational therapist.

Reason for referral

Lucas was referred to occupational therapy for an assessment of his physical and cognitive needs, to allow him to reach his optimal level of function.

Initial assessment

Lucas was independently mobile indoors and short distances outdoors using a walking stick with supervision.

He was independent with personal care and able to prepare simple meals such as breakfast and a hot drink, however he struggled with complex meal prep tasks. He previously enjoyed cooking and this had been the main household task he would participate in prior to his accident. Lucas’ goal was be able to independently cook a complex meal for his family.

Lucas required support to manage his daily routine; he required supervision to access the community and was dependent for financial management. He fatigued easily and struggled to join in with group conversations, so was increasingly socially isolated.

Recommendations for occupational therapy intervention were to

• Develop meaningful roles and a routine focusing on productivity and structure.
• Develop fatigue management, pacing and energy conservation techniques.
• Use relaxation techniques to help manage his fatigue.
• Develop memory aid strategies, such as using his phone as a reminder and a notebook to write down prompts and lists.
• Explore vocational pursuits

Other recommendations were;

• To continue with physiotherapy treatment
• To be assessed by a speech and Language therapist for continuing communication issues.
• To be assessed by a neuropsychologist for further assessment of his cognitive function and work collaboratively with the occupational therapist in the areas of vocational rehab and mood management.

Goal setting

Lucas was able to come up with an overall cooking goal with support from the occupational therapist; he wished to prepare spaghetti bolognese safely and independently without getting distracted from the task.

The occupational therapist then worked with Lucas and his family on the following short term goals:

• To be able to produce a shopping list with minimal assistance,
• To be able to access his local shops with distant supervision and
• To shop for the ingredients with distant supervision.

The short term goals were incorporated into a structured weekly timetable for Lucas to follow.

Assessment/Intervention

Assessment and treatment was completed simultaneously, through the use of functional tasks and repetitive practice of that task.

Although Lucas had an overall cooking goal, in order to achieve it, meant that he was required to work on other functional skills at the same time, such as searching for and locating items in his kitchen in order to work out what was missing and would need to go on a shopping list, safely accessing the community to get to the local shops and making his way around a supermarket, as well as paying for shopping and transporting it home.

Occupational therapists are very aware of how frustrating it can be for clients to achieve what seems to them to be the simplest of tasks and how this frustration can turn into a negative mind set and demoralise the client. In order to avoid this and empower the client to gain a sense of achievement, a graded approach to activities is often used.

In Lucas’ case he was initially given one step of the overall task to complete, i.e. cooking the mince independently and then would be assisted with the other steps. Over time he was encouraged to complete more of the steps on his own. Discussion with Lucas before starting a task and getting him to rate himself on how well he thought he would perform and then reflecting back at the end of the session on his actual performance also served as a method of encouraging self-monitoring and helped him to realise he could manage better than he thought.

Lucas was taught a strategy of using simple worded checklists for each step of the task and checking them off, before moving on to the next step.

The OT would intervene each time he deviated from the task and bring him back to the checklist.

To address attentional difficulties, the OT began to introduce distractions into the environment, i.e. radio on in the background or talking to Lucas when he was completing a task.

By the end of 12 weeks of rehab Lucas was able to make Spaghetti Bolognese with distant supervision.

Lucas had taken on board the strategies of using checklists to help him through the task, but was unable to recognise when he had deviated from a task and always required a prompt to return to his checklist. Lucas’ safety awareness during meal prep improved and family were happy for him to make them a meal with minimal support from themselves.

As Lucas had been required to regularly walk to his local shops, his confidence with community access improved along with confidence to speak with strangers and articulate his needs.

Lucas has not yet been able to return to work and is unsure of whether he wishes to do so, but he is interested in volunteering with a local charity as a means of further occupying his time and increasing his social interactions.

He continues to work with the occupational therapist on managing his fatigue.

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Occupational therapy for cognitive impairment in stroke patients

Tammy hoffmann.

University of Queensland, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, BrisbaneAustralia, 4072

Sally Bennett

Chia‐lin koh.

National Taiwan University, School and Graduate Institute of Occupational Therapy, College of Medicine, TaipeiTaiwan, 100

Kryss T McKenna

Deceased, formerly of the University of Queensland, BrisbaneAustralia,

Cognitive impairment is a frequent consequence of stroke and can impact on a person's ability to perform everyday activities. There are a number of different intervention strategies that occupational therapists may use when working with people who have cognitive impairment post‐stroke.

To determine whether occupational therapy improves functional performance of basic activities of daily living (ADL) and specific cognitive abilities in people who have cognitive impairment following a stroke.

Search methods

We searched the Cochrane Stroke Group Trials Register (last searched May 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) ( The Cochrane Library Issue 1, 2009), MEDLINE (1966 to April 2009), EMBASE (1980 to April 2009), CINAHL (1982 to April 2009), PsycINFO (1840 to April 2009), PsycBITE, OTseeker and Dissertation Abstracts (the latest three were searched up to April 2009). In an effort to identify further published, unpublished, and ongoing trials, we also tracked relevant references through the cited reference search in Science Citation Index (SCI) and Social Science Citation Index (SSCI), reviewed the reference lists of relevant studies and reviews, handsearched relevant occupational therapy journals, and contacted key researchers in the area.

Selection criteria

Randomised and quasi‐randomised controlled trials that evaluated an intervention focused on providing cognitive retraining to adults with clinically defined stroke and confirmed cognitive impairment. The intervention needed either to be provided by an occupational therapist or given under the supervision of an occupational therapist.

Data collection and analysis

Two review authors independently examined the abstracts that might meet the inclusion criteria, assessed the quality and extracted data. We have presented results using mean differences.

Main results

We included one trial with 33 participants in this review. We found no difference between groups for the two relevant outcomes that were measured: improvement in time judgement skills and improvement in basic ADLs on the Barthel Index.

Authors' conclusions

The effectiveness of occupational therapy for cognitive impairment post‐stroke remains unclear. The potential benefits of cognitive retraining delivered as part of occupational therapy on improving basic daily activity function or specific cognitive abilities, or both, of people who have had a stroke cannot be supported or refuted by the evidence included in this review. More research is required.

Cognitive impairment is common after stroke and can affect a person's ability to do everyday activities such as dressing, feeding, and showering. Occupational therapy aims to help people reach their maximum level of functional independence. This review of one trial including 33 participants found that there is currently insufficient evidence to establish the effectiveness of occupational therapy for cognitive impairment in people who have had a stroke. More well‐designed clinical trials which test occupational therapy interventions for cognitive impairment post‐stroke are needed.

Stroke is a leading cause of chronic disability in many developed countries in the world ( CDCP 2003 ; Thrift 2000 ). A frequent consequence of stroke is impairment of cognition ( Patel 2003 ; Tatemichi 1994 ). Cognition encompasses processes that enable people to 'think', including the ability to concentrate, remember and learn, and may also include metaprocesses such as executive functioning ( Unsworth 1999 ). There is some disagreement regarding the classification of specific cognitive domains and impairments. Some authors include visual‐spatial perception and apraxia as cognitive impairments ( Cicerone 2005 ). However, many texts also classify visual‐spatial perception and apraxia separately to cognitive impairments. For the purpose of this review cognition impairment is considered to encompass impairments in attention and concentration, memory, orientation, and/or executive functions in accordance with The National Stroke Foundation of Australia's Clinical Guidelines for Stroke Rehabilitation and Recovery ( National Stroke Foundation 2005 ). Patel et al found that, in the three‐year period after the onset of their first stroke, up to 39% of patients had cognitive impairment ( Patel 2003 ). A significant relationship has been found between cognitive abilities and functional performance ( Abreu 1987 ; Hanson 1997 ; Poole 1991 ). Thus, cognitive impairment can reduce the independence of people who have had a stroke when performing basic activities of daily living (such as eating, dressing, and toileting) and instrumental activities of daily living (such as housework and social interactions) ( Hochstenbach 2000 ; Patel 2003 ; Zinn 2004 ). As a result, people with cognitive impairment following stroke often require ongoing care and support, which can place a strain on caregivers and society ( Blake 2002 ; Doyle 2002 ). Therefore, it is important for researchers and clinicians to identify effective interventions to treat cognitive impairment following stroke.

Occupational therapy plays a unique and important role in a multidisciplinary approach to the treatment of cognitive impairment ( Zoltan 2007 ). Occupational therapists assess and treat cognitive deficits to assist patients to reach their maximum level of functional independence and fulfil desired and required life roles after stroke ( Legg 2006 ; Poole 1991 ). The two general techniques used by occupational therapists to treat cognitive impairment are remedial and compensatory approaches ( Blundon 2000 ; Poole 1991 ; Radomski 1994 ). Based on the concept of the plasticity of the human brain and its ability to reorganise after being damaged, the remedial approach aims to promote patients' function by retraining deficits in specific cognitive domains (e.g. attention, memory and organisation). This approach assumes that retrained skills will transfer to functional performance more broadly than the immediate task including such activities of daily living as managing finances or planning household tasks. The compensatory approach utilises patients' residual strengths to compensate for deficits and aims to restore their function by teaching and assisting them and their families to develop strategies to overcome performance deficits. Debate exists around the validity of the assumptions and the effectiveness of these approaches. It has been argued that the skills acquired through repetitive drill‐like exercises using a remedial approach may not be readily transferred to daily living activities ( Cobble 1991 ). Furthermore, direct training in specific functional activities as part of the compensatory approach may not necessarily generalise to improved performance in everyday activities in home, work or school, and in leisure contexts ( Hanson 1997 ). A comprehensive systematic review may help to clarify these debates and examine the effectiveness of occupational therapy in treating cognitive impairment.

To our knowledge, there is no systematic review that has specifically examined the effectiveness of interventions delivered by occupational therapists in treating cognitive impairment in people with stroke. A review by Cicerone et al addressed the issue of the effectiveness of cognitive rehabilitation in stroke patients; however, it is not specific to occupational therapy ( Cicerone 2000 ; Cicerone 2005 ). Two reviews have examined the effectiveness of occupational therapy with stroke patients in general, but did not focus on the treatment of cognitive impairment ( Ma 2002 ; Steultjens 2003 ). As occupational therapy is considered to be an important part of the multidisciplinary management of stroke, and treatment of cognitive impairment is a common focus of this intervention, it is important to review the effectiveness of occupational therapy in assisting people with cognitive impairment after stroke to improve their functional independence.

To determine the effectiveness of occupational therapy for people with cognitive impairment after a stroke. In particular, to determine whether occupational therapy improves functional performance of basic and instrumental ADL and cognitive abilities post‐stroke.

Criteria for considering studies for this review

Types of studies.

We restricted the review to randomised controlled trials (RCTs), clinical trials where participants were quasi‐randomly assigned to one of two or more treatment groups, and cross‐over trials.

Types of participants

We included trials if their participants were adults (aged 18 years or over) with a clinically defined stroke and confirmed cognitive impairment as specified in each trial. For the purpose of this review we focused on cognitive impairments including attention and concentration, memory, orientation, and/or executive functions. We excluded trials with mixed aetiology groups unless participants who had had (and only had) a stroke comprised more than 50% of the participants in the trial and separate data for the participants with stroke were available either in the published article or from the trial authors.

Types of interventions

We included all occupational therapy interventions for cognitive impairment in people with stroke. We defined occupational therapy interventions in this review as interventions carried out by an occupational therapist or under the supervision of an occupational therapist, or indexed in major international occupational therapy texts ( Katz 2005 ; Pedretti 2001 ; Trombly 2002 ). These interventions may take either a remedial or a compensatory approach, or both. The remedial approach focuses on training specific cognitive deficits using media such as pencil and paper, computer tasks and board games. In a compensatory approach interventions may include (1) training skills for daily activities (e.g. dressing, ambulation, driving, managing a meal) and vocation using compensatory strategies; (2) advising and educating about the use of assistive devices that aid cognitive function, such as an alarm watch, a hand‐held computer, or a medication container; and (3) educating patients, families, and caregivers about strategies to overcome patients' cognitive impairment. The dynamic interactional approach (previously referred to as multicontextual) is an integrated approach, encompassing both remedial and compensatory elements to encourage generalisation of the treatment effect achieved in a clinical setting to patients' real life performance situation ( Toglia 2005 ). We considered the dynamic interactional approach as a third type of intervention in this review, separate from remedial and compensatory approaches. For the purpose of this review we focused on cognitive impairments including attention and concentration, memory, orientation, and/or executive functions. We did not include studies that focused on apraxia or perceptual impairments without also containing elements of cognitive retraining.  We also did not include trials which examined the effects of change to pharmaceutical interventions on cognitive function following stroke.

Types of outcome measures

Primary outcomes.

The primary outcome measure was assessments of basic activities of daily living (ADL).

Secondary outcomes

Secondary outcome measures were assessments of instrumental ADL, community integration, resumption of life roles, and specific cognitive abilities such as attention, memory, orientation, and/or executive functions or general cognitive function.

Search methods for identification of studies

See the 'Specialized register' section in the Cochrane Stroke Group module.

We searched the Cochrane Stroke Group Trials Register, which was last searched by the Managing Editor in May 2009. In addition, using comprehensive search strategies, we searched the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) ( The Cochrane Library Issue1, 2009), MEDLINE (1966 to April 2009) ( Appendix 1 ), EMBASE (1980 to April 2009), CINAHL (1982 to April 2009), PsycINFO (1840 to April 2009), PsycBITE, OTseeker, and Dissertation Abstracts (we searched the last three up to April 2009). The search strategies included four major areas: stroke, cognitive impairment, occupational therapy interventions and trial methodology. We developed the search strategy in consultation with the Cochrane Stroke Group Trials Search Co‐ordinator and we consulted an experienced medical librarian about the search strategies for each database.

In an effort to identify further published, unpublished, and ongoing trials:

• we tracked relevant references through the cited reference search in Science Citation Index (SCI) and Social Science Citation Index (SSCI);
• we scanned the reference lists of identified studies and reviews;
• American Journal of Occupational Therapy (1947 to 1949);
• Australian Occupational Therapy Journal (1963 to 1990);
• Asian Journal of Occupational Therapy (2001 to 2006);
• Canadian Journal of Occupational Therapy (1955 to 1965);
• Hong Kong Journal of Occupational Therapy (2001 to 2006);
• Indian Journal of Occupational Therapy (2001 to 2005);
• Journal of Occupational Science Australia (1993 to 1994);
• New Zealand Journal of Occupational Therapy (1957 to 1978, 1990 to 1995);
• Occupational Therapy in Health Care (1984 to 1986);
• Occupational Therapy and Rehabilitation (1938 to 1951);
• South African Journal of Occupational Therapy (1959 to 1991);
• we contacted authors and key researchers in the area;
• we scanned the abstracts of non‐English language studies if the abstracts were available in English.

We used the search strategy for MEDLINE (Ovid) ( Appendix 1 ) and adapted it to search the other databases.

Study selection

One review author (CK) screened the titles of articles identified in the searches and references, eliminated irrelevant studies and obtained the abstracts of the remaining studies. Using these abstracts, two review authors (CK and TH or SB) independently completed the first phase of study selection according to the four eligibility criteria (types of studies, participants, interventions, and outcome measures). We obtained the full texts of the studies that were considered as eligible for inclusion from this process or for which eligibility was unclear. Two review authors (CK and TH or SB) independently completed the second study selection process to finally decide on each trial’s inclusion or exclusion. We resolved any disagreements by discussion based on the inclusion criteria. If we could not reach a consensus, the third review author made the decision. When it was unclear whether the intervention was delivered by an occupational therapist we contacted the study authors for clarification.

Assessment of methodological quality

Two review authors (TH and SB) independently evaluated the methodological quality of eligible trials. During this evaluation, the review authors were blinded to the source of publication and results. The four sources of potential bias in trials of intervention effectiveness that we evaluated were: selection bias, performance bias, detection bias and attrition bias. According to the definition by Juni et al ( Juni 2001 ) selection bias refers to biased allocation of participants to comparison groups (i.e. absence of, or inadequate, allocation concealment). We assessed the methods of allocation concealment of the eligible studies according to the three categories and criteria suggested in the Cochrane Handbook for Systematic Reviews of Interventions ( Higgins 2008 ): A ‐ adequate; B ‐ unclear; and C ‐ inadequate. Performance bias refers to unequal provision of care apart from the intervention under evaluation (i.e. lack of blinding of therapists or participants, or both) ( Higgins 2008 ). Detection bias refers to biased assessment of outcome (i.e. lack of blinding of outcome assessors) ( Higgins 2008 ). Attrition bias refers to biased occurrence and handling of deviations from the intervention protocol (i.e. lack of analysis according to intention‐to‐treat) and loss to follow‐up ( Higgins 2008 ). To evaluate the four types of bias in the eligible trials, we applied the eight internal validity items adapted from the PEDro scale in this review ( Moseley 2002 ). After reviewing the trials, we assigned each of the eight items a 'yes' (present) or 'no' (absent or not reported) to indicate the methodological quality of the studies according to the criteria used to rate articles in the OTseeker database (http://www.otseeker.com/scale.htm) ( Table 2 ).

Criteria for assessing the methodological quality of trials

Data extraction

Two review authors (TH and SB) independently recorded the following information using a self‐developed data extraction form.

• Sample characteristics such as: age, level of education, sex, first or recurrent stroke, type and severity of stroke, time since onset of stroke, type of cognitive impairment, sample size, number of drop outs.
• Methodological quality: according to the eight internal validity items as described in Table 2 .
• Details of the interventions: type of interventions (remedial, compensatory, or dynamic interactional approach), materials used in interventions (e.g. cards, boards, paper and pencil exercises, computer games), duration and frequency of interventions and follow‐up, individual or group therapy.
• Outcome measures: the outcome measures used in the trial and when they were administered.

The same two review authors independently extracted data using a data extraction form to record methodological and outcome data.

Data analysis

For continuous data, we planned to calculate two types of estimate. The measure of the treatment difference for any outcome would be the mean difference (MD) when the pooled trials use the same rating scale or test, and the standardised mean difference (SMD) (the absolute mean difference divided by the standard deviation) when they use different rating scales or tests. We planned to calculate each one, together with the corresponding 95% confidence interval (CI). For dichotomous data, we planned to compute the relative risk (RR) or odds ratio (OR) with 95% CI.

We planned to pool the results of trials to present the overall estimate of the treatment effect using a fixed‐effect model viewed to assess heterogeneity. We planned to test heterogeneity between trial results by using I 2 estimates ( Higgins 2003 ). We would consider an I 2 value above 50% substantial, indicating heterogeneity between trial results. If heterogeneity was present we would carry out a sensitivity analysis to explore the reasons for this. Otherwise, we would use a random‐effects model (in which case the confidence intervals will be broader than those of a fixed‐effect model).

We planned to carry out a sensitivity analysis to evaluate the effect of trial quality by analysing separately the following categories of studies:

• trials with and without adequate randomisation and concealment of treatment allocation;
• trials with and without intention‐to‐treat analysis;
• trials with follow‐up periods of less than six months duration, six to 12 months duration, and more than 12 months duration.

Description of studies

See: Characteristics of included studies ; Characteristics of excluded studies ; Characteristics of ongoing studies .

See: Characteristics of included studies ; Characteristics of excluded studies .

Results of the search

We conducted the most current search of electronic databases in May 2009. This search yielded a total of 1639 references. We identified only one trial that met the inclusion criteria. We identified an additional trial that met the criteria but it is an ongoing trial that was due for completion at the end of 2009.

Included studies

The included study ( Carter 1983 ) is a RCT that examined the effect of a cognitive skills remediation programme with 33 people who were receiving rehabilitation in a hospital following acute stroke. For the 16 participants in the intervention group, cognitive skills remediation training was administered on an individual basis for 30 to 40 minutes three times per week for an average of three to four weeks. The cognitive skills remediation training was based on the Thinking Skills Workbook ( Carter 1980 ). The comparison group of 17 participants received rehabilitation as usual. The primary outcome measures were tests of visual scanning, visual‐spatial matching and time judgement from the Thinking Skills Workbook ( Carter 1980 ). However, in this review we considered only the time judgement scores a measure of cognitive skill as this review classified visual scanning and visual‐spatial matching as perceptual skills. We extracted data about the functional outcomes from the Carter study from the second article published in 1988 ( Carter 1983 ), which reported participants' basic ADL scores on the Barthel Index. This study met the criteria for inclusion because it measured the effect of elements of cognitive training on basic activities of daily living and on specific cognitive skills (time judgement).

Excluded studies

We excluded trials from this review if the intervention did not address cognitive impairments of people following stroke; if the trials were not RCTs; if they were conducted with mixed aetiology groups and participants with stroke were fewer than 50% of the participants or data were not separately available for participants with stroke; or the intervention in the trial was not carried out or supervised by an occupational therapist. We also excluded studies if the focus was on interventions for perceptual impairments or apraxia without also including interventions for cognitive impairments. Studies listed in the Characteristics of excluded studies table are those that appeared to be relevant and focused on cognitive retraining, but to our knowledge were not carried out by occupational therapists or did not focus on cognitive retraining.

Risk of bias in included studies

Two authors rated the methodological quality of the study independently using the PEDro scale ( Maher 2003 ). Individual item scores can be found in Table 2 .

Sequence generation

The participants in the Carter 1983 study were randomly allocated to groups but it is unclear how this was carried out.

There was no mention within the Carter 1983 articles of allocation to group being concealed.

Blinding of participants and therapists was not reported and is unlikely to have been achievable. A blind testing procedure was attempted, but according to the authors it was possible for the outcome assessor to be aware of the group assignment of the participants because of the physical layout of the stroke unit.

Follow‐up and exclusions

Reported outcome data for the study were available for 85% of participants for the Barthel Index outcome. The authors state that Barthel scores were not available for three participants from the control group and two participants in the treatment group but no reason for this was provided. Although data were available for 33 participants for the cognitive tests the authors only calculated cognitive test scores for the 76% of participants who had pre‐test performance below 80%; that is, scores for participants who had 80% of better pre‐test scores were not included in the calculation. The authors state this was to prevent possible ceiling effects.

Selective reporting

It is unclear whether selective reporting occurred in the Carter 1983 study. The description of the method used stated that three aspects of cognition were measured and these were each reported on. However, the cognitive skills evaluation from the Thinking Skills Workbook ( Carter 1980 ) from which the tests were drawn for the Carter 1983 study included eight cognitive skills.

Other potential sources of bias

The Carter 1983 paper did not report use of intention‐to‐treat analysis.

Effects of interventions

Given that there was only one study included in this review, a meta‐analysis was not possible. We found no difference between groups for the two relevant outcomes that were measured: improvement in time judgement skills and improvement in basic ADLs on the Barthel Index.

The aim of this review was to identify and evaluate the effectiveness of occupational therapy for cognitive impairment following stroke. Only one trial met the criteria for inclusion: the Carter 1983 trial, therefore data could not be pooled for further analysis or interpretation. This study tested the effect of cognitive remediation skills training compared with usual rehabilitation for people with cognitive impairments following stroke. We found no differences between groups for the cognitive skill of time judgement ( Analysis 1.1 ) or for basic ADL measured using the Barthel Index ( Analysis 1.2 ). It is possible that the sample size of only 33 participants may not have been large enough to detect an effect if one existed. Therefore, this study provides insufficient evidence about the effectiveness or otherwise for this intervention.

Comparison 1 Cognitive skills remediation training versus usual rehabilitation, Outcome 1 Improvement in time judgement.

Comparison 1 Cognitive skills remediation training versus usual rehabilitation, Outcome 2 Improvement in Barthel Index.

The effectiveness of occupational therapy for cognitive impairment post‐stroke remains unclear. The potential benefits of cognitive retraining delivered as part of an occupational therapy service on improving basic daily activity function or specific cognitive abilities, or both, of people who have had a stroke cannot be supported or refuted by evidence from the reviewed RCT.

In order to obtain reliable and valid evidence of the effect of occupational therapy for cognitive impairment post‐stroke further methodologically rigorous investigations using RCTs are needed. The included study must be viewed in the light of its small sample size. Future studies should aim to have larger numbers of participants.

Acknowledgements

Appendix 1. medline search strategy, medline (ovid).

1. exp cerebrovascular disorders/ or brain injuries/ or brain injury, chronic/ 2. (stroke$ or cva or poststroke or post‐stroke).tw. 3. (cerebrovasc$ or cerebral vascular).tw. 4. (cerebral or cerebellar or brain$ or vertebrobasilar).tw. 5. (infarct$ or isch?emi$ or thrombo$ or emboli$ or apoplexy).tw. 6. 4 and 5 7. (cerebral or brain or subarachnoid).tw. 8. (haemorrhage or hemorrhage or haematoma or hematoma or bleed$).tw. 9. 7 and 8 10. exp hemiplegia/ or exp paresis/ 11. (hemipar$ or hemipleg$ or brain injur$).tw. 12. 1 or 2 or 3 or 6 or 9 or 10 or 11 13. cognition disorders/ or confusion/ or neurobehavioral manifestations/ or memory disorders/ 14. (agnosia or amnesia or confusion or inattention).tw. 15. cognition/ or Arousal/ or Orientation/ or Attention/ or memory/ or perception/ or mental processes/ or thinking/ or Concept Formation/ or Algorithms/ or "Recognition (Psychology)"/ or Judgment/ or Awareness/ or Problem Solving/ or "Generalization (Psychology)"/ or "Transfer (Psychology)"/ or comprehension/ or Impulsive Behavior/ or Learning/ 16. ((cogniti$ or arous$ or orientat$ or attention$ or concentrat$ or memor$ or recall or percept$ or think$ or sequenc$ or algorithm$ or judg?ment$ or awareness or problem solving or generali?ation or transfer or comprehension or learning) adj10 (disorder$ or declin$ or dysfunct$ or impair$ or deficit$ or abilit$ or problem$)).tw. 17. (dysexecutive syndrome$ or mental process$ or (concept adj5 formation) or impulsive behavio?r$ or executive function$).tw. 18. 13 or 14 or 15 or 16 or 17 19. Randomized Controlled Trials/ or random allocation/ or Controlled Clinical Trials/ or control groups/ or clinical trials/ or clinical trials, phase i/ or clinical trials, phase ii/ or clinical trials, phase iii/ or clinical trials, phase iv/ 20. double‐blind method/ or single‐blind method/ or cross‐over studies/ or Program Evaluation/ or meta‐analysis/ 21. randomized controlled trial.pt. or controlled clinical trial.pt. or clinical trial.pt. or meta analysis.pt. 22. random$.tw. 23. (controlled adj5 (trial$ or stud$)).tw. 24. (clinical$ adj5 trial$).tw. 25. ((control or treatment or experiment$ or intervention) adj5 (group$ or subject$ or patient$)).tw. 26. (quasi‐random$ or quasi random$ or pseudo‐random$ or pseudo random$).tw. 27. ((control or experiment$ or conservative) adj5 (treatment or therapy or procedure or manage$)).tw. 28. ((singl$ or doubl$ or tripl$ or trebl$) adj5 (blind$ or mask$)).tw. 29. (coin adj5 (flip or flipped or toss$)).tw. 30. versus.tw. 31. (cross‐over or cross over or crossover).tw. 32. (assign$ or alternate or allocat$ or counterbalance$ or multiple baseline).tw. 33. controls.tw. 34. (treatment$ adj6 order).tw. 35. (meta‐analy$ or metaanaly$ or meta analy$ or systematic review or systematic overview).tw. 36. or/19‐35 37. occupational therapy/ 38. Rehabilitation/ or Rehabilitation, Vocational/ 39. activities of daily living/ or self care/ 40. automobile driving/ or exp transportation/ 41. "Task performance and analysis"/ or Work simplification/ 42. exp leisure activities/ 43. Home care services/ or Home care services, hospital‐based/ 44. Recovery of function/ 45. exp work/ or Human activities/ 46. occupational therap$.tw. 47. ("activities of daily living" or ADL or EADL or IADL).tw. 48. rehabilitation.tw. 49. ((self or personal) adj5 (care or manage$)).tw. 50. (dressing or feeding or eating or toilet$ or bathing or mobil$ or driving or public transport or public transportation).tw. 51. exp self‐help devices/ 52. (assistive adj5 (device$ or technology)).tw. 53. or/37‐52 54. 12 and 18 and 36 and 53 55. limit 54 to (humans and "all adult (19 plus years)") 56. apraxias/ or apraxia, ideomotor/ or neglect/ or exp dementia/ or exp Arm/ or exp Hand/ or exp Depressive Disorder/ or depression/ or exp Pharmaceutical Preparations/ or exp Drug Therapy/ 57. (apraxi$ or dysprax$ or aphasi$ or dysphasi$ or dementia or alzheimer$).ti. 58. atrial.tw. 59. 56 or 57 or 58 60. 55 not 59 61. (dose$ or drug$).tw. 62. 60 not 61 63. Magnetic Resonance Imaging/ or Diffusion Magnetic Resonance Imaging/ or Imaging, Three‐Dimensional/ or Diagnostic Imaging/ or Radionuclide Imaging/ or Magnetic Resonance Imaging, Cine/ 64. 62 not 63 65. (MRI or fMRI).tw. 66. 64 not 65

Data and analyses

Comparison 1.

Cognitive skills remediation training versus usual rehabilitation

Protocol first published: Issue 2, 2007 Review first published: Issue 9, 2010

Differences between protocol and review

We have clarified the definition of occupational therapy from the original protocol such that in Types of interventions it now states "We defined occupational therapy interventions in this review as interventions carried out by an occupational therapist or under the supervision of an occupational therapist or indexed in major international occupational therapy texts".

Characteristics of studies

Characteristics of included studies [ordered by study id].

Carter 1983

N: number of participants RCT: randomised controlled trial

Characteristics of excluded studies [ordered by study ID]

Characteristics of ongoing studies [ordered by study id], contributions of authors.

Tammy Hoffmann: conceiving, designing, and co‐ordinating the review; advising on search strategies; screening search results; screening retrieved papers against inclusion criteria; appraising the quality of papers; extracting data from papers; managing and analysing the data for review; interpreting the data (providing methodological, clinical, and policy perspectives); and writing the review.

Sally Bennett: screening retrieved papers against inclusion criteria; appraising the quality of papers; extracting data from papers; managing and analysing the data for the review; interpreting the data (providing methodological, clinical, and policy perspectives); and writing the review.

Chia‐Lin Koh: designing the review; designing search strategies; undertaking searches; screening search results; organising the retrieval of papers; screening retrieved papers against inclusion criteria; writing to authors of papers for additional information; providing additional data about papers; obtaining and screening data on unpublished studies; managing and analysing the data for review; interpreting the data (providing methodological, clinical, and policy perspectives); and writing the review.

Kryss McKenna (Passed away in April 2009): conceiving, designing and co‐ordinating the initial stage of the review, and advising on search strategies. Screening papers, data extraction and analysis occurred after April 2009.

Declarations of interest

None known. Fourth author, Kryss McKenna, deceased: refer to published protocol for previous listed interests.

References to studies included in this review

• Carter LT, Howard BE, O'Neill WA. Effectiveness of cognitive skills remediation in acute stroke patients . American Journal of Occupational Therapy 1983; 37 ( 5 ):320‐6. [ PubMed ] [ Google Scholar ] Carter LT, Oliveira DO, Duponte J, Lynch SV. The relationship of cognitive skills performance to activity of daily living in stroke patients . American Journal of Occupational Therapy 1988; 42 ( 7 ):449‐55. [ PubMed ] [ Google Scholar ]

References to studies excluded from this review

• Boiko EA, Kulishova TV, Shumakher GI, Iusupkhodzhaev RV. [The role of physical exercises in the improvement of cognitive functions in patients who survived stroke, in the early rehabilitative period] . Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury 2008; 6 :9‐12. [ PubMed ] [ Google Scholar ]
• Chen SZ, Jiang Q, Liu P, Huang DF, Ding JX. Effect of the cognitive rehabilitation on the functional independence of hemiplegic patients with stroke . Chinese Journal of Clinical Rehabilitation 2006; 10 ( 18 ):14‐6. [ Google Scholar ]
• Chen X‐F. Effect of community‐based‐rehabilitation on activities of daily life and cognitive function in stroke patients . Chinese Journal of Clinical Rehabilitation 2006; 25 ( 10 ):4‐6. [ Google Scholar ]
• Dirette DK, Hinojosa J, Carnevale GJ. Comparison of remedial and compensatory interventions for adults with acquired brain injuries . Journal of Head Trauma Rehabilitation 1999; 14 ( 6 ):595‐601. [ PubMed ] [ Google Scholar ]
• Donkervoort M, Dekker J, Stehmann‐Saris FC, Deelman BG. Efficacy of strategy training in left hemisphere stroke patients with apraxia: a randomised clinical trial . Neuropsychological Rehabilitation 2001; 11 ( 5 ):549‐66. [ Google Scholar ]
• Doornhein K, DeHaan EHF. Cognitive training for memory deficits in stroke patients . Neuropsychological Rehabilitation 1998; 8 ( 4 ):393‐400. [ Google Scholar ]
• Edmans JA, Webster J, Lincoln NB. A comparison of two approaches in the treatment of perceptual problems after stroke . Clinical Rehabilitation 2000; 14 :230‐43. [ PubMed ] [ Google Scholar ]
• Gasparinni B, Satz P. A treatment of memory problems in left hemisphere CVA patients . Journal of Clinical Neuropsychology 1979; 1 ( 2 ):137‐50. [ Google Scholar ]
• Hu X, Dou Z, Zhu H, Wan G, Li J. The single blind procedure research of cognitive rehabilitation interventions on cognitive deficits in patients with stroke . Chinese Journal of Clinical Rehabilitation 2003; 7 ( 10 ):1521‐3. [ Google Scholar ]
• Man DW, Soong WY, Tam SF, Hui‐Chan CW. A randomized clinical trial study on the effectiveness of a tele‐analogy‐based problem‐solving programme for people with acquired brain injury (ABI) . NeuroRehabilitation 2006; 21 ( 3 ):205‐17. [ PubMed ] [ Google Scholar ]
• Mount J, Pierce SR, Parker J, DiEgidio R, Woessner R, Spiegel L, et al. Trial and error versus errorless learning of functional skills in patients with acute stroke . NeuroRehabilitation 2007; 22 ( 2 ):123‐32. [ PubMed ] [ Google Scholar ]
• Ploughman M, McCarthy J, Bosse M, Sullivan HJ, Corbett D, Ploughman M, et al. Does treadmill exercise improve performance of cognitive or upper‐extremity tasks in people with chronic stroke? A randomized cross‐over trial . Archives of Physical Medicine & Rehabilitation 2008; 89 ( 11 ):2041‐7. [ PubMed ] [ Google Scholar ]
• Sarkamo T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, et al. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke . Brain 2008; 131 ( 3 ):866‐76. [ PubMed ] [ Google Scholar ]
• Shottke H. Rehabilitation of attention deficits after stroke: efficacy of a neuropsychological training program for attention deficits . Verhaltenstherapie 1997; 7 :21‐33. [ Google Scholar ]
• Soderback, I. The effectiveness of training intellectual functions in adults with acquired brain damage. An evaluation of occupational therapy methods . Scandinavian Journal of Rehabilitation Medicine 1988; 20 ( 2 ):47‐56. [ PubMed ] [ Google Scholar ]
• Thickpenny‐Davis KL, Barker‐Collo SL. Evaluation of a structured group format memory rehabilitation program for adults following brain injury . Journal of Head Trauma Rehabilitation 2007; 22 ( 5 ):303‐13. [ PubMed ] [ Google Scholar ]

References to ongoing studies

• Dressing Rehabilitation Evaluation Stroke Study (DRESS) . Ongoing study 1 March 2008.

Additional references

• Abreu BC, Toglia JP. Cognitive rehabilitation: a model for occupational therapy . American Journal of Occupational Therapy 1987; 41 ( 7 ):439‐48. [ PubMed ] [ Google Scholar ]
• Blake H, Lincoln NB. Cognitive impairments following a stroke: the strain on caregivers . British Journal of Therapy and Rehabilitation 2002; 9 :334‐7. [ Google Scholar ]
• Blundon G, Smits E. Cognitive rehabilitation: a pilot survey of therapeutic modalities used by Canadian occupational therapists with survivors of traumatic brain injury . Canadian Journal of Occupational Therapy 2000; 67 ( 3 ):184‐96. [ PubMed ] [ Google Scholar ]
• Carter LT, Caruso JL, Languirand MA, Berard MA. Cognitive skills remediation in stroke and non‐stroke elderly . Clinical Neuropsychology 1980; 2 ( 3 ):109‐13. [ Google Scholar ]
• Centers for Disease Control and Prevention. Public health and aging: hospitalizations for stroke among adults aged > 65 years ‐ United States, 2000 . JAMA 2003; 290 ( 8 ):1023‐4. [ Google Scholar ]
• Cicerone KD, Dahlberg C, Kalmar K, Langenbahn DM, Malec JF, Bergquist TF, et al. Evidence‐based cognitive rehabilitation: recommendations for clinical practice . Archives of Physical Medicine and Rehabilitation 2000; 81 ( 12 ):1596‐615. [ PubMed ] [ Google Scholar ]
• Cicerone KD, Dahlberg C, Malec JF, Langenbahn DM, Felicetti T, Kneipp S, et al. Evidence‐based cognitive rehabilitation: updated review of the literature from 1998 through 2002 . Archives of Physical Medicine and Rehabilitation 2005; 86 ( 8 ):1681‐92. [ PubMed ] [ Google Scholar ]
• Cobble ND, Bontke CF, Brandstater ME, Horn LJ. Rehabilitation in brain disorders. 3. Intervention strategies . Archives of Physical Medicine and Rehabilitation 1991; 72 ( 4‐S ):S324‐31. [ PubMed ] [ Google Scholar ]
• Doyle PJ. Measuring health outcomes in stroke survivors . Archives of Physical Medicine and Rehabilitation 2002; 83 Suppl 2 :S39‐43. [ PubMed ] [ Google Scholar ]
• Hanson CS, Shechtman O, Foss JJ, Krauss‐Hooker A. Occupational therapy: current practice and training issues in the treatment of cognitive dysfunction . NeuroRehabilitation 1997; 8 ( 1 ):31‐41. [ PubMed ] [ Google Scholar ]
• Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses . BMJ 2003; 327 ( 7414 ):557‐60. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Higgins JP, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 5.0.0 [updated February 2008] . The Cochrane Collaboration, 2008. Available from www.cochrane‐handbook.org.
• Hochstenbach J. Rehabilitation is more than functional recovery . Disability and Rehabilitation 2000; 22 ( 4 ):201‐4. [ PubMed ] [ Google Scholar ]
• Juni P, Altman DG, Egger M. Systematic reviews in health care: assessing the quality of controlled clinical trials . BMJ 2001; 323 ( 7303 ):42‐6. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Katz N, editor. Cognition and occupation across the life span: models for intervention in occupational therapy . 2nd Edition. Bethesda, MD: American Occupational Therapy Association, 2005. [ Google Scholar ]
• Legg L, Drummond A, Langhorne P. Occupational therapy for patients with problems in activities of daily living after stroke . Cochrane Database of Systematic Reviews 2006, Issue 4 . [Art. No.: CD003585. DOI: 10.1002/14651858.CD003585.pub2] [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ma HI, Trombly CA. A synthesis of the effects of occupational therapy for persons with stroke, part II: remediation of impairments . American Journal of Occupational Therapy 2002; 56 ( 3 ):260‐74. [ PubMed ] [ Google Scholar ]
• Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials . Physical Therapy 2003; 83 ( 8 ):713‐21. [ PubMed ] [ Google Scholar ]
• Moseley AM, Herbert RD, Sherrington C, Maher CG. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro) . Australian Journal of Physiotherapy 2002; 48 ( 1 ):43‐9. [ PubMed ] [ Google Scholar ]
• National Stroke Foundation. Clinical Guidelines for Stroke Rehabilitation and Recovery . Retrieved from: www.strokefoundation.com.au2005.
• Patel M, Coshall C, Rudd AG, Wolfe CD. Natural history of cognitive impairment after stroke and factors associated with its recovery . Clinical Rehabilitation 2003; 17 ( 2 ):158‐66. [ PubMed ] [ Google Scholar ]
• Pedretti LW, Early MB, editors. Occupational therapy: practice skills for physical dysfunction . 5th Edition. St Louis: Mosby Inc, 2001. [ Google Scholar ]
• Poole J, Dunn W, Schell B, Tiernan K, Barnhart JM. Statement: occupational therapy services management of persons with cognitive impairments . American Journal of Occupational Therapy 1991; 45 ( 12 ):1067‐8. [ PubMed ] [ Google Scholar ]
• Radomski MV. Cognitive rehabilitation: advancing the stature of occupational therapy . American Journal of Occupational Therapy 1994; 48 ( 3 ):271‐3. [ PubMed ] [ Google Scholar ]
• Steultjens EM, Dekker J, Bouter LM, Nes JC, Cup EH, Ende CH. Occupational therapy for stroke patients: a systematic review . Stroke 2003; 34 ( 3 ):676‐87. [ PubMed ] [ Google Scholar ]
• Tatemichi TK, Desmond DW, Stern Y, Paik M, Sano M, Bagiella E. Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities . Journal of Neurology, Neurosurgery and Psychiatry 1994; 57 ( 2 ):202‐7. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Thrift AG, Dewey HM, Macdonell RA, McNeil JJ, Donnan GA. Stroke incidence on the east coast of Australia: the North East Melbourne Stroke Incidence Study (NEMESIS) . Stroke 2000; 31 ( 9 ):2087‐92. [ PubMed ] [ Google Scholar ]
• Toglia JP. A dynamic interactional approach to cognitive rehabilitation . In: Katz N editor(s). Cognition and occupation across the life span: models for intervention in occupational therapy . 2nd Edition. Bethesda, MD: American Occupational Therapy Association, 2005:29‐72. [ Google Scholar ]
• Trombly CA, Radomski MV. Occupational therapy for physical dysfunction . 5th Edition. Baltimore, MD: Williams & Wilkins, 2002. [ Google Scholar ]
• Unsworth C. Cognitive and perceptual dysfunction . Philadelphia: FA Davis Company, 1999. [ Google Scholar ]
• Zinn S, Dudley TK, Bosworth HB, Hoenig HM, Duncan PW, Horner RD. The effect of poststroke cognitive impairment on rehabilitation process and functional outcome . Archives of Physical Medicine and Rehabilitation 2004; 85 ( 7 ):1084‐90. [ PubMed ] [ Google Scholar ]
• Zoltan B. Vision, perception and cognition. A manual for the evaluation and treatment of the adult with acquired brain injury . Thorofare NJ: SLACK, 2007. [ Google Scholar ]

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Occupational Adaptation Intervention With Patients With Cerebrovascular Accident: A Clinical Study

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Jacquelyn Ward Gibson , Janette K. Schkade; Occupational Adaptation Intervention With Patients With Cerebrovascular Accident: A Clinical Study. Am J Occup Ther July/August 1997, Vol. 51(7), 523–529. doi: https://doi.org/10.5014/ajot.51.7.523

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Objective. The purpose of this study was to examine the use of the Occupational Adaptation frame of reference in the evaluation and treatment of patients with cerebrovascular accident (CVA).

Method. Outcomes of functional independence and discharge environment were measured through a quasi-experimental design. Twenty-five former patients served as the control subjects, and 25 patients admitted after the programmatic implementation of Occupational Adaptation served as the treatment subjects.

Results. Data analyses indicated that the Occupational Adaptation subjects achieved higher levels of functional independence and were discharged to less restrictive environments compared with the control subjects.

Conclusion. Use of intervention guided by the Occupational Adaptation frame of reference was associated with improved functional independence and discharge to less-restricted environments for this group of patients with CVA.

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• Sep 3, 2017

Case Study | Stroke Rehabilitation: Assessment and Upper Limb Intervention

Updated: Nov 8, 2020

By Jamie Grant - Director, The Occupational Therapy Hub. Originally written in 2016. UK stroke discharge service.

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