Please select the eligibility criteria that correspond to the clinical trial below.
Title: Guided Versus Directed Training in Acute Stroke Rehabilitation
Brief Summary: Individuals with cognitive impairments after stroke sustain significant disability in their daily tasks, and account for a significant proportion of stroke-related healthcare costs. This loss of independence is costly because individuals with stroke-related cognitive impairments require more rehabilitation and more resources to support their living, whether in institutional or community settings. The proposed study examines the effects of directed and guided training on the recovery of independence with daily activities in adults with stroke-related cognitive impairments in acute rehabilitation. The investigators predict that patients in both groups will demonstrate significant improvement in independence with daily activities in the first 12 months after rehabilitation admission, but that patients who receive guided training will demonstrate significantly more improvements than patients who received directed training.


Options:
A: Inclusion Criteria:

* Aged 18 years of age or greater
* Admitted to out-patient rehabilitation post ischemic stroke

Exclusion Criteria:

* more than 6 months post stroke onset
* those not requiring occupational therapy
* hemorrhagic stroke
* neurological diagnoses other than stroke
* major psychiatric illness
* moderate or severe aphasia (NIH Stroke Scale aphasia rating of 2 or more)
* dementia (Mini Mental State Exam scores of 24 or less)
B: Inclusion Criteria:

* first hospitalization with a diagnosis of stroke (previous experience of adjustment to stroke may influence outcomes),
* discharge from acute care hospital, inpatient rehabilitation or outpatient occupational therapy to a non-institutionalized setting,
* FIM scores at rehabilitation discharge of at least 3 for expression, comprehension, memory and problem-solving (to ensure potential participants' ability to participate in coaching process) and
* live within the City of Ottawa.

Exclusion Criteria:

* Those discharged from acute or inpatient rehabilitation and are referred to outpatient stroke rehabilitation for occupational therapy will be excluded until they complete their outpatient occupational therapy (due to potential overlap of client goals while in outpatient occupational therapy)
* have other degenerative neurological diagnoses (such as Parkinson's, Multiple Sclerosis) or
* have a current major depressive or psychotic disorder.
C: Inclusion Criteria:

* Aged 50 - 75 years
* Disability grade 2 or 3 on MRS\*)
* Being in the late-phase of stroke (1 - 5 years after an ischemic or hemorrhagic stroke)
* Ability to understand written and oral information and instructions in Swedish
* Having an own housing
* Ability to travel to the place of intervention and evaluation
* No need for personal assistance in activities of daily living while participating in the treatment (going to the toilet, transport/transportation services for disabled, walking)

Exclusion Criteria:

* Disability rated ˂ 2 or ˃ 3 on MRS\*)
* Pronounced fear of horses or allergy constituting a risk for the patients to participate in the therapeutic riding
* Heart conditions that constitutes a risk for the individual to participate in the interventions
* Non-controlled epileptic seizures constituting a risk for the patients to participate in the intervention
* Lack of cognitive and/or verbal ability that makes it difficult for the individual to understand instructions and/or evaluation
* Total paralysis of the affected arm
* Injury or disease that makes the individual not suitable for the trial
* Weight ˃ 95 kg (in order to spare the horses)
* Having more than a half-time employment
* Injury, disease or addiction that make the individual not suitable for the trial
* Participation in RGRM or therapeutic riding during the year prior to inclusion
* Having an additional stroke within the past year (TIA is however accepted)
* Lack of willingness to participate in both treatment methods
* Living ˃ 80 km from Gothenburg
* Dependent on transportation services for disabled across the community border which is not allowed according to the regulation
D: Inclusion Criteria:

* primary diagnosis of acute stroke
* admission to acute inpatient rehabilitation
* impairment in cognitive functions (as indicated by 14-item Executive Interview ≥ 3)

Exclusion Criteria:

* diagnosis of dementia in the medical record
* inability to follow two-step commands 80% of the time
* severe aphasia (score of 0 or 1 on the Boston Diagnostic Aphasia Examination 3rd Edition Severity Rating Scale)
* current untreated major depressive, bipolar, or psychotic disorder (PRIME-MD)
* drug or alcohol abuse within 3 months (Mini-International Neuropsychiatric Interview)

Answer: D