Please select the eligibility criteria that correspond to the clinical trial below.
Title: Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR) Treatment Approach for Stroke
Brief Summary: Stroke is the most serious disabling condition in the United States and the developed world. Novel stroke rehabilitation approaches, such as task-specific training, have shown promise in improving an individual's recovery in the rehabilitation setting; however, evidence suggests that these improvements are not generalized or transferred to the home, community, or work settings. Thus, these interventions usually do not impact overall health and participation outcomes. This research study seeks to improve task-specific training as a stroke rehabilitation approach by integrating it with evidence-based cognitive-oriented strategies which have shown great promise as a way to address the limitations of task-specific training. The new treatment protocol is called Cognitive-Oriented Strategy Training Augmented Rehabilitation, or COSTAR. The hypothesis of this study is that COSTAR will result in more efficient functional skill acquisition, better long-term retention of skills learned, and generalization and transfer of skills learned to home, community, and work settings.


Options:
A: Inclusion Criteria:

* diagnosis of stroke or TIA has been confirmed.
* newly referred to and eligible for home care services (physiotherapy, speech language therapy, occupational therapy, nursing) through the Toronto Central CCAC.
* living at home in the community (outside of an institutional setting) up to 18-months post-stroke.
* English speaking

Exclusion Criteria:

* refuse to give informed consent.
* more than 18 months post-stroke at time of recruitment.
* unable to read/write English and an appropriate translator is not available.
B: 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)
C: Inclusion Criteria:

1. age 18 or older;
2. have completed all physician recommended rehabilitation and currently not receiving rehabilitation services;
3. at least one-month post-stroke;
4. have self-reported unmet functional goals; and
5. NIH Stroke Scale (NIHSS) total score of 2-12.

Exclusion Criteria:

1. have sustained a hemorrhagic stroke;
2. NIH Stroke Scale (NIHSS) aphasia rating of 1 or more (impaired speech);
3. MoCA cognitive screen score of less than 21 (impaired general cognitive ability);
4. neurological diagnoses other than stroke;
5. major psychiatric illness (bipolar disorder, OCD, panic disorder, PTSD, and/or borderline personality disorder);
6. no major depressive symptoms (PHQ-9 \< 20);
7. a score of 6 or less on the CIHI aphasia screen combined items 64 and 66;
8. terminal illness;
9. blindness; and
10. non-English speaking.
D: Inclusion Criteria:

* Symptomatic ischemic stroke with clinical syndrome of stroke and a corresponding ischemic lesion.
* MRI or CT results compatible with clinical diagnosis of acute ischemic stroke
* NIH Stroke Scale Score on admission 1 to 14, both inclusive
* Modified Rankin Scale before stroke 0 to 2, inclusive
* Randomization within 3 months after stroke onset (goal: 80% within 3 weeks)
* Sufficient communication possible
* Informed consent given by the patient and/or the patient's legally acceptable representative

Exclusion Criteria:

* Substantial cognitive decline (Mini Mental State Examination (MMSE) score \> 24) or pre-existing dementia or Parkinson disease
* Persistent disturbed level of consciousness
* Persistent aphasia
* Pre-existing significant psychiatric diseases (i.e. Schizophrenia, Major Depression, Bipolar Disorders, all according to DSMIV); Patients with minor Depression (DSM IV) can be included
* Severe sensory impairment making neuropsychological testing impossible
* Severe comorbidity (e.g. unstable or severe cardiovascular or pulmonal disease, neoplasm, severe liver or renal insufficiency and symptomatic stenosis of the ipsilateral carotid artery, cancer...)
* Unreliability for follow up
* Unwillingness or inability to participate or to sign the informed consent

Answer: C