Multicontextual Treatment Approach in Stroke
Condition: Stroke; Cognitive Impairment; Quality of Life
MeSH terms: Stroke
Study type: Interventional

Summary: 
      BACKGROUND: It is known that cognitive disorders affect the rehabilitation of stroke patients
      but which cognitive rehabilitation intervention should apply to stroke patients and what
      their effects are on their life is not clear yet.

      OBJECTIVE: to investigate the effects of cognitive rehabilitation including combined
      approaches on quality of the life and social participation of stroke patients.

      METHODS: 20 patients with chronic stroke were randomly divided into two groups (Group 1 and
      2), each including 10. Patients in each group were treated with neurophysiological exercises
      3 times a week for 8 weeks and the subjects in Group 1 received cognitive rehabilitation
      additionally. The cognitive rehabilitation program consisted of individualized combined
      approaches including multicontextual treatment and bottom-up approaches. Loeweinstein
      Occupational Therapy Cognitive Assessment (LOTCA), Montreal Cognitive Assessment (MoCA) to
      assess cognitive status, Short Form-36 (SF-36) to assess the quality of life, Functional
      Independence Measure (FIM) to evaluate functional independence, Canadian Occupational
      Performance Measure and Craig Handicap Assessment and Reporting Technique- Short Form
      (CHART-SF) to evaluate social participation were used.
    

Detailed description: 
      Forty-two patients who were diagnosed with a stroke by a neurologist were admitted to the
      Stroke Unit of Sisli Memorial Hospital from November 2011 to April 2014. Our study was
      conducted on 20 patients who met the inclusion criteria of the study. Informed consent was
      obtained from each patient before the study. The Ethics Commission of Hacettepe University
      Senate (application No: 410.01-3346) approved this study. Patients were randomly divided into
      two groups of 10 people using a random number table. The number of cases was determined to be
      10 patients for each group by using the power analysis method. Power analysis was performed
      based on the LOTCA and MoCA scales which are expected to have the most changes after the
      therapy. In this small randomized controlled trial (Small RCT); while the first group (CRG)
      applied a neurophysiological and cognitive rehabilitation therapy consisting of
      individualized combined approaches including multi-contextual treatment and bottom-up
      approaches, the second group (CG) implemented only a neurophysiological treatment program as
      the control group.

      The 1st group determined by randomization applied a total of 2 hours-exercise programs
      consisting of 1-hour-neurophysiological exercise and 1-hour cognitive rehabilitation. The 2nd
      Group implemented only a 1-hour neuropsychological exercise program. The treatment programs
      determined for both groups were carried out 3 days a week for a total of 8 weeks. Cognitive
      rehabilitation sessions of the 1st group included 30 minutes of remedial and functional
      adaptive approaches and 30 minutes of implementation of Multicontextual treatment
      intervention.

      While determining the cognitive rehabilitation programs of the patients; the weak areas in
      their cognitive skills were identified by analyzing the tests conducted before the treatment.
      Restorative approaches consisted of the repetition of pencil-and-paper activities and
      computer-based exercises according to the weak cognitive skills of the patients determined by
      the assessments made.

      While determining a specific multi-contextual treatment intervention for the patients; their
      roles, personalities, habits, interests, requests, living conditions, and environments were
      questioned, the activities determined by COPM were revised and the essential requirements of
      this approach tried to be ensured.

      According to this approach, using multiple environments and conditions, transfer of learning,
      and increasing the patient's awareness were provided. Also, the usage of various strategies
      and associating the new knowledge with the old knowledge were emphasized
    

Intervention name(s): neurophysiological exercise; cognitive rehabilitation
Intervention type(s): Other; Other
Intervention description(s): The content of the treatment program consisted of neurophysiological exercises based on Bobath.; Cognitive rehabilitation sessions of the experimental group included 30 minutes of remedial and functional adaptive approaches and 30 minutes of implementation of Multicontextual treatment intervention.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: social participation; occupational therapy; stroke; cognition; quality of life