The Effects of Cognitive Rehabilitation on Motor Performance, Balance and Fear of Falling in Stroke Patients

Study Overview
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Brief Summary
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One of the most common complications in stroke patients is cognitive impairment. Cognitive impairment affects a large part of the life of stroke patients. However, the relationship between cognitive impairment and fear of falling in stroke patients has not been investigated in any study yet. Various treatment approaches have been developed to improve cognitive function. While some of these approaches focus on improving cognitive function, others aim to reach the maximum functional level with various compensation methods taught to the patient in the current cognitive situation. As a result of cognitive interventions, stroke patients' participation in daily life, adherence to treatment and quality of life increase. The aim of this study is to investigate the effects of cognitive interventions on motor performance, balance and fear of falling. This study will contribute to the literature by investigating these effects of cognitive rehabilitation.

Detailed Description
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Participants will be randomized into two groups as control and experimental groups. The control group will receive traditional rehabilitation intervention, while the experimental group will receive additional cognitive intervention to traditional rehabilitation. Two groups will be evaluated before and after the study. Participants' motor performance, balance and fear of falling will be determined by evaluation criteria.

Official Title
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The Effects of Cognitive Rehabilitation on Motor Performance, Balance and Fear of Falling in Stroke Patients

Conditions
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Stroke, Cognition Disorder, Fear Anxiety

Intervention / Treatment
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* Other: Cognitive Rehabilitation
* Other: Conventional Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Having been diagnosed with stroke The duration of the disease is in the range of 1-24 months Having a score of 21 or lower on the mini mental state test Having received 3 or more according to the Functional Ambulation Scale Not having a vision problem that will affect the vision of the materials to be used during the treatment Being able to communicate sufficiently to understand the simple orders given Exclusion Criteria: Having been diagnosed with bilateral stroke Having a neurological disease other than the diagnosis of stroke Development of aphasia after stroke
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Participants will be randomly divided into intervention and control groups. Both groups will be treated for 6 weeks. Each participant will be treated for a total of thirty hours, one hour a day, five days a week.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Control Group<br>Traditional exercises: stretching exercises, strengthening exercises, balance exercises, walking exercises and fine motor skill exercises. | Other: Conventional Therapy<br>* Strengthening, walking, balance and coordination exercises are performed according to the needs of the participants.<br>|
| Experimental: Cognitive Rehabilitation Group<br>Cognitive rehabilitation; memory, executive function, attention, concentration and calculation exercises. | Other: Cognitive Rehabilitation<br>* Language, memory, attention and executive function exercises are performed for the participants' deficient cognitive functions.<br>Other: Conventional Therapy<br>* Strengthening, walking, balance and coordination exercises are performed according to the needs of the participants.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Montreal Cognitive Assessment | Developed to evaluate mild cognitive impairments, Montreal Cognitive Assessment assesses different cognitive abilities including executive functions, visuospatial skills, memory, language, attention concentration, abstract thinking, calculation and orientation. It takes about 10 minutes to administer and the highest total score that can be obtained from the test is 30. Accordingly, scores of 21 and above are considered normal. | a day before the study start | 
| Montreal Cognitive Assessment | Developed to evaluate mild cognitive impairments, Montreal Cognitive Assessment assesses different cognitive abilities including executive functions, visuospatial skills, memory, language, attention concentration, abstract thinking, calculation and orientation. It takes about 10 minutes to administer and the highest total score that can be obtained from the test is 30. Accordingly, scores of 21 and above are considered normal. | through study completion, an average of 2 months | 
| Fugl-Meyer Assessment | The Fugl-Meyer Assessment is used to evaluate any loss or abnormality in physiological, anatomical structure or function in motor function. | a day before the study start | 
| Fugl-Meyer Assessment | The Fugl-Meyer Assessment is used to evaluate any loss or abnormality in physiological, anatomical structure or function in motor function. | through study completion, an average of 2 months | 
| Tinetti Balance & Gait Test | Tinetti Balance and Gait Scale is used to evaluate patients' balance and gait. | a day before the study start | 
| Tinetti Balance & Gait Test | Tinetti Balance and Gait Scale is used to evaluate patients' balance and gait. | through study completion, an average of 2 months | 
| Falls Efficacy Scale International (FES-I) | FES-I is a self-report questionnaire that provides information on the level of anxiety about falls for 16 activities of daily living. | a day before the study start | 
| Falls Efficacy Scale International (FES-I) | FES-I is a self-report questionnaire that provides information on the level of anxiety about falls for 16 activities of daily living. | through study completion, an average of 2 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Timed Up & Go (TUG) Test | TUG is a practical clinical assessment tool developed to measure the physical mobility and motor performance of elderly individuals. TUG measures the time for the person to stand up from the chair, walk 3 meters, and return to the chair and sit. | a day before the study start | 
| The Timed Up & Go (TUG) Test | TUG is a practical clinical assessment tool developed to measure the physical mobility and motor performance of elderly individuals. TUG measures the time for the person to stand up from the chair, walk 3 meters, and return to the chair and sit. | through study completion, an average of 2 months | 
| 10 meter walking test | 10-meter walking test is a practical clinical assessment tool developed to measure walking capacity and motor performance of elderly individuals. The 10-meter walking test is performed by measuring the time it takes for a person to walk at normal walking speed between two markers that are 10 meters apart. | a day before the study start | 
| 10 meter walking test | 10-meter walking test is a practical clinical assessment tool developed to measure walking capacity and motor performance of elderly individuals. The 10-meter walking test is performed by measuring the time it takes for a person to walk at normal walking speed between two markers that are 10 meters apart. | through study completion, an average of 2 months |