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Ben-Dor Cohen M, Nahum M, Traub Bar-Ilan R, Eldar E, Maeir A. Coping with emotional dysregulation among young adults with ADHD: A mixed-method study of self-awareness and strategies in daily life. Neuropsychol Rehabil 2024; 34:1161-1185. [PMID: 37971947 DOI: 10.1080/09602011.2023.2279181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 10/29/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Emotional dysregulation (ED) impacts functional outcomes among individuals with attention-deficit hyperactivity disorder (ADHD). Self-awareness and strategies may enhance coping with ED yet are rarely studied in ADHD. OBJECTIVES To explore ED-related self-awareness and strategies in daily life of adults with ADHD, and to examine the interrelations between them and their association with symptoms. METHODS Sixty young adults with ADHD participated in a mixed-method study. At baseline, self-awareness and strategies were assessed using the Self-Regulation Skills Interview (SRSI); ADHD symptoms were self-rated using the ASRS symptom checklist. Then, symptoms were rated over 5-days using ecological momentary assessment (EMA). RESULTS Significant challenges in self-awareness and strategies were demonstrated quantitatively and qualitatively. Awareness of ED was associated with variability of ADHD symptoms on EMA yet not with symptom severity. Qualitative content analysis revealed a range of self-awareness levels, which were related to noticing ED-related cues and understanding contextual factors predictive of ED. Self-awareness and strategies were significantly associated. Strategies varied regarding effort, individual preference and temporality. CONCLUSIONS Variability of ADHD symptoms was negatively associated with self-awareness of ED. Strategy selection in daily-life among adults with ADHD may be affected by self-awareness and by a possible trade-off between short-term effort and long-term effectiveness.
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Affiliation(s)
- Maayan Ben-Dor Cohen
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ruthie Traub Bar-Ilan
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eran Eldar
- Psychology Department, Faculty of Social Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Cognitive Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adina Maeir
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Salazar-Frías D, Rodríguez-Bailón M, Ricchetti G, Navarro-Egido A, de Los Santos M, Funes MJ. Training to deal with distractions and conflicting situations in activities of daily living after traumatic brain injury (TBI): Preliminary evidence from a single-case experimental design study. Neuropsychol Rehabil 2024:1-36. [PMID: 39010748 DOI: 10.1080/09602011.2024.2375495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/28/2024] [Indexed: 07/17/2024]
Abstract
TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03958487.
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Affiliation(s)
- Daniel Salazar-Frías
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
| | - María Rodríguez-Bailón
- Physiotherapy (Occupational Therapy) Department, Health Science School, University of Málaga, Málaga, Spain
| | - Giorgia Ricchetti
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
| | - Alba Navarro-Egido
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
| | - Macarena de Los Santos
- Mind, Brain and Behaviour Research Centre (CIMCYC), Methodology of Behavioural Sciences Department, School of Psychology, University of Granada, Granada, Spain
| | - María Jesús Funes
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
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Goverover Y, Sharan S, Krupp L, DeLuca J. Exploring the Efficacy of a Remote Strategy-Based Intervention for People With Multiple Sclerosis With Everyday Memory Impairments: A Pilot Study. Am J Occup Ther 2024; 78:7804205020. [PMID: 38801676 DOI: 10.5014/ajot.2024.050468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
IMPORTANCE This pilot study evaluates a remote strategy-based intervention for individuals with multiple sclerosis who experience everyday memory impairments. The intervention can potentially inform cognitive rehabilitation for this population. OBJECTIVE To investigate the feasibility and efficacy of an intervention (TELE-Self-GEN) to determine whether it can alleviate everyday memory impairments of individuals with multiple sclerosis. DESIGN Pretest-posttest. SETTING Community. PARTICIPANTS Ten adults with multiple sclerosis. INTERVENTION Six synchronous treatment sessions were delivered online via Zoom. The treatment protocol embedded a memory strategy (self-generated learning) within a metacognitive framework, including self-awareness and self-management strategies. The treatment emphasizes when and how self-generation should be used. OUTCOME Measurements assessed feasibility and participants' satisfaction with the intervention and its delivery method, as well as memory, everyday memory, and functional performance. RESULTS Participants expressed high satisfaction with the virtual treatment, highlighting its convenience as a key factor. Treatment resulted in improvements in memory performance, perceived memory ability in daily life, and functional performance. CONCLUSIONS AND RELEVANCE Results provide initial proof of concept in the utilization of a remotely delivered, strategy-based treatment approach to improve memory performance and functional abilities. The pilot data support a larger randomized clinical trial of the TELE-self-GEN. Plain-Language Summary: The results of this pilot study highlight the promising potential of TELE-self-GEN for people with multiple sclerosis (MS), who face memory challenges every day. This remotely delivered, strategy-based occupational therapy treatment approach, TELE-self-GEN, has the potential to significantly improve functional memory. The study participants reported improvements in their memory performance, perceived memory ability in daily life, and functional performance. These encouraging results serve as a foundation for more extensive clinical trials using TELE-self-GEN for people with MS.
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Affiliation(s)
- Yael Goverover
- Yael Goverover, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, New York University, New York, NY;
| | - Saumya Sharan
- Saumya Sharan, MS, OTR/L, is Student, Department of Occupational Therapy, New York University, New York, NY
| | - Lauren Krupp
- Lauren Krupp, MD, is Professor of Neurology and Director, Multiple Sclerosis Comprehensive Care Center, New York University Langone Health, New York, NY
| | - John DeLuca
- John DeLuca, PhD, is Senior Vice President for Research and Research Training and Professor of Physical Medicine and Rehabilitation and Neurosciences, Kessler Foundation, West Orange, NJ
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Eliav R, Nadler Tzadok Y, Segal-Rotenberg S, Kizony R. Efficacy of Intervention of Participation and Executive Functions (I-PEX) for Adults Following Traumatic Brain Injury: A Preliminary Pilot Randomized Controlled Trial. Neurorehabil Neural Repair 2024:15459683241231529. [PMID: 38375580 DOI: 10.1177/15459683241231529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Participation restrictions following traumatic brain injury are associated with executive function (EF) deficits (EFDs). The subacute recovery phase's specific characteristics (enhanced brain plasticity and impaired self-awareness) and contextual factors (inpatient setting) warrant adjusting cognitive rehabilitation protocols. The Intervention of Participation and Executive Functions (I-PEX) was designed to improve EFDs during subacute inpatient rehabilitation. OBJECTIVE To investigate the I-PEX's preliminary efficacy to improve EFDs during the performance of complex daily activities and enhance self-awareness, cognitive self-efficacy, participation, and quality of life postdischarge. METHODS A pilot pre-, post-, and follow-up double-blind randomized controlled trial with 25 participants randomly allocated to the I-PEX (n = 13) or treatment-as-usual (n = 12) group. Cognitive assessments were administered pre- and postintervention, and quality of life and participation questionnaires 1-month postdischarge. Data analysis included repeated measures analysis of variance mixed design and independent t-tests, extracting effect sizes. RESULTS Significant group-by-time interaction effect with a medium effect size was found for the primary outcome measure; EFs manifested in complex daily activities, indicating a larger improvement for the experimental group. The group effect was not significant. The experimental group's mean delta score (pre-post improvement) was significantly higher (1.75 ± 2.89; t(23) = 2.52, P = .019), with a large effect size (d = 1.012, 95% confidence interval [0.166-1.840]). We found no significant group and interaction effects for EFs, self-awareness, and cognitive self-efficacy or no significant differences in participation or quality of life postdischarge. CONCLUSIONS Results provide initial evidence for the I-PEX efficacy in treating EFDs in the subacute phase and could help determine effect size for future studies. CLINICAL TRIAL REGISTRY NUMBER ClinicalTrial.gov NCT04292925.
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Affiliation(s)
- Rotem Eliav
- Department of Occupational Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Department of Occupational Therapy, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Yael Nadler Tzadok
- Department of Occupational Therapy, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Shir Segal-Rotenberg
- Department of Occupational Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Department of Occupational Therapy, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Rachel Kizony
- Department of Occupational Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Depatrment of Occupational Therapy, Sheba Medical Center, Tel-Hashomer, Israel
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Smith PJ, Whitson HE, Merwin RM, O’Hayer CV, Strauman TJ. Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW). Front Aging Neurosci 2023; 15:1256430. [PMID: 38076541 PMCID: PMC10702760 DOI: 10.3389/fnagi.2023.1256430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/20/2023] [Indexed: 02/12/2024] Open
Abstract
Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.
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Affiliation(s)
- Patrick J. Smith
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Heather E. Whitson
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
- Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - Rhonda M. Merwin
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
| | - C. Virginia O’Hayer
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA, United States
| | - Timothy J. Strauman
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
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Jaywant A, Mautner L, Waldman R, O’Dell MW, Gunning FM, Toglia J. Feasibility and Acceptability of a Remotely Delivered Executive Function Intervention That Combines Computerized Cognitive Training and Metacognitive Strategy Training in Chronic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5714. [PMID: 37174232 PMCID: PMC10178100 DOI: 10.3390/ijerph20095714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/24/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
Executive dysfunction after stroke is associated with limitations in daily activities and disability. Existing interventions for executive dysfunction show inconsistent transfer to everyday activities and require frequent clinic visits that can be difficult for patients with chronic mobility challenges to access. To address this barrier, we developed a telehealth-based executive function intervention that combines computerized cognitive training and metacognitive strategy. The goal of this study was to describe intervention development and to provide preliminary evidence of feasibility and acceptability in three individuals who completed the treatment protocol. The three study participants were living in the community and had experienced a stroke >6 months prior. We assessed satisfaction (Client Satisfaction Questionnaire-8 [CSQ-8]), credibility (Credibility and Expectancy Questionnaire), and feasibility (percent of sessions completed). All three subjects rated the treatment in the highest satisfaction category on the CSQ-8, found the treatment to be credible, and expected improvement. Participants completed a median of 96% of computerized cognitive training sessions and 100% of telehealth-delivered metacognitive strategy training sessions. Individuals with chronic stroke may find a remotely delivered intervention that combines computerized cognitive training and metacognitive strategy training to be feasible and acceptable. Further evaluation with larger samples in controlled trials is warranted.
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Affiliation(s)
- Abhishek Jaywant
- Departments of Psychiatry & Rehabilitation Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Leah Mautner
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Rachel Waldman
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA
| | - Michael W. O’Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Faith M. Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY 10065, USA
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY 10522, USA
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Goodchild K, Fleming J, Copley JA. Assessments of Functional Cognition Used with Patients following Traumatic Brain Injury in Acute Care: A Survey of Australian Occupational Therapists. Occup Ther Health Care 2023; 37:145-163. [PMID: 34971350 DOI: 10.1080/07380577.2021.2020389] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This study aimed to describe how occupational therapists working in acute care settings in Australia assess cognitive function in patients with TBI, the influences on assessment choice, and clinician perceptions of performance-based assessment. An online survey was completed by 81 occupational therapists. The most common method of cognitive assessment was reported as non-standardized observation of functional tasks (94.7%), followed by carer-report / self-report (93%). Despite their being positive perceptions of performance-based assessment there was limited use in practice. Assessment use was impacted by practical and organizational constraints including access to assessment resources, time and the built environment in acute care.
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Affiliation(s)
- Katherine Goodchild
- Occupational Therapy Department, STARS Surgical Treatment and Rehabilitation Service, Brisbane, Australia.,Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jennifer Fleming
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jodie A Copley
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Jaywant A, Arora C, Toglia J. Online awareness of performance on a functional cognitive assessment in individuals with stroke: A case-control study. Neuropsychol Rehabil 2022; 32:1970-1988. [PMID: 35293836 DOI: 10.1080/09602011.2022.2050409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Unawareness is a significant barrier to cognitive rehabilitation following acquired brain injury. Little is known about online awareness of cognitively-based instrumental activities of daily living (C-IADL) after stroke, particularly C-IADLs that emphasize executive functions. Our goal was to evaluate in stroke patients (1) online awareness during and immediately after a C-IADL task that emphasizes executive functions and (2) the association between awareness and performance on the C-IADL task. Seventy-seven stroke patients on an acute inpatient rehabilitation unit and 77 control participants completed the 10-item Weekly Calendar Planning Activity (WCPA-10), a standardized C-IADL task that requires working memory, planning, shifting, and inhibition. Trained examiners observed the use of a self-checking strategy and self-recognition of errors during the task. Immediately after the task, participants estimated their accuracy, and rated their own performance, which was compared with objective accuracy. Relative to the control group, stroke patients overestimated their accuracy, less often recognized errors, and less frequently used a self-checking strategy. Overestimation was associated with worse overall performance on the WCPA-10. Findings suggest that poor online awareness of C-IADL performance is common in stroke patients undergoing acute inpatient rehabilitation. Increasing awareness through metacognitive interventions should be a core focus of early post-stroke cognitive rehabilitation.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Catherine Arora
- School of Health and Natural Science, Mercy College, Dobbs Ferry, NY, USA
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.,School of Health and Natural Science, Mercy College, Dobbs Ferry, NY, USA
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Jaywant A, Arora C, Lussier A, Toglia J. Impaired Performance on a Cognitively-Based Instrumental Activities of Daily Living Task, the 10-Item Weekly Calendar Planning Activity, in Individuals With Stroke Undergoing Acute Inpatient Rehabilitation. Front Neurol 2021; 12:704775. [PMID: 34367057 PMCID: PMC8337012 DOI: 10.3389/fneur.2021.704775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022] Open
Abstract
Performance-based, functionally relevant, and standardized measures of cognitive-instrumental activities of daily living (C-IADL) can complement neuropsychological tests of cognitive impairment and provide valuable clinical information to inform rehabilitation planning. Existing measures have been validated in the outpatient setting. Here, we sought to evaluate a 10-item, short-form of a C-IADL measure, Weekly Calendar Planning Activity (WCPA-10), in inpatients with stroke undergoing acute rehabilitation. The specific goal was to determine if the WCPA-10 could differentiate between stroke patients undergoing acute inpatient rehabilitation and healthy control individuals. We also explored whether the WCPA-10 would identify C-IADL limitations in stroke patients screened as having intact cognition. Seventy-seven stroke inpatients undergoing rehabilitation and 77 healthy control participants completed the WCPA-10, which involves entering a list of simulated, fictional appointments into a weekly schedule while keeping track of and adhering to multiple task rules and ignoring built-in obstacles and distractions. Compared to the control group, stroke patients had significantly worse accuracy, made more errors, used fewer cognitive strategies, followed fewer rules, took more time to complete the task, and were less efficient. 83% of stroke patients were less accurate than predicted by their age, and 64% used less strategies than their age prediction. Among 28 participants who screened as having “normal” cognitive function on the Montreal Cognitive Assessment, the majority had deficits on the WCPA-10. Our results provide initial support for use of a brief C-IADL assessment, WCPA-10, for individuals with stroke undergoing inpatient rehabilitation. They indicate that stroke patients have deficits in C-IADL accuracy, efficiency, and strategy use at this stage of stroke recovery. Results highlight the need to use performance based, functional cognitive assessments, even for those who perform well on cognitive screening tools.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, United States.,NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, United States
| | - Catherine Arora
- School of Health and Natural Science, Mercy College, Dobbs Ferry, NY, United States
| | - Alexis Lussier
- School of Health and Natural Science, Mercy College, Dobbs Ferry, NY, United States
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, United States.,NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, United States.,School of Health and Natural Science, Mercy College, Dobbs Ferry, NY, United States
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Nagelkop ND, Rosselló M, Aranguren I, Lado V, Ron M, Toglia J. Using Multicontext Approach to Improve Instrumental Activities of Daily Living Performance after a Stroke: A Case Report. Occup Ther Health Care 2021; 35:249-267. [PMID: 34039245 DOI: 10.1080/07380577.2021.1919954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cognitive deficits constitute one of the greatest challenges for independence achievement after a stroke. This paper provides an in depth view of the application of the Multicontext approach within routine Occupational Therapy care for a 41-year-old who demonstrated limited participation in activities of daily living as a consequence of executive function impairments and limited self-awareness. Results indicated improved online self-awareness, strategy use and functional performance, however, no changes were observed on a standard Awareness Questionnaire. This suggests that awareness within activities may be more important in contributing to effective strategy use and functional performance compared to verbal acknowledgment in an interview. Results also support the feasibility of the Multicontext approach within inpatient settings in Argentina.
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Affiliation(s)
| | | | | | | | | | - Joan Toglia
- Mercy College, School of Health and Natural Science, Dobbs Ferry, New York, USA
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