Timothy J. Wolf; Rehabilitation, Disability, and Participation Research: Are Occupational Therapy Researchers Addressing Cognitive Rehabilitation After Stroke?. Am J Occup Ther 2011;65(4):e46-e59. doi: 10.5014/ajot.2011.002089.
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I reviewed articles published in the American Journal of Occupational Therapy (AJOT) in 2009 and 2010 to assess (1) whether research was published in the practice area of rehabilitation, disability, and participation and (2) the evidence being produced in an underdeveloped subcategory of this practice area: cognitive rehabilitation after stroke. The review revealed one intervention effectiveness study that addressed cognitive rehabilitation poststroke published in the 2-year period. Further analysis of outside repositories of evidence in this area revealed that although some evidence supports rehabilitation approaches for people with cognitive dysfunction after a stroke, little research has been devoted to this practice area. The poststroke cognitive intervention approaches in use have been shown to have little or no effect on improving everyday life activity. Occupational therapy has a key research and practice role with the poststroke population, and occupational therapists should be at the forefront in developing the science to support the effectiveness of their services.
Intervention approaches addressing cognitive dysfunction poststroke should include participation in everyday life activities as an outcome measure. Past research and available evidence have shown that interventions in common use have a limited impact on changing everyday life outcomes for this client population.
Future intervention development should include methodologies to improve performance in everyday life for people with cognitive dysfunction poststroke. Generalization and transfer of cognitive intervention approaches are problematic and need to be addressed at the onset of intervention development. Intervention approaches that do not take into account the context in which an activity will be performed will not produce changes in everyday life participation.
The development and testing of cognitive intervention approaches should be carried out by a multidisciplinary team. Cognition is an overarching factor in all areas of function, and different professions have different expertise in addressing cognitive dysfunction. Physical therapists understand how cognition affects motor performance, speech therapists understand how cognition affects language, neuropsychologists understand how to capture cognitive dysfunction through standardized assessments, and occupational therapists understand how cognition supports performance in everyday life. Collaboration on multidisciplinary teams will enable occupational therapists to best contribute to the development of the science to support their role in this practice area.
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