From the Guidelines
Cognitive rehabilitation after stroke should be approached through a multi-disciplinary team, including the patient and their goals, family and friends, other caregivers, physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others, as this approach has been shown to result in small improvements in cognitive functioning compared to control conditions 1. The evidence for the multi-disciplinary approach to cognitive rehabilitation in patients with cerebrovascular accident (CVA) or stroke is based on several studies, including a 2023 scientific statement from the American Heart Association/American Stroke Association, which found that cognitive rehabilitation, including restorative cognitive training and functional cognitive rehabilitation, results in small improvements in cognitive functioning compared to control conditions 1. Some key points to consider when implementing a multi-disciplinary approach to cognitive rehabilitation after stroke include:
- The importance of communication and coordination among team members to maximize the effectiveness and efficiency of rehabilitation 1
- The use of a variety of activities, including practice requiring attention, planning or working memory with pencil and paper or computerized activities, and teaching of compensatory strategies 1
- The potential benefits of virtual reality tools and training and education for family and patients, although more research is needed to fully understand the effectiveness of these approaches 1
- The need for cognitive rehabilitation to begin as soon as medically feasible after stroke and to continue through both inpatient and outpatient phases, with sessions typically lasting 45-60 minutes each and incorporating both therapist-led activities and home practice exercises. Overall, the evidence suggests that a multi-disciplinary approach to cognitive rehabilitation after stroke can result in small but meaningful improvements in cognitive functioning, and that this approach should be tailored to the individual needs and goals of each patient.
From the Research
Evidence for Multi-Disciplinary Approach to Cognitive Rehabilitation
The evidence for a multi-disciplinary approach to cognitive rehabilitation in patients with cerebrovascular accident (CVA) or stroke is as follows:
- A study published in 2024 2 found that a multidomain cognitive training approach using a Virtual Reality Rehabilitation System (VRRS) resulted in significant improvements in working memory and language abilities, as well as a reduction in depression symptoms and caregiver burden.
- A consensus-based core recommendation from the Second Stroke Recovery and Rehabilitation Roundtable in 2019 3 highlighted the importance of cognitive rehabilitation in stroke recovery, but noted that there is currently insufficient evidence to build consensus on specific approaches.
- A systematic review of randomized controlled trials published in 2022 4 found evidence for the beneficial effects of various rehabilitation interventions, including virtual reality, computer-based cognitive rehabilitation, and non-aerobic exercises, on cognitive functions in individuals with stroke.
- A protocol for a systematic review and meta-analysis published in 2021 5 aimed to compare the efficacy of cognitive rehabilitation interventions for patients with post-stroke cognitive impairment, highlighting the need for further research in this area.
- An overview of recommendations arising from systematic reviews published in 2015 6 found support for the effectiveness of cognitive rehabilitation for some cognitive impairments, but identified significant gaps in the current evidence base and recommended further research to strengthen the evidence base.
Key Findings
- Multidomain cognitive training approaches have shown promise in improving cognitive functions in patients with stroke 2, 4.
- There is a need for further research to establish the most efficacious cognitive rehabilitation interventions for patients with post-stroke cognitive impairment 3, 5, 6.
- Virtual reality, computer-based cognitive rehabilitation, and non-aerobic exercises may be beneficial in promoting cognitive functions in patients with stroke 4.