From the Guidelines
The multi-context approach to cognitive rehabilitation after stroke is a recommended strategy, as it has substantial evidence supporting its effectiveness in improving cognitive function and promoting generalization of skills to everyday life. This approach involves practicing cognitive skills across different environments and situations, which leads to better transfer of cognitive skills to novel situations compared to single-context approaches 1. Several controlled studies have shown improvements in executive functioning, attention, memory, and problem-solving abilities when patients practice skills across varied contexts. For example, patients who practice memory strategies in different settings (hospital, home, community) show better functional outcomes than those who practice in only one environment.
The effectiveness of the multi-context approach appears to be related to the development of metacognitive strategies that help patients recognize when and how to apply learned skills in new situations. Neuroimaging studies suggest that multi-context training may promote neuroplasticity by engaging diverse neural networks. The approach typically involves 8-12 weeks of therapy with sessions occurring 2-3 times weekly, gradually increasing the variety and complexity of contexts. This approach aligns with our understanding of how the brain relearns skills after injury, as varied practice enhances neural reorganization and strengthens new connections that support cognitive recovery.
Some key recommendations for cognitive rehabilitation after stroke include:
- Using cognitive training strategies that consider practice, compensation, and adaptive techniques for increasing independence 1
- Implementing compensatory strategies to improve memory functions, including the use of internalized strategies and external memory assistive technology 1
- Providing enriched environments to increase engagement with cognitive activities 1
- Considering virtual reality training for verbal, visual, and spatial learning, although its efficacy is not well established 1
- Using errorless learning techniques for individuals with severe memory impairments, although there is limited transfer to novel tasks or reduction in overall functional memory problems 1
Overall, the multi-context approach to cognitive rehabilitation after stroke is a valuable strategy for improving cognitive function and promoting recovery, and should be considered as part of a comprehensive rehabilitation plan. The most recent and highest quality study supporting this approach is the 2016 guideline for adult stroke rehabilitation and recovery from the American Heart Association/American Stroke Association 1.
From the Research
Evidence for Multi-Context Approach
The evidence for a multi-context approach to cognitive rehabilitation in patients with cerebrovascular accident (CVA) or stroke is supported by several studies:
- A case report published in 2021 2 demonstrated the effectiveness of the Multicontext approach in improving instrumental activities of daily living performance after a stroke.
- The study found that the Multicontext approach improved online self-awareness, strategy use, and functional performance in a 41-year-old patient with executive function impairments and limited self-awareness.
Cognitive Rehabilitation Interventions
Cognitive rehabilitation interventions, including computer-assisted cognitive rehabilitation, have been shown to be effective in improving cognitive function in patients with stroke:
- A systematic review and meta-analysis published in 2022 3 found that computer-assisted cognitive rehabilitation significantly improved global cognition and activities of daily living in patients with post-stroke cognitive impairment.
- Another systematic review 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 cognition in individuals with stroke.
Effectiveness of Cognitive Rehabilitation
The effectiveness of cognitive rehabilitation in improving cognitive function in patients with stroke is supported by several studies:
- A study published in 2018 5 found that computerized cognitive training using Erica software improved cognitive function in patients with stroke, particularly in attention and memory abilities.
- A review published in 2005 6 found substantial evidence to support cognitive-linguistic therapies for people with language deficits after left hemisphere stroke, as well as visuospatial rehabilitation for deficits associated with visual neglect after right hemisphere stroke.
Key Findings
Key findings from the studies include:
- Computer-assisted cognitive rehabilitation can be a valuable technique for cognitive rehabilitation after stroke 3.
- The Multicontext approach can improve instrumental activities of daily living performance after a stroke 2.
- Cognitive rehabilitation interventions can improve cognitive function in patients with stroke, particularly in attention, memory, and executive function abilities 5, 4, 3, 6.