Effect of cognitive strategy training protocol on cognitive performance in stroke patients: a preliminary study

Abstract

Background: Stroke patients with cognitive impairment have difficulty with occupational performance such as basic activities of daily living (BADL), instrumental activities of daily living (IADL), work, leisure, and social participation In this study, the researcher developed cognitive strategy training protocol combination of the PRPP System of Intervention and the Multicontext Approach to improve cognitive performance through performing the IADL tasks. Objectives: To examine the task mastery of stroke patients during the performance of the IADL tasks, and to examine the effects of the cognitive strategy training protocol on cognitive performance in stroke patients. Methods: This research employed a quasi-experimental, one-group pretest-posttest design to compare pre-and post-test scores after receiving the cognitive training protocol. Eight stroke patients who met the criterior participatd in this study. The criterior were; diagnosed with first stroke within 6-24 months, had cognitive impairments as measured by the MoCA or MoCA-B, had zero to mild depression conditions as measured by the PHQ-9-Thai version, and did not have aphasia (motor, sensory, and global). All participants received the cognitive strategy training protocol three times a week, for 4 consecutive weeks. Each session took approximately 60 minutes per day. The intervention was divided into three main phases with 12 sessions of intervention. The participants completed and prioritized five tasks based on their needs and desires selected by the Canadian Occupational Perform Measure (COPM). After that, participants performed the first three tasks and were videotaped while they were performing the tasks. Outcome measurement of the pre-test and post-test scores were the PRPP System-Thai version. Scores of Stage One of the PRPP System-Thai version were analyzed using descriptive statistics and scores of Stage Two of the PRPP System-Thai version were computed by using the Wilcoxon signed-rank test. Results: The finding of this study showed that, before the intervention, all participants got pre-test percentage scores below the criterion of 100% which presented lower task mastery than expected. After the intervention, every participant had higher scores of the post-test percentage scores of Stage One of the PRPP System for at least 1 activity even though still had scores below 100%. Most of them (5 out of 8) showed higher scores in both activities but some participants indicated lower scores after the intervention in one out of two activities, and one participant showed equal pre-test and post-test scores. The analytic results from the Wilcoxon signed-rank test showed no significant difference between the pre-test and post-test scores in all activities (p>0.05). However, the descriptive-analytic results of the post-test percentage scores of Stage Two of the PRPP System, 4 out of 8 participants had higher scores for at least 1 activity even if still had scores below 100%. Two participants presented higher scores in both activities. Nevertheless, one participant indicated lower scores after the intervention in one out of two activities, and some participants also showed equal pre-test and post-test scores. The tendency of increased performance of the participants after the intervention despite the significant difference was found.