Well then it is obvious that your first task is to get the survivor back to their original cognitive ability. This is your doctor's responsibility. Don't let them abdicate responsibility by using the statement: 'All strokes are different, all stroke recoveries are different.'. Screaming may be required, no excuses are allowed from your stroke medical 'professionals.'
Abstract WP206: Cognitive Functioning Predicts Engagement in Inpatient Stroke Rehabilitation
Originally published12 Feb 2020Stroke. ;51:AWP206
Abstract
Introduction:
Patient engagement during inpatient stroke rehabilitation (ISR) is
critical to long-term outcomes. Cognitive deficits have demonstrated
impact on engagement in rehabilitation. Here, we prospectively
investigated the relationship between specific cognitive domains and
patient engagement during ISR.
Methods: Of 423 patients completing ISR, 127 (30%) had complete data with mean age=67.63+15.46 years, NIHSS=6.78+5.68, and onset from stroke to ISR admission=8.55+7.72 days. The sample comprised 55% males and 56.7% had a college education or more. The National Institute of Neurologic Disorders - Canadian Stroke Network (NINDS-CSN) 30-minute cognitive screening battery was administered within 72 hours of ISR admission to assess verbal fluency, executive functioning, and memory. The Hopkins Rehabilitation Engagement Ratings Scale (HRERS; total score 0-30, higher=greater engagement) was completed by treating therapists at ISR discharge. Spearman rank-order correlations (rs) examined the relationships between the HRERS total score and the NINDS-CSN total (the mean z-score across subtests) as well as its 8 subtests. Items with correlations p<.10 were entered into a logistic regression (controlling for age, comorbidity, and stroke severity) to predict low (HRERS ≤ 25) versus high engagers (HRERS > 26).
Results: NINDS-CSN total and 6 subtests assessing verbal fluency and executive function were weakly to moderately correlated with HRERS scores (rs=0.23-.38, all p’s <.01). Memory subtests were not associated with HRERS. Higher NINDS-CSN total score and subtests reflecting executive functions modestly increased the odds of being a high engager (Odds Ratios ranged from 1.03-1.08, 95% CIs ranged from 1.013-1.134, all p’s < .01).
Conclusion: Poor executive functioning may pose a barrier to patient engagement in ISR. Executive functions may impact patients’ ability to shift among activities, maintain attention, and rapidly process information during therapy. Rehabilitation therapists should consider making environmental modifications, providing more frequent guidance and positive reinforcement, and presenting simplified material to increase engagement in stroke patients with executive dysfunction.
Methods: Of 423 patients completing ISR, 127 (30%) had complete data with mean age=67.63+15.46 years, NIHSS=6.78+5.68, and onset from stroke to ISR admission=8.55+7.72 days. The sample comprised 55% males and 56.7% had a college education or more. The National Institute of Neurologic Disorders - Canadian Stroke Network (NINDS-CSN) 30-minute cognitive screening battery was administered within 72 hours of ISR admission to assess verbal fluency, executive functioning, and memory. The Hopkins Rehabilitation Engagement Ratings Scale (HRERS; total score 0-30, higher=greater engagement) was completed by treating therapists at ISR discharge. Spearman rank-order correlations (rs) examined the relationships between the HRERS total score and the NINDS-CSN total (the mean z-score across subtests) as well as its 8 subtests. Items with correlations p<.10 were entered into a logistic regression (controlling for age, comorbidity, and stroke severity) to predict low (HRERS ≤ 25) versus high engagers (HRERS > 26).
Results: NINDS-CSN total and 6 subtests assessing verbal fluency and executive function were weakly to moderately correlated with HRERS scores (rs=0.23-.38, all p’s <.01). Memory subtests were not associated with HRERS. Higher NINDS-CSN total score and subtests reflecting executive functions modestly increased the odds of being a high engager (Odds Ratios ranged from 1.03-1.08, 95% CIs ranged from 1.013-1.134, all p’s < .01).
Conclusion: Poor executive functioning may pose a barrier to patient engagement in ISR. Executive functions may impact patients’ ability to shift among activities, maintain attention, and rapidly process information during therapy. Rehabilitation therapists should consider making environmental modifications, providing more frequent guidance and positive reinforcement, and presenting simplified material to increase engagement in stroke patients with executive dysfunction.
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