Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 29,42 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Tuesday, January 14, 2025
Cognitive Impairment After Stroke: Rehabilitation Strategies and SMART Goal Setting
The only goal in stroke is 100% recovery! Don't follow this SMART goal idea, it is just trying to lower your recovery expectation(One goal only; 100% recovery) by pushing the tyranny of low expectations; so you won't ever think that all your stroke medical 'professionals' ARE COMPLETELY INCOMPETENT!
Target audience: Persons at risk for, or who have experienced, poststroke cognitive impairment.
How does stroke affect thinking skills poststroke?
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A stroke
occurs when there is a disruption of blood supply to the brain, leading
to the death or damage of brain cells. There are 2 main types of stroke: ischemic and hemorrhagic.
Ischemic strokes occur when a blood clot in a vessel blocks the blood
flow to the brain. Hemorrhagic strokes occur when an artery ruptures,
causing bleeding into the brain.
•
Cognition is the comprehensive term for thinking processes related to recognizing, understanding, and problem-solving. Cognitive impairment is a condition that affects various processes, such as thinking, memory, concentration, and decision-making abilities.1 A stroke can affect various cognitive skills, such as memory, visual processing, reasoning, recognition, comprehension, and the ability to formulate thoughts and produce spontaneous speech.
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Each
area of the brain is responsible for a different aspect of cognitive
function. The area of your brain that is affected by the stroke
determines what symptoms of cognitive impairment you may experience. For
instance, a stroke in the frontal lobe of the brain may lead to
challenges in reasoning, decision-making, and learning new skills.
Poststroke
cognitive impairment (PSCI) affects various mental processes, including
thinking, memory, concentration, and decision-making abilities.
Although PSCI encompasses a range of cognitive impairment symptoms, they
are typically not severe enough to qualify as dementia. Approximately
30% of stroke survivors are diagnosed with PSCI. Risk factors for
developing PSCI include being aged >65 years, having high blood
pressure, diabetes, atrial fibrillation, and smoking.
Poststroke cognitive impairment and dementia
•
Some individuals may experience poststroke cognitive impairment and dementia (PSCID).3
Approximately 30% of stroke survivors develop dementia (PSCID) within 1
year. Although PSCI and PSCID are related conditions that can occur
after a stroke, PSCID represents a more advanced stage of cognitive
decline than typically associated with the stroke itself. Early
intervention, rehabilitation, and lifestyle management strategies are
essential for addressing the different levels of cognitive impairment in
both PSCI and PSCID.
What are some cognitive changes you may experience with PSCI?1
What is neuroplasticity? How does it affect my cognitive recovery?
•
After a stroke, the brain can still recover to some extent due to “neuroplasticity.” Neuroplasticity
is a process that enhances connections between intact brain cells.
Think of brain reserve as the “hardware” of our brain. This reserve is
influenced by factors such as brain size and number of neurons before a
stroke.
Image, table 1
Orientation difficulties
Difficulty remembering the date, month, year, or the people and places around you.
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Awareness
Difficulty
realizing you have some cognitive issues, leading to a lack of
awareness or forgetfulness. This may also include being unaware of or
denying having a disability or impairment such as unawareness of having
significant weakness or paralysis on one side of the body and its
limitation or believing they can move that side normally.
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Attention difficulties
Experiencing difficulty focusing on a recipe while cooking or on lights while driving.
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Short-term or long-term memory difficulties
Difficulty remembering important information, such as conversations, medication schedules, and birthdays.
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Organizing and planning difficulties
Struggling to efficiently organize mail or plan an event.
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Unilateral neglect
While getting dressed, you may forget to attend to body parts or check for glasses placed on the affected side.
On
the other hand, cognitive reserve is like the “software” of your brain.
It is determined by a variety of complex mental and intellectual
activities that you engage in throughout your life. Both the brain and
cognitive reserves can compensate for the damage caused by a stroke.
Why is cognitive rehabilitation important in my recovery?
•
Cognitive rehabilitation
is a type of therapy that aims to improve cognitive functions such as
attention (eg, selective attention and sustained attention), memory (eg,
working memory and short-term), executive functions (eg, planning,
problem-solving, and decision-making), and language (eg, understanding
spoken or written language, conveying language, and social skills). The
primary goal of this therapy is to assist individuals with specific
cognitive difficulties in enhancing their participation in daily
activities, such as managing their medication, using the telephone to
call someone, taking public transport, and handling their finances.
Regular practice of cognitive exercises enhances memory and thinking
skills for better daily life functioning.
•
If
you require cognitive rehabilitation, it is recommended that you
collaborate with a psychologist/neuropsychologist, speech and language
therapist, occupational therapist, or physiotherapist. These
professionals will assist you in identifying specific problem areas and
developing a treatment plan tailored to your needs.
•
Collaborating
with your family and health care team, you can establish personalized
goals and implement cognitive rehabilitation strategies at home.
What are some rehabilitation strategies that I can do at home?4
There
are many types of cognitive exercises and strategies that you can do on
your own at home or in the community outside of your formal therapy
sessions with a health care provider. Table 2 provides you with some ideas of what cognitive skills you may want to work on.
Cognitive Changes
Rehabilitation Strategies
Image, table 2
Orientation difficulties
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Use a daily planner to remember your appointment dates. Read newspapers or listen to the news to keep up-to-date with events.
Image, table 2
Awareness
•
Video
record yourself doing a task such as making a meal, putting away the
dishwasher, or completing your morning self-care routine and view it
later to see how you perform.
•
Get feedback from family, friends, and clinicians on how you perform a task.
Image, table 2
Attention difficulties
•
Engage in activities such as solving block designs, puzzles, crosswords, or sudoku.
•
Identify visual differences between pictures.
•
When
working on demanding activities such as paying bills, reading a book,
or cooking, it is important to minimize distractions in the environment.
What are some cognitive rehabilitation interventions I can do with my therapist?4
Rehabilitation
strategies can be performed at home with the assistance of family
members or independently. However, you can also seek support from your
health care team to optimize your progress. Some of the topics discussed
in this section can be carried out with the help of your therapist (table 3).5-8 Moreover, you can engage in some of these activities outside your therapy sessions to further enhance your cognitive abilities.
Thinking skills with the help of tools or strategies
•
A strategy is a helpful tool used to complete daily activities.
•
Your
therapist may notice that you tend to ignore items on your left side of
vision. Your therapist will instruct you to turn your head to the left
when looking at items located on the left side.
NIBS may promote cognitive functions such as attention and working memory
•
Your
therapist will place electrodes over your head to stimulate your brain
to improve your ability to learn skills, improve your planning
abilities, and to enhance your memory.
Table 3
Rehabilitation strategies from health care providers.
How can I maximize my cognitive rehabilitation through SMART goals?
Setting
goals is essential to cognitive rehabilitation as it can lead to
greater satisfaction, motivation, recovery, and meaningful outcomes.9
Creating personal goals is an effective way to prioritize what matters
most and bring about positive change in your daily routine.
•
The
SMART goal framework is a common guide that helps you set an effective
goal. You can set goals at home, independently, or with the help of a
family member and/or health care provider. Your goals should be: Specific to you and your needs, Measurable; Attainable; Relevant to you; and have a Timeframe. Figure 1 provides an example of goal setting.
It is recommended that the goals you set should be agreed on by you, your family, and health care team.
(Your only goal is 100% recovery! DEMAND YOUR HEALTH CARE TEAM DELIVERS THAT! NO excuses!)
What other strategies can help my cognitive recovery?
Complementary and integrative medicine
Cognitive recovery can involve complementary and integrative medicine practices such as yoga, mindfulness, and meditation.
•
Yoga practice teaches self-control and discipline and allows mind and body to work together.10
•
Mindfulness
is the state of being fully present in the moment and being aware of
your thoughts, emotions, and sensations. Practicing mindfulness can
enhance attention span and performance in demanding cognitive tasks.11
•
Meditation
aids in training attention and awareness, contributing to the cognitive
recovery process. Additionally, meditation helps reduce symptoms of
depression, tiredness, and fatigue. You can practice meditation on your
own using various meditation applications, such as Calm, Headspace,
Unplug, and Buddhify.
Applications for Brain Training
Some applications can be helpful for training memory and attention, as well as challenging your reasoning skills.12
Here are some examples available on Android or iOS: Peak (PopReach
Incorporated), Neuronation (NeuroNation), Train your Brain (Senior
Games), Impulse - Brain Training (GMRD Apps Limited), Brainwell Mind
& Brain Trainer (Monclarity, LLC), and Lumosity (Lumos Labs, Inc).
To learn more about cognition poststroke, you can find additional resources in table 4.
This page was developed by Urvashy Gopaul, PT, MSc, PhD (email address: Urvashy.Gopaul@uhn.ca);
Pooja Jethani, Dr.OT, OTR/L; Nabila Enam, OTD, OTR/L; Anahita Amirpour,
RNA, MSc; Olivia Crozier, BHSc; Marina Charalambous, SLT, PhD; and Mark
Bayley, MD.
Disclaimer
This
information is not meant to replace the advice of a medical
professional and should not be interpreted as a clinical practice
guideline. Statements or opinions expressed in this document reflect the
views of the contributors and do not reflect the official policy of the
American Congress of Rehabilitation Medicine, unless otherwise noted.
Always consult your health care provider about your specific health
condition. This Information/Education Page may be reproduced for
noncommercial use for health care professionals and other service
providers to share with their patients or clients. Any other
reproduction is subject to approval by the publisher.
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