Strategy Training During Inpatient Rehabilitation May Prevent Apathy Symptoms After Acute Stroke

This is so fucking simple to explain the cause of apathy. Your doctor gives you no information on your recovery possibilities or even the stroke protocols you will be using with efficacy percentages. With no clue on your recovery apathy can result. Solve the correct problem, protocols and rehabilitation, not the fucking side effect of apathy. Don't they teach cause and effect in college anymore?
http://www.ncbi.nlm.nih.gov/pubmed/25595665

Skidmore ER¹, Whyte EM², Butters MA³, Terhorst L⁴, Reynolds CF 3rd⁵.

Author information

Abstract

BACKGROUND:

Apathy, or lack of motivation for goal-directed activities, contributes to reduced engagement in and benefit from rehabilitation, impeding recovery from stroke.

OBJECTIVE:

To examine the effects of strategy training, a behavioral intervention used to augment usual inpatient rehabilitation, on apathy symptoms over the first 6 months after stroke.

DESIGN:

Secondary analysis of randomized controlled trial.

SETTING:

Acute inpatient rehabilitation.

PARTICIPANTS:

Participants with acute stroke who exhibited cognitive impairments (Quick Executive Interview Scores ≥3) and were admitted for inpatient rehabilitation were randomized to receive strategy training (n = 15, 1 session per day, 5 days per week, in addition to usual inpatient rehabilitation) or reflective listening (n = 15, same dose).

METHODS:

Strategy training sessions focused on participant-selected goals and participant-derived strategies to address these goals, using a global strategy training method (Goal-Plan-Do-Check). Reflective listening sessions focused on participant reflections on their rehabilitation goals and experiences, facilitated by open-ended questions and active listening skills (attending, following, and responding).

MAIN OUTCOME MEASURES:

Trained raters blinded to group assignment administered the Apathy Evaluation Scale at study admission, 3 months, and 6 months. Data were analyzed with repeated-measures fixed-effects models.

RESULTS:

Participants in both groups had similar subsyndromal levels of apathy symptoms at study admission (strategy training, mean = 25.79, standard deviation = 7.62; reflective listening, mean = 25.18, standard deviation = 4.40). A significant group × time interaction (F2,28 = 3.61, P = .040) indicated that changes in apathy symptom levels differed between groups over time. The magnitude of group differences in change scores was large (d = -0.99, t28 = -2.64, P = .013) at month 3 and moderate to large (d = -0.70, t28 = -1.86, P = .073) at month 6.

CONCLUSION:

Strategy training shows promise as an adjunct to usual rehabilitation for maintaining low levels of poststroke apathy.
Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

PMID:

25595665

[PubMed - indexed for MEDLINE]

PMCID:

PMC4466065

Free PMC Article

Strategy Training Shows Promise for Addressing Disability in the First 6 Months After Stroke

So rather than prevent a lot of disability by stopping the neuronal cascade of death they went down the route of trying to ameliorate the problems. Damn it all, learn about cause and effect.
http://www.ncbi.nlm.nih.gov/pubmed/25505221

Skidmore ER¹, Dawson DR², Butters MA³, Grattan ES⁴, Juengst SB⁴, Whyte EM³, Begley A³, Holm MB⁴, Becker JT⁴.

Author information

Abstract

BACKGROUND:

Cognitive impairments occur frequently after stroke and contribute to significant disability. Strategy training shows promise but has not been examined in the acute phase of recovery.

OBJECTIVE:

We conducted a single-blind randomized pilot study estimating the effect of strategy training, relative to reflective listening (attention control), for reducing disability and executive cognitive impairments.

METHODS:

Thirty participants with acute stroke who were enrolled in inpatient rehabilitation and had cognitive impairments were randomized to receive strategy training (n = 15, 10 sessions as adjunct to usual inpatient rehabilitation) or reflective listening (n = 15, same dose). The Functional Independence Measure assessed disability at baseline, rehabilitation discharge, 3, and 6 months. The Color Word Interference Test of the Delis-Kaplan Executive Function System assessed selected executive cognitive impairments (inhibition, flexibility) at baseline, 3, and 6 months.

RESULTS:

Changes in Functional Independence Measure scores for the 2 groups over 6 months showed significant effects of group (F1,27 = 9.25, P = .005), time (F3,74 = 96.00, P < .001), and group * time interactions (F3,74 = 4.37, P < .007) after controlling for baseline differences in stroke severity (F1,27 = 6.74, P = .015). Color Word Interference Inhibition scores showed significant effects of group (F1,26 = 6.50, P = .017) and time (F2,34 = 4.74, P = .015), but the group * time interaction was not significant (F2,34 = 2.55, P = .093). Color Word Interference Cognitive Flexibility scores showed significant effects of group (F1,26 = 23.41, P < .001), time (F2,34 = 12.77, P < .001), and group * time interactions (F2,34 = 7.83, P < .002). Interaction effects suggested greater improvements were associated with strategy training.

CONCLUSIONS:

Strategy training shows promise for addressing disability in the first 6 months after stroke. Lessons from this pilot study may inform future clinical trials.

Strategy Training Shows Promise for Addressing Disability in the First 6 Months After Stroke

Ask your doctor what the hell strategy training is and what the protocol is. If s/he doesn't know, Why the hell are you paying them? They should know about up and coming therapies before they get published if they are any good at all.
http://nnr.sagepub.com/content/29/7/668?etoc

1. Elizabeth R. Skidmore, PhD1
2. Deirdre R. Dawson, PhD2,3
3. Meryl A. Butters, PhD1,4
4. Emily S. Grattan, MS1
5. Shannon B. Juengst, PhD1
6. Ellen M. Whyte, MD1,4
7. Amy Begley, MA1,4
8. Margo B. Holm, PhD1
9. James T. Becker, PhD1

1. ¹University of Pittsburgh, Pittsburgh, PA, USA
2. ²Rotman Research Institute at Baycrest, Toronto, Ontario, Canada
3. ³University of Toronto, Toronto, Ontario, Canada
4. ⁴Western Psychiatric Institute & Clinic, Pittsburgh, PA, USA

1. Elizabeth Skidmore, Department of Occupational Therapy, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260, USA. Email: skidmore@pitt.edu

Abstract

Background. Cognitive impairments occur frequently after stroke and contribute to significant disability. Strategy training shows promise but has not been examined in the acute phase of recovery. Objective. We conducted a single-blind randomized pilot study estimating the effect of strategy training, relative to reflective listening (attention control), for reducing disability and executive cognitive impairments. Methods. Thirty participants with acute stroke who were enrolled in inpatient rehabilitation and had cognitive impairments were randomized to receive strategy training (n = 15, 10 sessions as adjunct to usual inpatient rehabilitation) or reflective listening (n = 15, same dose). The Functional Independence Measure assessed disability at baseline, rehabilitation discharge, 3, and 6 months. The Color Word Interference Test of the Delis–Kaplan Executive Function System assessed selected executive cognitive impairments (inhibition, flexibility) at baseline, 3, and 6 months. Results. Changes in Functional Independence Measure scores for the 2 groups over 6 months showed significant effects of group (F_1,27 = 9.25, P = .005), time (F_3,74 = 96.00, P < .001), and group * time interactions (F_3,74 = 4.37, P < .007) after controlling for baseline differences in stroke severity (F_1,27 = 6.74, P = .015). Color Word Interference Inhibition scores showed significant effects of group (F_1,26 = 6.50, P = .017) and time (F_2,34 = 4.74, P = .015), but the group * time interaction was not significant (F_2,34 = 2.55, P = .093). Color Word Interference Cognitive Flexibility scores showed significant effects of group (F_1,26 = 23.41, P < .001), time (F_2,34 = 12.77, P < .001), and group * time interactions (F_2,34 = 7.83, P < .002). Interaction effects suggested greater improvements were associated with strategy training. Conclusions. Strategy training shows promise for addressing disability in the first 6 months after stroke. Lessons from this pilot study may inform future clinical trials.

Strategy Training Shows Promise for Addressing Disability in the First 6 Months After Stroke

This is all well and good but I bet we wouldn't need as much after the fact rehabilitation if our stroke medical teams would stop all the death and destruction during the neuronal cascade of death in the first week. Would music listening produce the same results? Send your doctor after the strategy training protocols.
http://nnr.sagepub.com/content/early/2014/11/21/1545968314562113?papetoc

1. Elizabeth R. Skidmore, PhD1
2. Deirdre R. Dawson, PhD2,3
3. Meryl A. Butters, PhD1,4
4. Emily S. Grattan, MS1
5. Shannon B. Juengst, PhD1
6. Ellen M. Whyte, MD1,4
7. Amy Begley, MA1,4
8. Margo B. Holm, PhD1
9. James T. Becker, PhD1

1. ¹University of Pittsburgh, Pittsburgh, PA, USA
2. ²Rotman Research Institute at Baycrest, Toronto, Ontario, Canada
3. ³University of Toronto, Toronto, Ontario, Canada
4. ⁴Western Psychiatric Institute & Clinic, Pittsburgh, PA, USA

1. Elizabeth Skidmore, Department of Occupational Therapy, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260, USA. Email: skidmore@pitt.edu

Abstract

Background. Cognitive impairments occur frequently after stroke and contribute to significant disability. Strategy training shows promise but has not been examined in the acute phase of recovery. Objective. We conducted a single-blind randomized pilot study estimating the effect of strategy training, relative to reflective listening (attention control), for reducing disability and executive cognitive impairments. Methods. Thirty participants with acute stroke who were enrolled in inpatient rehabilitation and had cognitive impairments were randomized to receive strategy training (n = 15, 10 sessions as adjunct to usual inpatient rehabilitation) or reflective listening (n = 15, same dose). The Functional Independence Measure assessed disability at baseline, rehabilitation discharge, 3, and 6 months. The Color Word Interference Test of the Delis–Kaplan Executive Function System assessed selected executive cognitive impairments (inhibition, flexibility) at baseline, 3, and 6 months. Results. Changes in Functional Independence Measure scores for the 2 groups over 6 months showed significant effects of group (F_1,27 = 9.25, P = .005), time (F_3,74 = 96.00, P < .001), and group * time interactions (F_3,74 = 4.37, P < .007) after controlling for baseline differences in stroke severity (F_1,27 = 6.74, P = .015). Color Word Interference Inhibition scores showed significant effects of group (F_1,26 = 6.50, P = .017) and time (F_2,34 = 4.74, P = .015), but the group * time interaction was not significant (F_2,34 = 2.55, P = .093). Color Word Interference Cognitive Flexibility scores showed significant effects of group (F_1,26 = 23.41, P < .001), time (F_2,34 = 12.77, P < .001), and group * time interactions (F_2,34 = 7.83, P < .002). Interaction effects suggested greater improvements were associated with strategy training. Conclusions. Strategy training shows promise for addressing disability in the first 6 months after stroke. Lessons from this pilot study may inform future clinical trials.