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PURPOSE Cerebral vascular accidents (CVA) are a leading cause of cognitive impairment in the United States, and 80% of CVA survivors experience new or worsening impairment (Knight-Greenfield et al., 2019; Zhang et al., 2021). Functional cognition is vital to an individual’s participation in occupations that are necessary and meaningful to them. Occupational therapy practitioners play a unique role in addressing functional cognition through intervention planning and implementation. The purpose of this study is to understand the most effective occupational therapy interventions addressing functional cognition in older adults post CVA.
DESIGN We conducted a systematized review of articles pertaining to occupational therapy interventions for improving functional cognition in older adults after CVA. Articles that met inclusion criteria included well-designed randomized control trails (RCT) (level I) and low quality RCT and cohort studies (level II), were published between 2013 and 2023, included an occupational therapy intervention targeting cognition, and had a population mainly consisting of older adults post CVA.
METHOD We reviewed 154 articles by screening the titles and abstracts for inclusion criteria. After each article was reviewed, we found 10 articles that met the overall inclusion criteria. We hand searched each of the 10 articles and found one additional article that met the inclusion criteria. We used the US Preventative Services Task Force levels of certainty to appraise the evidence in each article. We used an evidence table to extract and organize data from each article and divide articles into common themes.
RESULTS We found eleven articles that met the inclusion criteria and identified four themes: virtual reality and computer-based interventions, exercise-based interventions, strategy training, and the OPC-Stroke program. We found strong evidence for virtual reality and computer-based interventions with eight level I articles indicating virtual reality or computer-based interventions as effective in improving functional cognition. We found moderate evidence for the use of strategy training with two level I articles. We found low strength of evidence for the effectiveness of exercise with only one low-quality, RCT. We found low strength of evidence for the OPC-Stroke program with only one low quality RCT.
CONCLUSION Virtual reality and computer-based training are the best supported occupational therapy interventions to address functional cognition among older adults post CVA. We recommend OT practitioners routinely incorporate these interventions into the plan of care for those with cognitive impairments post CVA. Strategy training, exercise, and OPC- Stroke showed moderate or low strength of evidence and may be provided on a case-by-case basis. The next step for future research on this topic may be to conduct more studies with strong methodologies about the effects of strategy training, exercise, and OPC-Stroke on functional cognition to further assess their effectiveness in remediating functional cognition deficits in older adults post CVA.
Occupational therapy interventions, functional cognition, post CVA, post stroke, improving functional cognition
Harrison, Brady A.; Preissler, Alexa A.; Rogers, Emilea R.; and Singh, Allison D., "Occupational Therapy Interventions to Improve Functional Cognition in Older Adults After Stroke: A Systematic Review" (2023). Student Systematic Reviews: Occupational Therapy. 10.