Stroke Structured Abstract - S #11
Cognitive training may be more effective than regular rehabilitation in improving stroke clients' verbal function, memory, and logical thinking
CITATION: Söderback, I., (1988). The effectiveness of training intellectual functions in adults with acquired brain damage: An evaluation of occupational therapy methods. Scandinavian Journal of Rehabilitation Medicine, 20, 47-56.
LEVEL OF EVIDENCE: IC2b
What is the effectiveness and maintenance of OT training of intellectual functions?
Randomized controlled trial (RCT)
Patients were randomly assigned to one of four groups:
Intellectual Functional Training (IFT) + regular rehabilitation (RR) (n = 15)
Intellectual Housework Training (IHT) + RR (n = 19)
IFT + IHT + RR (n = 15)
RR (n = 18)
SAMPLING PROCEDURE/INCLUSION CRITERIA
Inclusion criteria: between 17 and 65 years of age; have some experience with housework; status post acute, acquired brain damage; rehabilitation indicated. 131 persons were recruited from March 1983 through March 1986. Of the 131 selected for inclusion, 72 were enrolled in rehabilitation clinics (making them eligible to participate in this study). Of the original 131, 41 could not be accommodated in rehab facilities, 14 declined to participate, and 4 were unable to participate because of the severity of brain damage.
N = 67
Male = 35
Female = 32
Mean age = 47
LCVA = 26
RCVA = 35
Attrition = 7%
Of the 72 enrolled, 5 failed to complete the study; no demographics given for these 5.
6 patients were not designated LCVA or RCVA.
(R = Reliability established; V = Validity established)
Intellectual Function Assessment (IFA) - R, V
Intellectual Housework Assessment (IHA) - R, V
Experimental Group #1 (IFT + RR): Material of paper-and-pen character was used in a variety of combinations and extent to train visual perception; and spatial, verbal, numerical, memory, and logical functions.
Experimental Group #2 (IHT + RR): Housework (e.g. food preparation, shopping, baking, cooking, setting the table, cleaning, etc.) was used after the occupational therapist used activity analysis and synthesis to find the most suitable treatment media for each subgoal.
Experimental Group #3 (IFT + IHT +RR): Combination of all three treatment approaches.
Control Group (RR): training included printing, macramé, sewing, games, handwriting, leatherwork, weaving, woodwork, pottery, painting, gardening, building models, and reading the newspaper.
WHO DELIVERED INTERVENTION
FREQUENCY & DURATION
Subjects received an average of 40 hours of treatment
Experimental Group #1 (E1) = 37, 1-hour sessions.
Experimental Group #2 (E2) = 16, 2.5-hour sessions.
Experimental Group #3 (E3) = 14, 1-hour sessions of IFT & 8, 2.5-hour sessions of IHT
Control Group(C): 43 hours over 79 days.
E1 vs C: significant difference in the attention subtest (p = .03) of the IHA, effect size r = .31.
E2 vs C: Significant differences in the verbal (p = .02, r = .34) and memory (p = .01, r = .38) subtests of the IHA.
E3 vs C: Significant differences in the verbal (p = .01, r = .40), memory (p = .005, r = .45), and logic (p = .001, r = .59) subtests of the IHA.
No Significant differences between the Control Group and any of the Experimental Groups were found on any of the subtests of the IFA.
All groups improved on three to seven subtests. The overall effect sizes r for the Experimental Group #1, Experimental Group #2, Experimental Group #3 and Control Group were .50, .49, .60, and .37, respectively (confounded with maturation).
THREATS TO VALIDITY
Spontaneous recovery was not controlled for.
Multiple statistical tests without correction at the alpha level.
Possible equivalence of treatment between RR (crafts & activities) and IFT (paper-and-pencil exercises for perception and cognition).
The development of intellectual functions within each group was obvious in most areas, but less so within the RR Group than in the others. In some areas (verbal and memory function), individualized intellectual training (IFT, IHT, and IFT + IHT) was more effective than the regular rehabilitation program of occupational therapy. The combination of IFT and IHT or IHT alone are usable in the OT rehabilitation of persons with acquired brain damage for training in verbal, numerical, praxis, memory, and logical functions.
The findings suggest that in some areas of intellectual function, using a cognitive training strategy combining paper-and-pencil tasks and functional tasks (e.g., housework) may be more effective than a rehabilitation program of arts and crafts.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Hui-ing Ma, ScD, OTR, and Catherine A. Trombly, ScD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.