Strategy Training for Stroke Survivors

Overseen By Elizabeth Skidmore, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Haifa

Disqualifiers: Dementia, Severe aphasia, CNS disorder, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 10

Duration: 6 weeks

50 Participants Needed

Trial Summary

What is the purpose of this trial?

This trial will provide strategy training to adult stroke survivors living in the community. The study aims to see if having a pet helps improve their thinking skills and participation in community activities. Strategy training teaches new ways to think and solve problems, which can help with daily tasks.

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Strategy Training, Metacognitive Strategy Training for stroke survivors?

Research shows that strategy training can help reduce disability in stroke survivors, including those with cognitive impairments and aphasia (difficulty with language). Studies found improvements in daily activities and engagement in rehabilitation, suggesting that this treatment helps patients learn new ways to manage their challenges. ^{1 2 3 4 5}

Is strategy training safe for stroke survivors?

The available research does not report any specific safety concerns related to strategy training for stroke survivors, suggesting it is generally safe for use in humans. ^{2 3 6 7 8}

How is the treatment Strategy Training unique for stroke survivors?

Strategy Training is unique because it focuses on enhancing problem-solving skills to help stroke survivors manage daily challenges, rather than just addressing physical symptoms. It is particularly promising for reducing disability and is adaptable for people with aphasia (language difficulties), which is often excluded from other treatments. ^{3 4 5 6 9}

Research Team

Naor Domotor, PhD

Principal Investigator

University of Pittsburgh

Eligibility Criteria

This trial is for adult stroke survivors who are at least 3 months post-stroke, experiencing reduced activity levels and some cognitive impairment. Participants must live with a pet, be willing to undergo a 6-week home-based program with two sessions weekly, and have had a primary diagnosis of acute stroke.

Inclusion Criteria

It has been over 3 months since I had a stroke.

You are not able to do at least 80% of the activities you used to do before having a stroke, as determined by an Activity Card Sort.

You live in a shared living space with a pet.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive strategy training for 10-15 sessions, 45 minutes each session, delivered by a trained occupational therapist in the home

6 weeks

10-15 visits (in-person)

Follow-up

Participants are monitored for changes in community participation, executive function, and attention

3 months

Treatment Details

Interventions

• Strategy Training

Trial Overview The study is testing 'strategy training' to see if it helps improve cognitive performance and community involvement in stroke survivors. It will also explore whether having pets affects the outcomes of this intervention.

Participant Groups

Group I: Stroke survivors with pets Experimental Treatment 1 Intervention

Stroke survivors with pets will receive strategy training for 10-15 sessions, 45 minutes each session, delivered by a trained occupational therapist in the home.

Group II: Stroke survivors without pets Active Control 1 Intervention

Stroke survivors without pets will receive strategy training for 10-15 sessions, 45 minutes each session, delivered by a trained occupational therapist in the home.

Who Is Running the Clinical Trial?

University of Haifa

Lead Sponsor

Trials

126

Recruited

22,200+

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

Findings from Research

Meta-cognitive strategy training, specifically the CO-OP method, was successfully implemented during inpatient rehabilitation for a patient with cognitive impairments after a right hemisphere stroke, showing its feasibility in a clinical setting.

The participant demonstrated significant improvements in rehabilitation engagement and functional independence, with notable increases in performance scores across various measures, suggesting potential benefits of this training approach for stroke recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The feasibility of meta-cognitive strategy training in acute inpatient stroke rehabilitation: case report. Skidmore, ER., Holm, MB., Whyte, EM., et al.[2021]

An adapted metacognitive strategy training protocol for 16 adults with mild to moderate aphasia was found to be feasible in an inpatient stroke rehabilitation setting, with therapists delivering the intervention effectively.

Participants showed significant improvement in disability, achieving a mean change of 21.8 on the Functional Independence Measure, comparable to results from previous trials involving individuals without aphasia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Metacognitive Strategy Training Is Feasible for People With Aphasia. Kersey, J., Evans, WS., Mullen, K., et al.[2022]

A pilot study involving 10 adults with stroke-related cognitive impairments showed that strategy training, when added to usual rehabilitation care, is feasible and well-accepted, with high participant retention and satisfaction rates.

Participants who received strategy training demonstrated significantly less disability at six months compared to those who received an attention control session, suggesting that this approach may effectively enhance recovery in stroke rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing complex interventions: lessons learned from a pilot study examining strategy training in acute stroke rehabilitation. Skidmore, ER., Dawson, DR., Whyte, EM., et al.[2021]

In a study of 44 chronic stroke survivors, adding cognitive strategy training to task-specific training (COSTAR) did not show significant benefits over traditional task-specific training (TST) in improving activity and participation outcomes, despite both groups showing some improvement.

The high attrition rate in the COSTAR group (50%) compared to the TST group (25%) may have influenced the results, suggesting that while cognitive strategies could enhance generalization of skills, their immediate impact on activity performance was not evident in this trial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive oriented strategy training augmented rehabilitation (COSTAR) for ischemic stroke: a pilot exploratory randomized controlled study. Wolf, TJ., Doherty, M., Boone, A., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

The feasibility of meta-cognitive strategy training in acute inpatient stroke rehabilitation: case report. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Transfer of training effects in stroke patients with apraxia: an exploratory study. [2019]

3. England pubmed.ncbi.nlm.nih.gov

Pilot RCT examining feasibility and disability outcomes of a mobile health platform for strategy training in inpatient stroke rehabilitation (iADAPT). [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Metacognitive Strategy Training Is Feasible for People With Aphasia. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Developing complex interventions: lessons learned from a pilot study examining strategy training in acute stroke rehabilitation. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Strategy Training Shows Promise for Addressing Disability in the First 6 Months After Stroke. [2018]

7. England pubmed.ncbi.nlm.nih.gov

Cognitive oriented strategy training augmented rehabilitation (COSTAR) for ischemic stroke: a pilot exploratory randomized controlled study. [2022]

8. England pubmed.ncbi.nlm.nih.gov

A decision-neuroscientific intervention to improve cognitive recovery after stroke. [2021]

9. England pubmed.ncbi.nlm.nih.gov

Implementing strategy training in Taiwan: perspectives of individuals with Acquired brain injury. [2023]