Functional Cognitive Rehabilitation as a Primer to Activity-Based Stroke Telerehabilitation: Feasibility, Acceptability, and Engagement

Background/Objectives: Cognitive deficits are common after stroke and often compound motor impairments, hindering functional recovery—yet cognition remains under-addressed in stroke care. This pilot trial evaluated the feasibility and acceptability of a novel stroke telerehabilitation program—COG + OT—that delivers brief, functionally oriented cognitive rehabilitation as a primer to activity-based occupational therapy (OT). Methods: Twenty stroke survivors with arm/hand paresis participated in this single-arm pilot trial. The 8-week COG + OT program included 13 sessions across three phases: (1) cognitive rehabilitation (sessions 1–4), (2) application of cognitive strategies to task-practice OT (sessions 5–10), and (3) integration of cognitive skills into OT (sessions 11–13). Outcomes included feasibility (retention, adherence), acceptability (self-reported interest and usefulness of cognitive strategies, intervention acceptability), and engagement (digital literacy, barriers, and self-reported strategy use). Results: Retention was 95% and adherence was 99.6%. Participants reported moderate interest in cognitive strategies pre-intervention (M = 3.86/5) and found them moderately to very useful post-intervention (M = 4.42/5). Intervention acceptability and appropriateness were rated highly (M = 4.4/5). Common barriers included cognitive, environmental, and language factors; digital/technological barriers were infrequent. Self-reported use of cognitive strategies was moderate to high. Conclusions: The results of this trial strongly support the feasibility and acceptability of the COG + OT program for stroke survivors. Importantly, all participants were able to meaningfully engage in the program despite marked variability in cognitive and clinical characteristics. These findings support further investigation through randomized controlled trials to evaluate efficacy.