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Brain Sciences
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The Impact of Stroke on Functional Cognition and Rehabilitation Approaches
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The Impact of Stroke on Functional Cognition and Rehabilitation Approaches

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurorehabilitation".

Deadline for manuscript submissions: closed (31 July 2025) | Viewed by 15356

Special Issue Editor

Prof. Dr. Glen Gillen

E-Mail Website
Guest Editor
Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, Columbia University, New York, NY, USA
Interests: stroke rehabilitation; occupational therapy

Special Issue Information

Dear Colleagues,

Stroke is a global cause of severe disability. Therefore, this Special Issue of Brain Sciences, “The Impact of Stroke on Functional Cognition and Rehabilitation Approaches”, will focus on the cognitive impairments that occur after stroke. These include, but are not limited to, memory loss, attention deficits, unilateral attention loss (neglect), executive dysfunction, etc.

More specifically, it will focus on the impact of cognitive impairments on everyday living (activity limitations) and how these limitations impact life roles (participation restrictions).

The issue will include manuscripts that describe assessment procedures and intervention approaches.

Prof. Dr. Glen Gillen
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cerebrovascular accident
  • stroke
  • cognition
  • activities of daily living
  • quality of life
  • assessment
  • intervention

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Published Papers (7 papers)

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Research

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20 pages, 2138 KB  
Article
Functional Cognitive Rehabilitation as a Primer to Activity-Based Stroke Telerehabilitation: Feasibility, Acceptability, and Engagement
by Stephanie Aghamoosa, Kelly Rishe, Julianne Laura, Patricia Finetto, Stephanie Garner, Lisa M. McTeague, Deena Schwen Blackett and Michelle L. Woodbury
Brain Sci. 2025, 15(12), 1298; https://doi.org/10.3390/brainsci15121298 - 30 Nov 2025
Viewed by 1206
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue The Impact of Stroke on Functional Cognition and Rehabilitation Approaches)
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18 pages, 460 KB  
Article
Comparing the CO-OP ApproachTM to Usual Occupational Therapy for Adults with Executive Dysfunction Following Acquired Brain Injury: A Randomized Controlled Trial
by Deirdre R. Dawson, Nicole D. Anderson, Yael Bar, Malcolm A. Binns, Adora Chui, Anne W. Hunt, Emily Nalder and Merrick Zwarenstein
Brain Sci. 2025, 15(11), 1195; https://doi.org/10.3390/brainsci15111195 - 5 Nov 2025
Viewed by 2585
Abstract
Impairments of executive function following acquired brain injury including stroke (ABI) contribute significantly to long-lasting everyday difficulties in life. Pilot work on the CO-OP ApproachTM (Cognitive Orientation to daily Occupational Performance Approach), a contextualized strategy training intervention, with ABI adults with executive [...] Read more.
Impairments of executive function following acquired brain injury including stroke (ABI) contribute significantly to long-lasting everyday difficulties in life. Pilot work on the CO-OP ApproachTM (Cognitive Orientation to daily Occupational Performance Approach), a contextualized strategy training intervention, with ABI adults with executive dysfunction showed improved performance on untrained everyday life tasks and cognitive flexibility. Objective: Our objective was to determine the efficacy of the CO-OP Approach relative to usual occupational therapy (UOT) for community-dwelling adult survivors of ABI with executive dysfunction. Methods: Eighty-seven participants were randomized to receive CO-OP (n = 45) or UOT (n = 42) in their homes. All participants identified five personally meaningful, everyday life goals (using the Canadian Occupational Performance Measure (COPM)) and received up to 15 one-hour treatment sessions twice per week. Three goals were trained, and two were untrained. Interventions were provided by occupational therapists registered with their regulatory college. The CO-OP group was trained to apply a meta-cognitive strategy to three goals. The UOT group received therapy based on the clinicians’ (experienced in community settings) determination. Testers were masked to the participants’ group. Analysis at the primary outcome (Post-test, ~10 weeks following baseline) was on an intent-to-treat basis. Results: Participants in the CO-OP group had a mean age of 57.5 years, a mean time post-ABI of 5.3 years, and were 57.8% men. Those in the usual OT group had a mean age of 54.7 years, a mean time post-ABI of 6.2 years, and were 69.0% men. The CO-OP group reported statistically significant higher improvements on COPM performance and satisfaction scores post-test for untrained and trained goals. However, these benefits were not retained at follow-up (three months post-baseline). Conclusions: The CO-OP ApproachTM shows promise for improving performance in everyday life goals for individuals with chronic ABI relative to usual community occupational therapy. Achieving retention of these benefits remains a challenge. Full article
(This article belongs to the Special Issue The Impact of Stroke on Functional Cognition and Rehabilitation Approaches)
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14 pages, 302 KB  
Article
Validity of the Japanese Version of the Weekly Calendar Planning Activity (WCPA)-10 on Assessing Executive Function in Patients with Acquired Brain Injury (ABI)
by Asako Matsubara, Yasuhiro Higashi, Mio Kawabata and Katsunobu Sugihara
Brain Sci. 2025, 15(9), 993; https://doi.org/10.3390/brainsci15090993 - 15 Sep 2025
Viewed by 1323
Abstract
Background: The Weekly Calendar Planning Activity (WCPA) is one of the assessments of functional cognition, including executive function, by the cognitive instrumental activities of daily living (C-IADL). It is translated and adapted in many countries, but not in Japan. Methods: This [...] Read more.
Background: The Weekly Calendar Planning Activity (WCPA) is one of the assessments of functional cognition, including executive function, by the cognitive instrumental activities of daily living (C-IADL). It is translated and adapted in many countries, but not in Japan. Methods: This study aimed to examine the validity of the Japanese version of the WCPA-10 (WCPA-10-J) in patients with acquired brain injury (ABI), and to explore the characteristics of cognitive strategy use among that population. Fifty-three patients with ABI aged 27–81 years and 52 healthy controls (HCs) completed the WCPA-10-J, three neuropsychological tests, and the assessment of the instrumental activities of daily living (IADL). Results: Results demonstrated that the WCPA-10-J was able to discriminate between the patients with ABI and the HCs. We found significant limitations in ABI patients’ ability to use strategies. Concurrent, convergent, and ecological validities were partly demonstrated through correlations between the neuropsychological test scores, IADL, and the WCPA-10-J performance. Conclusions: This study provides initial evidence for the validity of the WCPA-10-J for patients with ABI and suggests the need to use performance-based tests even in patients with normal cognitive screening test results. The WCPA-10-J could provide useful information for strategy-based interventions for patients with ABI. Full article
(This article belongs to the Special Issue The Impact of Stroke on Functional Cognition and Rehabilitation Approaches)
25 pages, 4418 KB  
Article
ADL-Focused Occupation-Based Neurobehavioral Evaluation Software: Addition of a Rasch-Based Stroke Subscale to Measure Outcomes
by Guðrún Árnadóttir, Laufey Halla Atladóttir, Garðar Ingvarsson, Helgi Sigtryggsson and Bjarni Ármann Atlason
Brain Sci. 2025, 15(9), 904; https://doi.org/10.3390/brainsci15090904 - 23 Aug 2025
Viewed by 1790
Abstract
Background: Measurements are necessary in rehabilitation for evaluating service effectiveness. The ADL-focused Occupation-based Neurobehavioral Evaluation (A-ONE) is used for evaluating ADL performance and the impact of neurobehavioral impairments on the performance. Recently, Rasch-based software was constructed for the A-ONE ADL and neurobehavioral scales. [...] Read more.
Background: Measurements are necessary in rehabilitation for evaluating service effectiveness. The ADL-focused Occupation-based Neurobehavioral Evaluation (A-ONE) is used for evaluating ADL performance and the impact of neurobehavioral impairments on the performance. Recently, Rasch-based software was constructed for the A-ONE ADL and neurobehavioral scales. It converts ordinal rating scale scores into measures, estimates missing data values and calculates the statistical significance of changes. Objectives: To expand the A-ONE software by developing a cerebrovascular accident (CVA) neurobehavioral subscale. Additionally, to pilot-test whether the ADL and CVA scales of the software can detect statistically significant improvements. Method: Rasch analysis was used for evaluating the item fit, PCA, person separation and reliability to establish the internal validity of the CVA subscale (n = 222). The external validity (n = 22) was obtained by comparing A-ONE software measures to Winsteps measures. Subsequently 21 pre–post-intervention comparisons were made of stroke patients using both the ADL and CVA scales. Results: All set criteria for internal and external validity were met. By using the software clinically after incorporating the CVA subscale, statistically significant changes were detected in 90.5% of comparisons using the ADL scale and 36.4% using the CVA scale. The intervention program used was determined to consist of 66.4% occupation-based activities. Conclusions: This study is the first to deliver a clinically deployable Rasch-based CVA subscale integrated into routine occupational therapy software. The A-ONE software offers considerable time saving for therapists and the potential to detect significant differences in performance and impairment impact. It contributes to the removal of clinical obstacles toward the use of the instrument as an outcome measure and encourages the use of measures in rehabilitation. Full article
(This article belongs to the Special Issue The Impact of Stroke on Functional Cognition and Rehabilitation Approaches)
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10 pages, 202 KB  
Article
Interrater Reliability of the Occupational Therapy Anticipatory Awareness Test: A Performance-Based Cognitive Assessment
by Danielle Mahoney, Stephanie Alvarado and Rochelle Mendonca
Brain Sci. 2025, 15(5), 511; https://doi.org/10.3390/brainsci15050511 - 16 May 2025
Viewed by 1147
Abstract
Background: Functional cognitive impairments caused by acquired brain injury (ABI) negatively impact an individual’s daily functioning. Impaired self-awareness can pose obstacles to task execution and participation. Traditional assessment methods for self-awareness lack a functional approach, highlighting the need for performance-based assessments such as [...] Read more.
Background: Functional cognitive impairments caused by acquired brain injury (ABI) negatively impact an individual’s daily functioning. Impaired self-awareness can pose obstacles to task execution and participation. Traditional assessment methods for self-awareness lack a functional approach, highlighting the need for performance-based assessments such as the Occupational Therapy Anticipatory Awareness Test (OTAAT). The purpose of this study was to establish the interrater reliability of the OTAAT in adults with ABI. Methods: This was a two-phase study. Phase One involved the recruitment of three participants with ABI, who then underwent OTAAT administration within a setting of their choosing. OTAAT performances were recorded. In Phase Two, ten occupational therapists assessed the Phase One participants’ performances using the OTAAT. Phase Two’s raters’ outcomes were obtained by research personnel. These data were then collected and analyzed by research staff to measure interrater reliability using the Intraclass Correlation Coefficient (ICC) via IBM Statistical Package for the Social Sciences (SPSS) software. A two-way random effect, absolute agreement, multiple-rater/measurement ICC was adopted for this study. Results: Data analysis demonstrated strong interrater reliability for the OTAAT, demonstrating its consistency to measure self-awareness in individuals with ABI across different raters. Specifically, the ICC values indicated strong agreement among raters in their assessment of participants’ self-awareness performance using the OTAAT. Conclusions: The OTAAT has strong interrater reliability and holds promise as a valuable addition to neurorehabilitation practice. This study demonstrates the reliability of the OTAAT as a tool for assessing self-awareness in the ABI population. Full article
(This article belongs to the Special Issue The Impact of Stroke on Functional Cognition and Rehabilitation Approaches)

Review

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13 pages, 786 KB  
Review
Compensatory Strategies to Improve Functional Cognition Post-Stroke: A Review for Caregiver Empowerment and Burden Reduction
by Caroline Zemsky and Glen Gillen
Brain Sci. 2025, 15(12), 1297; https://doi.org/10.3390/brainsci15121297 - 30 Nov 2025
Viewed by 1946
Abstract
Background/Objectives: Acquired brain injuries (ABIs), such as stroke, are a major cause of disability globally and frequently affect functional cognition. Functional cognition is the ability to use cognitive processes including memory, attention, and executive functioning to perform daily tasks. When these processes [...] Read more.
Background/Objectives: Acquired brain injuries (ABIs), such as stroke, are a major cause of disability globally and frequently affect functional cognition. Functional cognition is the ability to use cognitive processes including memory, attention, and executive functioning to perform daily tasks. When these processes are disrupted, it affects the individual in their participation, independence, and quality of life; it also places a significant burden on family members who often become primary caregivers. The aim of this review is to summarize evidence-based strategies to enhance functional cognition following strokes in an attempt to decrease the caregiver burden and improve both patients and their caregivers’ quality of life. Methods: This review summarizes and interprets findings using an annotated bibliography review and systematic search strategy to gather the most effective and relevant evidence-based interventions for those with ABIs and strokes experiencing memory, attention, and executive dysfunction. Studies outlining adaptive and compensatory interventions were included. Results: Evidence suggests compensatory strategies including environmental and external memory aids, structured routine, technological interventions, metacognitive strategies, as well as attention processing, strategy, and visual imagery training. These tactics demonstrate improvement in functional cognition domains of memory, (particularly prospective memory, i.e., remembering to perform future tasks), attention, and executive functioning after stroke and other ABIs. Conclusions: Effective intervention strategies can help individuals’ post-stroke become more independent in their participation and activities of daily living, leading to decreased caregiver burden and improvements in functional independence and quality of life in both patients and their caregivers. It is suggested that caregivers use these evidence-based approaches in their residential environments. Full article
(This article belongs to the Special Issue The Impact of Stroke on Functional Cognition and Rehabilitation Approaches)
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Other

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11 pages, 226 KB  
Opinion
Sexuality and Stroke: The Importance of Considering Cognitive and Perceptual Impairments in Post-Stroke Sexual Functioning
by Daniel Geller and Samantha Wong
Brain Sci. 2025, 15(8), 797; https://doi.org/10.3390/brainsci15080797 - 26 Jul 2025
Cited by 1 | Viewed by 2555
Abstract
Sexuality and intimacy are essential aspects of the human experience for all people, contributing significantly to physical and emotional connections, well-being, and quality of life. Despite their importance, these topics are frequently overlooked in stroke rehabilitation, especially for those with cognitive and perceptual [...] Read more.
Sexuality and intimacy are essential aspects of the human experience for all people, contributing significantly to physical and emotional connections, well-being, and quality of life. Despite their importance, these topics are frequently overlooked in stroke rehabilitation, especially for those with cognitive and perceptual impairments. Existing research on post-stroke sexual rehabilitation tends to focus on sexual dysfunction and the secondary physical and psychological stroke symptoms, with little attention to cognitive and perceptual impairments. Cognitive deficits, such as decreased memory, generalized attention, and executive function not only can hinder sexual participation but also raise the complex issue of capacity to consent. This paper argues that it is imperative for researchers and healthcare practitioners to address cognitive and perceptual challenges, understand consent laws in their respective regions, and consider the influence of culture and social norms in order to support the sexual rights and well-being of all stroke survivors. Furthermore, this article provides some practical recommendations, from an occupational therapy perspective, that healthcare practitioners can provide to clients and their partners. Full article
(This article belongs to the Special Issue The Impact of Stroke on Functional Cognition and Rehabilitation Approaches)
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