Integrative executive function training in chronic stroke—A case example

Abstract

Cognitive and functional impairments are common sequelae following stroke, often resulting in significant disabilities that persist years post-stroke. While the degree of impairments varies with pathology and location of stroke, it is widely understood that executive dysfunction including disturbances of attention, complex information processing, inhibition, reasoning, and flexible thinking underlie a majority of the impairments. Existing rehabilitation approaches predominantly focus on mitigating targeted cognitive deficits (e.g., language disturbance, neglect of one side of the body, memory). Remediation approaches to address executive dysfunction in chronic stages of recovery post-stroke are limited. The Strategic Memory Advanced Reasoning Training (SMART) that teaches strategies to improve higher order reasoning skills has proven to enhance executive functions, strengthen brain networks and improve participation in daily life activities in adults with traumatic brain injury. The current case example, part of an ongoing larger study, discusses post-SMART performance of a 57-year-old female stroke survivor, who sustained a left middle cerebral artery infarct in July 2015. The participant showed gains in executive functions and participation in leisure pursuits following 10 SMART sessions. These preliminary findings prove feasibility of the training approach and offer promise of neuroplasticity during chronic stages of recovery.