Date Presented 03/26/20
We investigated whether using ADLs as a means of treatment in the home environment for six weeks could improve cognition and visual perception in patients with stroke. Twenty-four patients were randomized to receive home-based ADL and hospital-based traditional rehabilitation. Our findings showed that there was a statistically significant improvement and small effect size in visual perception. No significant improvement was found in cognition, but small effect size was noticed.
Primary Author and Speaker: En-Chi Chiu
Contributing Authors: Fang-Chi Chi
PURPOSE: Deficits of cognition and visual perception are commonly recognized in patients with stroke. Home rehabilitation is a direct way to observe patients’ performance in their living environment and provides feasible treatment plans in a real home environment. Activities of daily living (ADL) is one of main occupations administered in daily life. The purpose of this study was to investigate whether using ADL tasks as means of treatment in home environment could improve cognition and visual perception in patients with stroke.
DESIGN: This study was a pilot randomized clinical trial. The inclusion criteria were following: (1) diagnosis of stroke; (2) age above 20; (3) score of 3-4 on the modified Rankin Scale; (4) able to understand instructions and follow them; and (5) willing to participate in the study. Exclusion criteria were as follows: (1) orthopedic disorder (e.g., joint deformation) (2) progressive disease (e.g., dementia and Parkinsonism); and (3) peripheral nerve injury. Twenty-four patients with stroke were randomly assigned to one of two groups: ADL group (n=12) and control group (n=12). The ADL group administered ADL tasks that patients perceive as difficult in their home environment (50 minutes each time, once a week, for 6 weeks) while the control group received the hospital-based traditional rehabilitation.
METHOD: Outcome measures of this study contained the Mini Mental State Examination (MMSE) and the Test of Visual Perceptual Skills-Third Edition (TVPS-3). The MMSE measures general cognitive function. The TVPS-3 assesses visual perception. The Mann-Whitney U test was used to investigate the differences in score changes of the MMSE and TVPS-3 between the ADL group and control group (two-tailed, α=0.05). The effect size (success rate difference, SRD) was estimated for nonparametric statistics.
RESULTS: The patients in the ADL group showed a statistically significant improvement in the total score of the TVPS-3 (p=0.042) with small effect size (SRD=0.21). No significant difference was found in the MMSE score (p=0.397), but small effect size (SRD=0.17) was noticed.
CONCLUSION: The participants who receive the 6-week ADL training in home environment demonstrated significant improvement in their visual perception. Future studies using specific cognitive measures (e.g., attention, memory and executive functions) are recommended to investigate the effects of ADL tasks on specific cognitive functions.
References
Lopez-Liria, R., Vega-Ramirez, F. A., Rocamora-Perez, P., Aguilar-Parra, J. M., & Padilla-Gongora, D. (2016). Comparison of Two Post-Stroke Rehabilitation Programs: A Follow-Up Study among Primary versus Specialized Health Care. PLoS One, 11(11), e0166242. doi: 10.1371/journal.pone.0166242
Mercier, L., Audet, T., Hebert, R., Rochette, A., & Dubois, M. F. (2001). Impact of motor, cognitive, and perceptual disorders on ability to perform activities of daily living after stroke. Stroke, 32(11), 2602-2608. doi: 10.1161/hs1101.098154
