Improvement of Executive Functions With the CO-OP Method in the Adult Subject After Stroke

Improvement of Executive Functions With the CO-OP Method in the Adult Subject After Stroke

The research focuses on top-down intervention approaches and more specifically on the Cognitive Orientation to daily Occupational Performance (CO-OP) method in the rehabilitation of executive function disorders in adult post-stroke subjects in chronic phase. The main objective of this study is therefore to improve performance in significant activities of daily living for people with chronic post-stroke dysexecutive disorders.

Today, approaches to intervention with adults after stroke can be categorized into two groups: bottom-up approaches (neurodevelopmental, sensory integration, mental imagery, cognitive stimulation, perceptual-motor/kinesthetic training...) and top-down approaches (task-oriented approach, neuromotor task training, occupational performance coaching, the CO-OP approach). Although bottom-up intervention approaches have existed for several years longer than top-down approaches, in general, top-down intervention approaches have shown better results.

In the latest work with post-stroke adults with objective cognitive impairment, the data indicate the relevance of CO-OP in improving performance and satisfaction, attention, inhibition and flexibility or apathy.

This study aims to demonstrate the effectiveness of the CO-OP approach in adult post-stroke patients in chronic phase, specifically on planning function, through the Single Case Experimental Design methodology by randomized intervention (3 patients) over 6 weeks of treatment and 10 weeks of evaluation.

Inclusion Criteria:

• Stroke responsible for a dysexecutive syndrome authenticated by the GREFEX battery
• Stroke more than 6 months old (chronic phase)
• Social security affiliation
• Signing of a free and informed consent following clear and detailed information.

Exclusion Criteria:

• Disorder of comprehension objectified by the - LAnguage Screening Test (LAST) (minimum score 4/8 in expression and 6/7 in comprehension)
• Significant anosognosia of dysexecutive syndrome
• Pregnant women
• Neurological condition other than stroke or psychiatric disorder
• Patient following a rehabilitation with a liberal therapist targeting executive functions during the period of participation in the study.