Congnitive Deficits Following Stroke

Abstract

Summary Summary The rehabilitation of survivors of stroke places heavy demands on NHS resources. Studies investigating the efficacy of stroke rehabilitation have produced equivocal results. In this paper we focus on the effects of cognitive deficits on motor functioning (in particular, disorders of praxis and attention) and report some results of particular relevance to physiotherapists. For instance, a symmetrical approach to treatment may not only improve motor function but may also help reduce the severity of unilateral neglect (ie encouraging the patient to orient visually to the affected side should improve the ability to attend to and to be aware of the affected side of space. Motor cues are more likely to be effective than visual cues if motor performance is required, and in particular cueing is most likely to be effective if it is initiated by a patient rather than a therapist. Simultaneous bi-lateral exercises should be avoided unless attempts are made to overcome any effect of extinction, where a patient may attend only to the unaffected limb. In addition, cases of dyspraxia show that pathological functioning may be transferred between the hemispheres. Sequential bi-lateral exercises are to be preferred; the effect of the intact limb performing a pattern of movement may provide the visual experience of what the movement should be, and there also may be activation of homologous motor areas via the corpus callosum which may facilitate the normal movement pattern.