Cognitive self-training during early stroke rehabilitation and its effect on patient agency.

Abstract

Early activation post-stroke may improve functional outcomes. However, stroke patients in inpatient rehabilitation often remain inactive outside scheduled therapy sessions. Lack of hospital equipment and low internal motivation may limit activity levels and contribute to boredom. Cognitive activities are affected the most. To address this, we developed 'KOGNIKAT', a compendium of 270 pen-and-pencil self-guided exercises covering 5 cognitive domains and 3 difficulty levels, with user-friendly instructions and options for social engagement. We investigated the compendium's accessibility and impact on patients' motivation, mood, activity levels and coping during early inpatient rehabilitation at a subacute stroke unit. We conducted an exploratory qualitative study using semi-structured interviews with 17 stroke patients who used the compendium ≥3 times. Thematic analysis revealed three main themes: i) Agency in the patient role: using KOGNIKAT increased patients' sense of agency; ii) Illness awareness: KOGNIKAT enabled patients to explore their cognition, eliciting both positive and negative emotions; iii) Facilitators and barriers: individual differences and the stroke unit environment, including staff, influenced KOGNIKAT use. We conclude that KOGNIKAT can be a valuable tool for active patient involvement during early post-stroke rehabilitation as it enhanced patient's sense of control and facilitated adaptive coping strategies.