A Pilot Return-to-Work Cognitive Intervention After Stroke

Stroke is the fourth leading cause of death and the leading cause of adult disability in Singapore. Statistics indicate a concerning rise in young stroke cases. The burden of stroke care is expected to increase exponentially, posing significant challenges to the healthcare system and society. Cognitive impairment after stroke has been documented in up to one-third of stroke survivors. These impairments may be subtle but persistent and progressive even after the stroke survivor appears to have made functional recovery in other areas. Existing services in Singapore for stroke survivors typically target physical and daily functioning outcomes with little focus on cognitive functioning. Moreover, there is a lack of services for stroke survivors who face difficulties in returning to work due to cognitive impairment even when they have achieved optimal physical recovery. An important assessment of a rehabilitation intervention programme is in examining whether it drives positive neuroplasticity, which leads to improved cognitive and functional outcomes. There is presently a dearth of literature in brain mechanisms underlying the impact of cognitive rehabilitation.

A community-based brain health intervention, the Train-Your-Brain Stroke Recovery Programme, will be delivered by registered clinical neuropsychologists. Designed to enhance cognitive function and return-to-work outcomes in stroke survivors with mild cognitive impairment, the intervention will be evaluated using a mixed-methods randomized controlled trial. Stroke survivors will be randomized 1:1 into either the intervention or control arm. Caregivers, given their critical support role, will also be recruited to participate in the study. Outcome measures include feasibility of intervention, acceptability of intervention, cognitive function, return-to-work outcomes, changes in biomarkers, neuroimaging findings, psychosocial health, fatigue, and self-care. Outcome measures will be conducted pre-intervention, post-intervention, and 6-month follow-up.

Inclusion criteria

(for stroke survivors):

• Between 21 to 65 years old
• Ability to provide informed consent
• Consent to recording / photo-taking
• Living in the community with at least three months after stroke
• Looking to return to work or switch jobs after stroke
• No significant aphasia or physical disability issues which will impede them from performing cognitive tasks in the interventions and assessments
• No major psychiatric illnesses
• Able to understand and converse in English
• Score on MoCA ≤22 and/or SDMT ≤13 (for those educated ≤6 years) or SDMT ≤32 (for those educated >6 years)
• Meet criteria for Mild Cognitive Impairment based on the Vascular Dementia Battery

Inclusion criteria

(for caregivers):

• At least 21 years old
• Ability to provide informed consent
• Consent to recording / photo-taking
• Staying with or having knowledge of the stroke survivor's functioning
• No major psychiatric illnesses
• Able to understand and converse in English

Exclusion criteria

(for stroke survivors):

• Less than 21 years old
• More than 65 years old
• Unable to provide informed consent
• Refuse recording
• Not living in the community and having less than three months after stroke
• Significant aphasia or physical disability issues which will impede them from performing cognitive tasks in the interventions and assessments
• Major psychiatric illnesses
• Not able to understand and converse in English

Exclusion criteria

(for caregivers):

• Less than 21 years old
• Unable to provide informed consent
• Refuse recording
• Not staying with or not having knowledge of the stroke survivor's functioning
• Major psychiatric illnesses
• Not able to understand and converse in English