Designing stroke services for the delivery of cognitive rehabilitation: A qualitative study with stroke rehabilitation professionals

Neuropsychol Rehabil. 2023 Jan;33(1):24-47. doi: 10.1080/09602011.2021.1977155. Epub 2021 Oct 14.

Abstract

This qualitative study explored the potential to deliver cognitive rehabilitation for post-stroke cognitive impairment (PSCI), with a specific focus on barriers and facilitators to its delivery from the perspective of Irish stroke rehabilitation professionals. Sixteen semi-structured interviews were completed with healthcare professionals in both hospital and community settings. The sample comprised physiotherapists, occupational therapists, nurses, a stroke physician, a psychologist, a neuropsychologist, a speech and language therapist, a dietician, and a public health nurse. Interviews were audio-recorded and analysed in NVivo using inductive Thematic Analysis. Barriers and facilitators to the delivery of cognitive rehabilitation were identified and described under four key themes: (i) Cognitive screening; (ii) Cognitive rehabilitation: no one size fits all; (iii) Psychology: the lost dimension of stroke rehabilitation; and (iv) Joining the dots in the community. Staffing required to deliver cognitive rehabilitation for PSCI was highlighted as under-resourced in the Republic of Ireland. Inadequate resourcing of neuropsychology and stroke-related psychological services, in particular, has had negative implications for the delivery of cognitive rehabilitation. Stroke-specific cognitive rehabilitation expertise is virtually inaccessible in the community, highlighting an urgent need for investment in specialist rehabilitation teams to deliver cognitive rehabilitation in this setting.

Keywords: Stroke; cognitive impairment; cognitive rehabilitation; neuropsychology; qualitative research.

MeSH terms

  • Cognitive Dysfunction* / etiology
  • Cognitive Training
  • Humans
  • Qualitative Research
  • Stroke Rehabilitation* / methods
  • Stroke* / complications