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

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

Acknowledgements

The authors would like to acknowledge all participants for their contribution to this study. Thanks also to Kathleen Harkin (SPHeRE Programme Scholar, Trinity College Dublin) for her assistance as second coder during the analysis.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Intercollegiate Stroke Working Party. National Clinical Guideline for Stroke. London: Royal College of Physicians, 2016.

2 Headway is an Irish registered charity and internationally accredited brain injury services organisation that supports adults (18+) who are affected by brain injury: https://headway.ie/

3 Quest Brain Injury Services is a community rehabilitative service for adults (18+) who have sustained an acquired brain injury: https://www.rehab.ie/national-learning-network/find-out-more-about-nln/brain-injury-services-quest-/

Additional information

Funding

This work was supported by Health Research Board: [Grant Number SPHeRE/2013/1].