Individual analysis of temporal processes to investigate memory and attention in long-term stroke survivors

Memory and attention deficits are common sequale following stroke. Despite this, our understanding of these impairments, ways to rehabilitate them and the influence of other variables on these cognitive functions is limited. This thesis incorporates a person-specific methodology to explore in more depth memory and attention problems in long-term stroke survivors. Five studies are reported, the first two are systematic reviews which concluded that there is some evidence in support of memory and attention rehabilitation and physical mobility rehabilitation post-stroke but that the methodological quality of the N-of-1 studies is weak. The second systematic review also revealed that there have been no studies carried out with the aim of increasing overall levels of physical activity in stroke. Studies three and four investigated memory and attention problems in long-term stroke survivors using objective and subjective measures, and assessed the extent to which fluctuations in mood, anxiety and sleep quality and caregiver psychological and behavioural characteristics influenced self-reported memory and attention. Results showed that long-term stroke survivors experience a range of memory and attention deficits but fluctuation in test performance indicates within-person variability. The studies also showed that memory and attention was temporally associated and predicted by their own mood, anxiety and sleep quality and caregiver mood, anxiety and sleep quality, but the patterns of associations and the effects of the predictors varied across stroke survivors. The final study assessed the feasibility of a combined walking and cognitive training programme with the aim of improving memory and attention. It was concluded that the study was not feasible as it stands. Several methodological amendments would have to be made and then the effects of these changes examined thereafter. Together, the results have implications for the assessment and the rehabilitation of memory and attention functions post-stroke.Memory and attention deficits are common sequale following stroke. Despite this, our understanding of these impairments, ways to rehabilitate them and the influence of other variables on these cognitive functions is limited. This thesis incorporates a person-specific methodology to explore in more depth memory and attention problems in long-term stroke survivors. Five studies are reported, the first two are systematic reviews which concluded that there is some evidence in support of memory and attention rehabilitation and physical mobility rehabilitation post-stroke but that the methodological quality of the N-of-1 studies is weak. The second systematic review also revealed that there have been no studies carried out with the aim of increasing overall levels of physical activity in stroke. Studies three and four investigated memory and attention problems in long-term stroke survivors using objective and subjective measures, and assessed the extent to which fluctuations in mood, anxiety and sleep quality and caregiver psychological and behavioural characteristics influenced self-reported memory and attention. Results showed that long-term stroke survivors experience a range of memory and attention deficits but fluctuation in test performance indicates within-person variability. The studies also showed that memory and attention was temporally associated and predicted by their own mood, anxiety and sleep quality and caregiver mood, anxiety and sleep quality, but the patterns of associations and the effects of the predictors varied across stroke survivors. The final study assessed the feasibility of a combined walking and cognitive training programme with the aim of improving memory and attention. It was concluded that the study was not feasible as it stands. Several methodological amendments would have to be made and then the effects of these changes examined thereafter. Together, the results have implications for the assessment and the rehabilitation of memory and attention functions post-stroke