Gaining insight into the cognitive-motor relationship after stroke : attentively moving rehabilitation forward

Abstract: The central focus of this thesis was on deepening the understanding of the relationship between cognitive and motor functions after stroke. To achieve this, I formulated three aims. The first aim was to evaluate the efficacy of combined cognitive-and-motor therapy for improving cognitive, motor and cognitive-motor outcomes after stroke. Cognitive-and-motor therapy engages individuals simultaneously in motor and cognitive behaviors. By doing so, it is suggested that greater therapeutic effects can be gained, as compared to isolated motor or cognitive interventions. The second aim was to delve deeper into this relationship, by examining the association between specific cognitive and motor deficits after stroke. While stroke can lead to a wide spectrum of neurocognitive and motor deficits, my research specifically focused on the association between spatial neglect and postural control. This is particularly relevant, considering that spatial neglect is a very prevalent cognitive disorder after stroke. It is characterized by a lateralized attention deficit that predominantly affects one side of space or the body. I focused on two subtypes of spatial neglect: visuospatial neglect and personal neglect. In addition to these cognitive aspects, I chose to assess postural control as a critical aspect of motor functioning. Postural control refers to the control of the body\u2019s position in space, for the dual purpose of stability (controlling the center of mass in relation to the base of support) and orientation (controlling the body segments to each other, the task and the environment). This is a complex motor skill, derived from the interaction between multiple sensorimotor and cognitive processes. As its definition implies, postural control is significant for the performance of various daily-life activities, such as sitting, standing and functional mobility. Therefore, gaining a deeper understanding of the factors contributing to the restoration of postural control after stroke holds great significance. The third and final aim was to evaluate the recovery time course of visuospatial and personal neglect, as this seems to be crucial to consider when studying the association of spatial neglect with postural control