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SMART Program in Chronic Stroke

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Annals of International Occupational Therapy

Asha Vas, PhD, OT, CBIST, Alisa Woods, MS, CCC-SLP, Molly Keebler, MS, CCC-SLP and Stephen Spees, BS

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Long-term functional cognitive impairments are common sequelae of stroke, often resulting in decreased participation in daily life activities. Earlier research showed the benefits of training paradigms targeted at memory, attention, and some executive functions. The current study examined the feasibility of a functionally relevant training program called Strategic Memory Advanced Reasoning Tactics, or SMART™. The SMART program teaches strategies to improve abstract reasoning skills and has been shown to enhance aspects of functional cognition, strengthen brain networks, and improve participation in daily life activities across clinical populations. The current study describes the benefits of the SMART program in adults (N = 12) between 54 and 77 years (64.46 ± 8.14 years) with chronic stroke. Participants had 10 sessions of the SMART program over a period of 6 weeks. The findings showed significant gains in abstract reasoning (p < .05) and participation in daily activities after the SMART program. These gains were relatively stable 6 months later. These findings offer the promise of cognitive gains, even years after stroke. Limitations of the study include a small sample size, potential confounding as a result of additional ongoing therapy, and a relatively short period of follow-up. Further research is needed to examine the benefits of the SMART program. 

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