Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Oct 10, 2025
Date Accepted: Sep 8, 2026
Integrating Functional Cognitive Rehabilitation with Activity-Based Stroke Telerehabilitation: Intervention Design and Development
ABSTRACT
Background:
Many stroke survivors experience chronic cognitive deficits that, together with motor impairments, negatively impact well-being and daily function. Critically, post-stroke cognitive deficits can interfere with successful engagement in rehabilitation programs aimed at improving participation in home and community activities. To address this issue, we developed a new telehealth intervention that integrates brief, function-oriented cognitive rehabilitation (COG) into an existing upper extremity-focused, activity-based occupational therapy (OT) program.
Objective:
To describe the development and specification of a telehealth intervention (COG+OT) that integrates functional cognitive rehabilitation into activity-based stroke telerehabilitation.
Methods:
COG+OT was developed using a multi-disciplinary, theory-informed process guided by principles of functional cognitive rehabilitation. It is reported according to the Template for Intervention Description and Replication checklist for rehabilitation (TIDieR-Rehab). The intervention was developed by a team with expertise in stroke rehabilitation from the fields of OT, neuropsychology, clinical psychology, and speech-language pathology. Cognitive rehabilitation content was adapted from an evidence-based compensatory strategy program and condensed into a brief “primer” format. This component was iteratively integrated into an existing upper-extremity, activity-based OT telerehabilitation program to support engagement and transfer of strategies to real-world functional tasks. In this paper, we describe intervention structure, content, delivery, and tailoring procedures.
Results:
COG+OT is an 8-week, 13-session telehealth intervention delivered in three phases: (1) cognitive strategy training (“primer”, sessions 1-4), (2) review and guided application of strategies within OT activities (sessions 5-10), and (3) integration of strategies to support generalization to everyday contexts (sessions 11-13). The intervention combines individualized, strategy-based cognitive rehabilitation with goal-oriented OT using a titrated approach. Patient-facing materials, structured session workflows, and therapist-guided metacognitive strategies support tailoring and real-world application.
Conclusions:
COG+OT is a theory-informed, user-centered intervention that provides a structured approach for integrating functional cognitive rehabilitation into stroke telerehabilitation. This work establishes a well-specified, replicable intervention model and supports future feasibility, effectiveness, and implementation studies. Clinical Trial: ClinicalTrials.gov: NCT06555302
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.