A neurocognitive approach for recovering upper extremity movement following subacute stroke: a randomized controlled pilot study.

Only four participants were analysed in each group, and one participant withdrew after the 5-week assessment, so the study is very small and not powered. The significance level was used only in an exploratory sense, and the primary outcome did not show a statistically significant difference. Despite randomization, the control group started with lower hand scores than the neurocognitive group, so baseline imbalance may affect the comparison. All participants also received occupational therapy, and both groups received the same mobilizations, proprioceptive input and textured surfaces, so the effect of the added sensory-discrimination tasks cannot be separated. Only the evaluator was blinded; participants and therapists were not blinded. People with global aphasia, somatoagnosia or neglect, tone above Modified Ashworth Scale 2, or other concurrent therapies except occupational therapy were excluded, so results do not apply to those patients. The study included subacute stroke from 15 days to 3 months, Mini-Mental test at least 24, and enough trunk control to sit with dorsal support, so it does not apply to more impaired or earlier stroke groups. Memory, attention and neuroimaging were not assessed. The reported retention rate was 89%.

Do not conclude that the neurocognitive protocol caused the larger hand and arm score changes. The primary outcome was not statistically significant, the sample was very small, and all participants also received occupational therapy plus the same mobilizations and tactile input. The added sensory-discrimination tasks cannot be separated from those co-interventions.