Can Post-Stroke Cognitive Function Improve Through Simple Goal Setting?

We set goals for ourselves every day.  We write them down them, we measure them, we tick them off.  Setting measurable goals has been used for years in business settings, in cognitive behaviour therapy and many other contexts.  Achieving our goals then contributes to our day-to-day feelings of accomplishment.

But can giving people simple, yet concrete targets – that they can visualize and strive for – improve cognitive function following a common health event such as a stroke?

Keera Fishman, an ONDRI Scholar with a PhD in Clinical Psychology, set out to answer this question – leading to a recent publication in the journal Stroke.¹

Cognitive difficulties are common following a stroke, affecting 20% to 50% of stroke survivors.²  While there has been significant research conducted on peoples’ physical recovery following stroke, far less has been written about associated cognitive recovery.

Dr. Fishman, along with collaborators Dr. Richard Swartz, stroke neurologist and cognitive scientist, Sunnybrook Health Sciences Centre, and Dr. Andrea Ashbaugh, University of Ottawa, were particularly interested in motivation, and the effect this might have on clinical outcomes. They designed a study based on Locke and Latham’s goal setting theory,³ which hypothesizes that performance will improve when specific, challenging (but attainable), and measurable goals are set – as opposed to easy, vague, or nonexistent goals.

Employing the principles of this goal setting theory led to the innovative design of this randomized controlled study.

Study Design

Fishman’s study involved 72 participants from Sunnybrook’s academic stroke prevention clinic, who had experienced a stroke at least 3 months prior. All participants completed initial measures of cognitive (thinking) tasks including: executive function (planning, organization, etc.); attention/working memory (paying attention, actively working with information without losing track of it); verbal learning (learning through spoken words); and verbal recall (remembering things that have been spoken about).

• Half the participants were then randomly assigned to receive short (20 second) goal-setting instructions before completing the cognitive tasks again
• The other half were only given the standard, manualized instructions before completing the tasks again

Results

Results showed that the group receiving the goal-setting instructions achieved meaningful improvements in verbal executive function; attention/working memory; and verbal learning – when compared with the group receiving standard instructions. Only verbal recall scores were not improved.

Why is this important?

Study results suggest that cognitive impairment after a stroke is not a fixed/permanent problem that comes directly from the brain injury.

Rather, the study highlights that thinking abilities after stroke can be improved by enhancing motivation – setting a clear, attainable, challenging goal is enough to improve thinking function without any drugs, surgery, or hours of practice.

This opens the door to new treatment approaches that could help people with cognitive impairment after a stroke function better in their day-to-day lives.

“What this study allows us to imagine is creating a structured clinical environment where goals can be set as a core part of post-stroke treatment… not taking for granted that everyone knows how to set goals or is motivated to set goals… and that setting these goals can make a meaningful difference in stroke survivors’ cognition and possibly their quality of life. This collaborative approach allows us to get back to things that are meaningful, and may really make a difference for people in a simple way. And isn’t that what clinical practice is all about?” said Fishman.

More research is needed in this area to ensure that the improvements we see on cognitive test scores also result in better quality of life and daily function.