Post-stroke patients have trouble following instructions

BEER-SHEVA, Israel, January 6, 2025 – The ability to follow instructions and its impact on the rehabilitation of stroke patients has never been investigated. At the Joint Laboratory for Neurological Rehabilitation Research of Ben-Gurion University of the Negev and Adi-Negev Nahalat Eran, researchers explored following instructions and patients' motor recovery. Their findings were published in the journal Neuropsychology.

Every day we use our ability to understand instructions for routine daily activities. But what happens to stroke survivors with impairments that affect this ability? Dr. Reut Binyamin-Netser and Prof. Lior Shmuelof from the Department of Cognitive and Brain Sciences at Ben-Gurion University of the Negev examined how stroke affects the ability to follow changing instructions and what cognitive abilities underlie this ability.

Stroke occurs because of a sudden disruption in the blood supply to brain tissue by a blood clot or by bleeding. This disruption causes neuronal damage that can manifest in various ways. One of the most common impairments (72% of cases) after stroke is cognitive impairment. Cognitive impairment manifests in memory and attention problems and in impairments in abilities that require executive functions, adaptation processes to change, adjustments to unexpected situations, and self-control. These impairments lead to functional deficits and predict a lower chance of independent functioning after stroke. Another consequence of cognitive impairment after stroke is impairment in the learning ability of subjects, which may affect their ability to participate in and benefit from the rehabilitation treatment they receive.

To investigate the phenomenon, the researchers examined two groups of subjects. One group consisted of 31 stroke patients, while 36 subjects in the same age range (55-75) served as a control group. All participants in the study were given computerized tasks in which they had to respond to stimuli according to their color and location on the screen, and other tasks designed to characterize cognitive abilities such as response inhibition ability and information processing speed using symbols.

The results showed a decrease in accuracy and response times during instruction following a stroke (compared to the control group). In addition, there was a decrease in information processing speed and a decrease in response inhibition ability. A relationship was also found between the patients' response inhibition abilities and their ability to follow instructions.

"Response inhibition ability affects the ability of patients to participate in the rehabilitation process," explained Dr. Binyamin-Netser. "Understanding instructions and tasks is also the basis for motor rehabilitation since the process is a product of instruction."

According to Prof. Shmuelof: "The study opens the door to examining the relationship between cognitive functions and motor and cognitive recovery. This connection is critical in an era where technologies such as video games play a central role in rehabilitation."

The researchers recommend starting an intensive rehabilitation program using computerized technologies as early as possible to improve the stroke recovery process.

"The cognitive ability of the patient is critical to the success of such interventions. Improving motor and cognitive rehabilitation are intertwined, so understanding instructions is the basis for the entire process," summarized Dr. Binyamin-Netser.

Anat Shaked Ravni, an engineer from the Department of Cognitive and Brain Sciences at Ben-Gurion University of the Negev, also participated in the study.

The research was supported by the Israel Science Foundation ((grant number 1244/22), the Marcus Foundation (Ben-Gurion University of the Negev) and Adi Negev.