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Sara Mcewen - One of the best experts on this subject based on the ideXlab platform.
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Cognitive oriented Strategy training augmented rehabilitation costar for ischemic stroke a pilot exploratory randomized controlled study
Disability and Rehabilitation, 2021Co-Authors: Timothy J. Wolf, Jorge Rios, Helene J. Polatajko, Sara Mcewen, Meghan Doherty, Carolyn M. Baum, Anna E BooneAbstract:Purpose: To investigate the effect of adding Cognitive Strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared wit...
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Cognitive oriented Strategy training augmented rehabilitation (COSTAR) for ischemic stroke: a pilot exploratory randomized controlled study.
Disability and Rehabilitation, 2019Co-Authors: Timothy J. Wolf, Anna Boone, Jorge Rios, Helene J. Polatajko, Meghan Doherty, Carolyn M. Baum, Sara McewenAbstract:: Purpose: To investigate the effect of adding Cognitive Strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared with TST on activity and participation for chronic stroke survivors in an outpatient occupational therapy setting Materials and methods: We conducted an exploratory, single-blind, randomized controlled trial. Participants were randomized to TST or COSTAR protocol. Our primary outcomes measured activity and participation after stroke: the Stroke Impact Scale (SIS), Canadian Occupational Performance Measure (COPM), and Performance Quality Rating Scale (PQRS). Results: Forty-four participants were randomized. The COSTAR group had an attrition rate of 50% and an average of 9.8 of 12 sessions were completed; the TST group had an attrition rate of 25% and an average of 10.7 sessions were completed. Generally both groups improved on the majority of primary and secondary outcomes. There is little evidence to support a beneficial effect of COSTAR over TST for improvement of primary measures of activity performance or secondary measures. Conclusion: Negligible findings may be attributed to an inadvertent treatment group equivalency. Further, the research design did not allow for adequate measurement of the effect of each intervention on participants' ability to generalize learned skills. Implications for rehabilitation Stroke rehabilitation is largely based upon the principles of task-specific training, which is associated with improvements in upper extremity motor performance; however, TST requires a heavy dosage and lacks generalization to untrained activities. Cognitive Strategy use has been associated with improved generalization of treatment to untrained activities and novel contexts however, it is often not used in TST protocols. The results of this preliminary study found no clear advantage between task-specific training and Strategy-adapted task-specific training on trained and untrained activities when both interventions targeted activity performance. Task-specific training, if focused at the activity performance level rather than the impairment reduction level, may have a stronger effect on improving in individual's ability to participate in everyday life activities even without the use of Cognitive-strategies. Incorporating Cognitive Strategy-use into TST would likely produce the greatest effect on generalization and transfer of the treatment effects to other activities and contexts rather than solely on activity performance of trained activities.
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implementing a function based Cognitive Strategy intervention within inter professional stroke rehabilitation teams changes in provider knowledge self efficacy and practice
PLOS ONE, 2019Co-Authors: Sara Mcewen, Deirdre R Dawson, Michelle Donald, Katelyn S R Jutzi, Kayann Allen, Lisa Avery, Mary Egan, Katherine Dittmann, Anne HuntAbstract:Background The Cognitive Orientation to daily Occupational Performance (CO-OP) approach is a complex rehabilitation intervention in which clients are taught to use problem-solving Cognitive strategies to acquire personally-meaningful functional skills, and health care providers are required to shift control regarding treatment goals and intervention strategies to their clients. A multi-faceted, supported, knowledge translation (KT) initiative was targeted at the implementation of CO-OP in inpatient stroke rehabilitation teams at five freestanding rehabilitation hospitals. The study objective was to estimate changes in rehabilitation clinicians’ knowledge, self-efficacy, and practice related to implementing CO-OP. Methods A single arm pre-post and 6-month follow up study was conducted. CO-OP KT consisted of a 2-day workshop, 4 months of implementation support, a consolidation session, and infrastructure support. In addition, a sustainability plan was implemented. Consistent with CO-OP principles, teams were given control over specific implementation goals and strategies. Multiple choice questions (MCQ) were used to assess knowledge. A self-efficacy questionnaire with 3 subscales (Promoting Cognitive Strategy Use, PCSU; Client-Focused Therapy, CFT; Top-Down Assessment and Treatment, TDAT) was developed for the study. Medical record audits were used to investigate practice change. Data analysis for knowledge and self-efficacy utilized mixed effects models. Medical record audits were analyzed with frequency counts and chi-squares. Results Sixty-five health care providers consisting mainly of occupational and physical therapists entered the study. Mixed effects models revealed intervention effects for MCQs, CFT, and PCSU at post intervention and follow-up, but no effect on TDAT. No charts showed any evidence of CO-OP use at baseline, compared to 8/40 (20%) post intervention. Post intervention there was a trend towards reduction in impairment goals and significantly more component goals were set (z = 2.7, p = .007).
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pilot randomized controlled trial investigating Cognitive Strategy use to improve goal performance after stroke
American Journal of Occupational Therapy, 2012Co-Authors: Helene J. Polatajko, Sara Mcewen, Jennifer D Ryan, Carolyn M. BaumAbstract:OBJECTIVE. The authors compared changes in client performance on three goals poststroke after the Cognitive Orientation to daily Occupational Performance (CO–OP) intervention or standard occupational therapy (SOT) to determine the magnitude and direction of change. METHOD. Eight people living in the community following a stroke were randomly assigned to receive CO–OP (n = 4) or SOT (n = 4). CO–OP is a 10-session, Cognitive-oriented approach to improving performance that uses client-driven Cognitive strategies. SOT was therapist driven and combined task-specific and component-based training. Goal performance was measured by the therapist-rated Performance Quality Rating Scale (PQRS) and the participant-rated Canadian Occupational Performance Measure (COPM). RESULTS. Using Mann-Whitney U test, we found that CO–OP participants showed significantly greater improvement in performance (PQRS, p = .02; COPM Performance, p = .02) compared with SOT but no improvement in satisfaction (COPM Satisfaction, p = .38). CONCLUSION. The CO–OP group demonstrated larger performance improvements than the SOT group. Because of the promising results, an investigation using a larger sample is warranted
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Cognitive Strategy use to enhance motor skill acquisition post stroke a critical review
Brain Injury, 2009Co-Authors: Sara Mcewen, Maria Huijbregts, Jennifer D Ryan, Helene J. PolatajkoAbstract:Objective: The objective of this critical review was to examine the literature regarding the use of Cognitive strategies to acquire motor skills in people who have had a stroke, to determine which strategies are in use and to compile evidence of their effectiveness.Search terms: A computerized search of a range of databases was conducted using the following search terms: stroke, cerebrovascular accident; combined with Strategy training, learning strateg*, Cognitive strateg*, metaCognitive strateg*, goal setting, goal planning, goal attainment, goal direct*, goal orient*, self talk, imagery, mental practice, self evaluat*, ready*, attentional focus*, problem solv*, goal management; combined with motor, mobility, activit*, skill, task, function, ADL.Results: Twenty-six articles were reviewed. Seven studies investigated general Cognitive strategies and 19 investigated task-specific strategies. The most commonly studied task-specific Strategy was motor imagery. Findings suggest that general Strategy training ...
Timothy J. Wolf - One of the best experts on this subject based on the ideXlab platform.
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Cognitive oriented Strategy training augmented rehabilitation costar for ischemic stroke a pilot exploratory randomized controlled study
Disability and Rehabilitation, 2021Co-Authors: Timothy J. Wolf, Jorge Rios, Helene J. Polatajko, Sara Mcewen, Meghan Doherty, Carolyn M. Baum, Anna E BooneAbstract:Purpose: To investigate the effect of adding Cognitive Strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared wit...
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Cognitive oriented Strategy training augmented rehabilitation (COSTAR) for ischemic stroke: a pilot exploratory randomized controlled study.
Disability and Rehabilitation, 2019Co-Authors: Timothy J. Wolf, Anna Boone, Jorge Rios, Helene J. Polatajko, Meghan Doherty, Carolyn M. Baum, Sara McewenAbstract:: Purpose: To investigate the effect of adding Cognitive Strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared with TST on activity and participation for chronic stroke survivors in an outpatient occupational therapy setting Materials and methods: We conducted an exploratory, single-blind, randomized controlled trial. Participants were randomized to TST or COSTAR protocol. Our primary outcomes measured activity and participation after stroke: the Stroke Impact Scale (SIS), Canadian Occupational Performance Measure (COPM), and Performance Quality Rating Scale (PQRS). Results: Forty-four participants were randomized. The COSTAR group had an attrition rate of 50% and an average of 9.8 of 12 sessions were completed; the TST group had an attrition rate of 25% and an average of 10.7 sessions were completed. Generally both groups improved on the majority of primary and secondary outcomes. There is little evidence to support a beneficial effect of COSTAR over TST for improvement of primary measures of activity performance or secondary measures. Conclusion: Negligible findings may be attributed to an inadvertent treatment group equivalency. Further, the research design did not allow for adequate measurement of the effect of each intervention on participants' ability to generalize learned skills. Implications for rehabilitation Stroke rehabilitation is largely based upon the principles of task-specific training, which is associated with improvements in upper extremity motor performance; however, TST requires a heavy dosage and lacks generalization to untrained activities. Cognitive Strategy use has been associated with improved generalization of treatment to untrained activities and novel contexts however, it is often not used in TST protocols. The results of this preliminary study found no clear advantage between task-specific training and Strategy-adapted task-specific training on trained and untrained activities when both interventions targeted activity performance. Task-specific training, if focused at the activity performance level rather than the impairment reduction level, may have a stronger effect on improving in individual's ability to participate in everyday life activities even without the use of Cognitive-strategies. Incorporating Cognitive Strategy-use into TST would likely produce the greatest effect on generalization and transfer of the treatment effects to other activities and contexts rather than solely on activity performance of trained activities.
Helene J. Polatajko - One of the best experts on this subject based on the ideXlab platform.
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Cognitive Strategy training in childhood onset movement disorders replication across therapists
Frontiers in Pediatrics, 2021Co-Authors: Helene J. Polatajko, Hortensia Gimeno, Jeanpierre Lin, Victoria Cornelius, Richard G BrownAbstract:Objective: To explore preliminary effectiveness of the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach in improving outcomes in childhood-onset hyperkinetic movement disorders (HMDs) including dyskinetic cerebral palsy following deep brain stimulation (DBS) across UK clinical occupational therapists. Methods: Randomized, multiple-baseline, Single Case Experimental Design N-of-1 trial with replications across participants. Five self-selected goals were identified: three goals were worked on during CO-OP and two goals were left untreated and used to assess skills transfer. Participants were between 6 and 21 years and had received DBS surgery with baseline Manual Ability Classification System (MACS) levels I-IV. Participants were randomized to typical or extended baseline (2 vs. 6 weeks), followed by 10 weekly individual CO-OP sessions. The primary outcome was functional performance measured by the Performance Quality Rating Scale-Individualized (PQRS-I), assessed before, during, and following treatment. Outcome assessors were blinded to baseline allocation, session number, and assessment time. A non-overlapping index, Tau-U, was used to measure effect size. Results: Of the 12 participants recruited, 10 commenced and completed treatment. In total, 63% of trained goals improved with effect sizes 0.66-1.00 ("moderate" to "large" effect), seen for all children in at least one goal. Skills transfer was found in 37% of the untrained goals in six participants. Conclusions: Cognitive Strategy use improved participant-selected functional goals in childhood-onset HMD, more than just practice during baseline. Preliminary effectiveness is shown when the intervention is delivered in clinical practice by different therapists in routine clinical settings.
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Cognitive oriented Strategy training augmented rehabilitation costar for ischemic stroke a pilot exploratory randomized controlled study
Disability and Rehabilitation, 2021Co-Authors: Timothy J. Wolf, Jorge Rios, Helene J. Polatajko, Sara Mcewen, Meghan Doherty, Carolyn M. Baum, Anna E BooneAbstract:Purpose: To investigate the effect of adding Cognitive Strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared wit...
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Cognitive oriented Strategy training augmented rehabilitation (COSTAR) for ischemic stroke: a pilot exploratory randomized controlled study.
Disability and Rehabilitation, 2019Co-Authors: Timothy J. Wolf, Anna Boone, Jorge Rios, Helene J. Polatajko, Meghan Doherty, Carolyn M. Baum, Sara McewenAbstract:: Purpose: To investigate the effect of adding Cognitive Strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared with TST on activity and participation for chronic stroke survivors in an outpatient occupational therapy setting Materials and methods: We conducted an exploratory, single-blind, randomized controlled trial. Participants were randomized to TST or COSTAR protocol. Our primary outcomes measured activity and participation after stroke: the Stroke Impact Scale (SIS), Canadian Occupational Performance Measure (COPM), and Performance Quality Rating Scale (PQRS). Results: Forty-four participants were randomized. The COSTAR group had an attrition rate of 50% and an average of 9.8 of 12 sessions were completed; the TST group had an attrition rate of 25% and an average of 10.7 sessions were completed. Generally both groups improved on the majority of primary and secondary outcomes. There is little evidence to support a beneficial effect of COSTAR over TST for improvement of primary measures of activity performance or secondary measures. Conclusion: Negligible findings may be attributed to an inadvertent treatment group equivalency. Further, the research design did not allow for adequate measurement of the effect of each intervention on participants' ability to generalize learned skills. Implications for rehabilitation Stroke rehabilitation is largely based upon the principles of task-specific training, which is associated with improvements in upper extremity motor performance; however, TST requires a heavy dosage and lacks generalization to untrained activities. Cognitive Strategy use has been associated with improved generalization of treatment to untrained activities and novel contexts however, it is often not used in TST protocols. The results of this preliminary study found no clear advantage between task-specific training and Strategy-adapted task-specific training on trained and untrained activities when both interventions targeted activity performance. Task-specific training, if focused at the activity performance level rather than the impairment reduction level, may have a stronger effect on improving in individual's ability to participate in everyday life activities even without the use of Cognitive-strategies. Incorporating Cognitive Strategy-use into TST would likely produce the greatest effect on generalization and transfer of the treatment effects to other activities and contexts rather than solely on activity performance of trained activities.
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pilot randomized controlled trial investigating Cognitive Strategy use to improve goal performance after stroke
American Journal of Occupational Therapy, 2012Co-Authors: Helene J. Polatajko, Sara Mcewen, Jennifer D Ryan, Carolyn M. BaumAbstract:OBJECTIVE. The authors compared changes in client performance on three goals poststroke after the Cognitive Orientation to daily Occupational Performance (CO–OP) intervention or standard occupational therapy (SOT) to determine the magnitude and direction of change. METHOD. Eight people living in the community following a stroke were randomly assigned to receive CO–OP (n = 4) or SOT (n = 4). CO–OP is a 10-session, Cognitive-oriented approach to improving performance that uses client-driven Cognitive strategies. SOT was therapist driven and combined task-specific and component-based training. Goal performance was measured by the therapist-rated Performance Quality Rating Scale (PQRS) and the participant-rated Canadian Occupational Performance Measure (COPM). RESULTS. Using Mann-Whitney U test, we found that CO–OP participants showed significantly greater improvement in performance (PQRS, p = .02; COPM Performance, p = .02) compared with SOT but no improvement in satisfaction (COPM Satisfaction, p = .38). CONCLUSION. The CO–OP group demonstrated larger performance improvements than the SOT group. Because of the promising results, an investigation using a larger sample is warranted
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Cognitive Strategy use to enhance motor skill acquisition post stroke a critical review
Brain Injury, 2009Co-Authors: Sara Mcewen, Maria Huijbregts, Jennifer D Ryan, Helene J. PolatajkoAbstract:Objective: The objective of this critical review was to examine the literature regarding the use of Cognitive strategies to acquire motor skills in people who have had a stroke, to determine which strategies are in use and to compile evidence of their effectiveness.Search terms: A computerized search of a range of databases was conducted using the following search terms: stroke, cerebrovascular accident; combined with Strategy training, learning strateg*, Cognitive strateg*, metaCognitive strateg*, goal setting, goal planning, goal attainment, goal direct*, goal orient*, self talk, imagery, mental practice, self evaluat*, ready*, attentional focus*, problem solv*, goal management; combined with motor, mobility, activit*, skill, task, function, ADL.Results: Twenty-six articles were reviewed. Seven studies investigated general Cognitive strategies and 19 investigated task-specific strategies. The most commonly studied task-specific Strategy was motor imagery. Findings suggest that general Strategy training ...
Carolyn M. Baum - One of the best experts on this subject based on the ideXlab platform.
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Cognitive oriented Strategy training augmented rehabilitation costar for ischemic stroke a pilot exploratory randomized controlled study
Disability and Rehabilitation, 2021Co-Authors: Timothy J. Wolf, Jorge Rios, Helene J. Polatajko, Sara Mcewen, Meghan Doherty, Carolyn M. Baum, Anna E BooneAbstract:Purpose: To investigate the effect of adding Cognitive Strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared wit...
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Cognitive oriented Strategy training augmented rehabilitation (COSTAR) for ischemic stroke: a pilot exploratory randomized controlled study.
Disability and Rehabilitation, 2019Co-Authors: Timothy J. Wolf, Anna Boone, Jorge Rios, Helene J. Polatajko, Meghan Doherty, Carolyn M. Baum, Sara McewenAbstract:: Purpose: To investigate the effect of adding Cognitive Strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared with TST on activity and participation for chronic stroke survivors in an outpatient occupational therapy setting Materials and methods: We conducted an exploratory, single-blind, randomized controlled trial. Participants were randomized to TST or COSTAR protocol. Our primary outcomes measured activity and participation after stroke: the Stroke Impact Scale (SIS), Canadian Occupational Performance Measure (COPM), and Performance Quality Rating Scale (PQRS). Results: Forty-four participants were randomized. The COSTAR group had an attrition rate of 50% and an average of 9.8 of 12 sessions were completed; the TST group had an attrition rate of 25% and an average of 10.7 sessions were completed. Generally both groups improved on the majority of primary and secondary outcomes. There is little evidence to support a beneficial effect of COSTAR over TST for improvement of primary measures of activity performance or secondary measures. Conclusion: Negligible findings may be attributed to an inadvertent treatment group equivalency. Further, the research design did not allow for adequate measurement of the effect of each intervention on participants' ability to generalize learned skills. Implications for rehabilitation Stroke rehabilitation is largely based upon the principles of task-specific training, which is associated with improvements in upper extremity motor performance; however, TST requires a heavy dosage and lacks generalization to untrained activities. Cognitive Strategy use has been associated with improved generalization of treatment to untrained activities and novel contexts however, it is often not used in TST protocols. The results of this preliminary study found no clear advantage between task-specific training and Strategy-adapted task-specific training on trained and untrained activities when both interventions targeted activity performance. Task-specific training, if focused at the activity performance level rather than the impairment reduction level, may have a stronger effect on improving in individual's ability to participate in everyday life activities even without the use of Cognitive-strategies. Incorporating Cognitive Strategy-use into TST would likely produce the greatest effect on generalization and transfer of the treatment effects to other activities and contexts rather than solely on activity performance of trained activities.
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pilot randomized controlled trial investigating Cognitive Strategy use to improve goal performance after stroke
American Journal of Occupational Therapy, 2012Co-Authors: Helene J. Polatajko, Sara Mcewen, Jennifer D Ryan, Carolyn M. BaumAbstract:OBJECTIVE. The authors compared changes in client performance on three goals poststroke after the Cognitive Orientation to daily Occupational Performance (CO–OP) intervention or standard occupational therapy (SOT) to determine the magnitude and direction of change. METHOD. Eight people living in the community following a stroke were randomly assigned to receive CO–OP (n = 4) or SOT (n = 4). CO–OP is a 10-session, Cognitive-oriented approach to improving performance that uses client-driven Cognitive strategies. SOT was therapist driven and combined task-specific and component-based training. Goal performance was measured by the therapist-rated Performance Quality Rating Scale (PQRS) and the participant-rated Canadian Occupational Performance Measure (COPM). RESULTS. Using Mann-Whitney U test, we found that CO–OP participants showed significantly greater improvement in performance (PQRS, p = .02; COPM Performance, p = .02) compared with SOT but no improvement in satisfaction (COPM Satisfaction, p = .38). CONCLUSION. The CO–OP group demonstrated larger performance improvements than the SOT group. Because of the promising results, an investigation using a larger sample is warranted
Jorge Rios - One of the best experts on this subject based on the ideXlab platform.
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Cognitive oriented Strategy training augmented rehabilitation costar for ischemic stroke a pilot exploratory randomized controlled study
Disability and Rehabilitation, 2021Co-Authors: Timothy J. Wolf, Jorge Rios, Helene J. Polatajko, Sara Mcewen, Meghan Doherty, Carolyn M. Baum, Anna E BooneAbstract:Purpose: To investigate the effect of adding Cognitive Strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared wit...
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Cognitive oriented Strategy training augmented rehabilitation (COSTAR) for ischemic stroke: a pilot exploratory randomized controlled study.
Disability and Rehabilitation, 2019Co-Authors: Timothy J. Wolf, Anna Boone, Jorge Rios, Helene J. Polatajko, Meghan Doherty, Carolyn M. Baum, Sara McewenAbstract:: Purpose: To investigate the effect of adding Cognitive Strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared with TST on activity and participation for chronic stroke survivors in an outpatient occupational therapy setting Materials and methods: We conducted an exploratory, single-blind, randomized controlled trial. Participants were randomized to TST or COSTAR protocol. Our primary outcomes measured activity and participation after stroke: the Stroke Impact Scale (SIS), Canadian Occupational Performance Measure (COPM), and Performance Quality Rating Scale (PQRS). Results: Forty-four participants were randomized. The COSTAR group had an attrition rate of 50% and an average of 9.8 of 12 sessions were completed; the TST group had an attrition rate of 25% and an average of 10.7 sessions were completed. Generally both groups improved on the majority of primary and secondary outcomes. There is little evidence to support a beneficial effect of COSTAR over TST for improvement of primary measures of activity performance or secondary measures. Conclusion: Negligible findings may be attributed to an inadvertent treatment group equivalency. Further, the research design did not allow for adequate measurement of the effect of each intervention on participants' ability to generalize learned skills. Implications for rehabilitation Stroke rehabilitation is largely based upon the principles of task-specific training, which is associated with improvements in upper extremity motor performance; however, TST requires a heavy dosage and lacks generalization to untrained activities. Cognitive Strategy use has been associated with improved generalization of treatment to untrained activities and novel contexts however, it is often not used in TST protocols. The results of this preliminary study found no clear advantage between task-specific training and Strategy-adapted task-specific training on trained and untrained activities when both interventions targeted activity performance. Task-specific training, if focused at the activity performance level rather than the impairment reduction level, may have a stronger effect on improving in individual's ability to participate in everyday life activities even without the use of Cognitive-strategies. Incorporating Cognitive Strategy-use into TST would likely produce the greatest effect on generalization and transfer of the treatment effects to other activities and contexts rather than solely on activity performance of trained activities.