Post-stroke patients have difficulty following instructions, making rehabilitation uncertain

Researchers at the Ben-Gurion University of the Negev in Beersheba examined how a stroke affects the ability to follow changing instructions.

By JUDY SIEGEL-ITZKOVICH JANUARY 19, 2025 04:21

Identification and rapid response to stroke (photo credit: freepik)

Every year, about 18,000 people in Israel suffer a stroke, but only about 5,200 receive advanced disability-preventing treatments within the available time window.

Some 15 million people worldwide suffer a stroke every year; five million die, and another five million are left permanently disabled, placing a burden on families and communities. Stroke is one of the three leading causes of death and one of the main causes of disability in the Western world.

Every day, we use our capacity to understand instructions for routine daily activities that have a major impact on stroke patients’ rehabilitation but have never been studied before.

Dr. Reut Binyamin-Netser and Prof. Lior Shmuelof from the Department of Cognitive and Brain Sciences at Ben-Gurion University of the Negev in Beersheba examined how a stroke affects the ability to follow changing instructions and what cognitive abilities underlie this ability.

The study was conducted at the Joint Laboratory for Neurological Rehabilitation Research of BGU and ADI-Negev Nahalat Eran. Anat Shaked Ravni, BGU engineer, also participated in the study.

A stroke patient walks (credit: Negev Lab)

They and their team have just published their findings in the journal Neuropsychology under the title “Rapid instructed task learning is impaired after stroke and associated with impairments in prepotent inhibition and processing speed.”

Stroke usually occurs because of a sudden disruption in the blood supply to brain tissue by a blood clot or bleeding, resulting in neuronal damage that can present in various ways.

Causing cognitive impairment

One of the most common disabilities that occurs (72% of cases) after stroke is cognitive impairment: memory and attention problems and difficulties that require executive functions, adaptation processes to change, adjustments to unexpected situations, and self-control.

These disabilities lead to functional deficits, a lower chance of independent functioning after stroke, and difficulty participating in and benefiting from their rehabilitation treatment.

To investigate the phenomenon, the researchers examined two groups of subjects living at ADI-Negev. One group consisted of 31 stroke patients, while 36 people who had not suffered a stroke but were in the same age range (55 to 75) served as a control group.

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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, as well as other tasks designed to characterize cognitive abilities, such as response inhibition ability and information processing speed using symbols.

The results showed decreased accuracy and response times during instruction following a stroke. In addition, there was a decrease in information processing speed and response inhibition, the ability to suppress prepotent behavior that is inappropriate or no longer required. A relationship was also found between the patient’s response inhibition abilities and ability to follow instructions.

THE INABILITY to respond makes it difficult for patients to be rehabilitated, said Binyamin-Netser. Understanding instructions and tasks is also the basis for motor rehabilitation – opening/closing bottle lids, picking up a glass of water and drinking it, arranging puzzles, picking small objects from one container and moving them to another, turning doorknobs, reading magazines, and turning the pages of books or newspapers.

“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,” commented Binyamin-Netser.

“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,” added Shmuelof, who was interviewed by The Jerusalem Post. The researchers recommend starting an intensive rehabilitation program using computerized technologies as early as possible to improve the stroke recovery process.

Founded in 2005, the ADI-Negev Nahalat Eran Rehabilitation Village was named to honor the memory of Eran Almog, the late son and guiding light of founders Didi and Maj.-Gen. (res.) Doron Almog.

Fueled by his love for Eran, who was born with severe autism and cognitive disabilities, Doron Almog – a celebrated IDF hero and Israel Prize Laureate – led the creation of the one-of-a-kind rehabilitation village in the South where people from diverse backgrounds and all levels of ability can live, heal, and grow together.

“Six years ago, we established a translational medicine lab at ADI-Negev to turn basic research into benefits for the patients, as there was a large gap between them,” Shmuelof said. “It was very successful. We tried to explain the phenotype of damage they suffered and create a profile for follow-up.

“Some patients had only a partial recovery because they were not getting enough rehabilitation and not getting it fast enough. Stroke sufferers can now take part in a program for 40 more hours of rehabilitation in a month, and this intensity is very beneficial.

“We have also opened at BGU a new center for occupational training so we will have more professionals who will be able to work with them.”