Executive Function Predicts Mobility and Balance in Stroke Rehabilitation: A Cohort Study

Research Objectives: To investigate the effect of executive function on mobility and balance in acute stroke rehabilitation.

Design: This was a cohort study with outcomes assessed at admission and discharge.

Setting: Data were extracted from electronic medical records of an acute inpatient rehabilitation unit at a large, urban, academic medical center.

Participants: Participants were 266 adults with stroke admitted to the inpatient rehabilitation unit between 2012 and 2016. Participants were a subgroup of a larger cohort (n=408) who completed the Symbol Digit Modalities Test (SDMT), a measure of executive function.

Interventions: This was an observational study of rehabilitation outcomes.

Main Outcome Measures: The primary outcomes were the baseline-adjusted discharge scores of the Functional Independence Measure mobility subscale and the Berg Balance Scale. The primary predictor was executive function as measured by the SDMT, administered at admission. Covariates considered included sex, age, stroke severity, days post stroke, length of stay, lesion type, comorbidities, and lesion side. The FIM Cognitive subscale was included in each model to distinguish between executive function and general cognitive function.

Results: The SDMT was a significant predictor of baseline-adjusted mobility at discharge (B=0.08; 95% CI=0.03-0.15, standardized B=.15). Other significant predictors included age, sex, and length of stay. The SDMT was a significant predictor of baseline-adjusted balance at discharge (B=0.14, 95%CI=0.01-0.27, standardized B=.11). Other significant predictors included age. FIM Cognitive scores significant predictors of mobility but not balance.

Conclusions: Executive function is a factor in mobility gains during inpatient rehabilitation for stroke, though the association is modest. Rehabilitation professions should consider the impact on mobility. Cognitive rehabilitation addressing executive function may aid in mobility progress. Executive function contributes to improvements in balance, but the contributions are very small.

Author(s) Disclosures: The authors have no conflicts to disclose.