Neuropsychological interventions in stroke survivors: implications for evidence based psychological practice

Stroke survivors should be considered at high risk for cognitive impairment and emotional disorders, linked with disability, poor functional outcome and life dissatisfaction. The aim is to provide indications about the neuropsychological interventions based on existing evidence, appropriateness and clinical effectiveness. Guidelines in stroke management, systematic reviews and randomized controlled clinical trials about cognitive and emotional disorders, neuropsychological rehabilitation and psychological treatments in stroke survivors were used to provide good practices. They were searched with multiple search strategies and appropriate key words in Cochrane Central Register of Controlled Trials and in the Medline and Psychinfo databases. Implications for psychological practice. There is a strong evidence and expert consensus to support the use of post stroke neuropsychological assessment, based on a considerable amount of studies. There is evidence of first grade of benefit of cognitive rehabilitation in terms of improvement in scores on neuropsychological tests, but there is poor evidence for increase in functional outcome and quality of life. Evidence is emerging that some psychological treatments seems to be effective in stroke survivors, but more evidence is required to recommend the routine use of psychotherapy after stroke. Tools to examine executive functions, attention, memory, visuospatial domains, neurobehavioral change and emotional distress are recommended. A compilation of indications for cognitive rehabilitation and psychological treatment is suggested. Psychological treatment and neuropsychological rehabilitation needs to be developed in rehabilitation services to improve the quality of life of stroke survivors. General expert consensus and validation of practices and protocols needs to be accomplished.