Adaptive Working Memory Training and Functional Outcomes Post-Stroke: A Randomized Trial

Background: Cognitive deficits following ischemic stroke significantly impair functional independence, particularly in instrumental activities of daily living. Previous research highlights working memory as a key target for rehabilitation, but the effectiveness of adaptive working memory training in improving functional outcomes remains underexplored. This study draws on the theoretical framework linking cognitive reserve and neuroplasticity to post-stroke recovery, hypothesizing that targeted cognitive interventions can enhance both working memory and instrumental activities of daily living performance. Materials and Methods: A randomized controlled trial was conducted with 32 participants who experienced ischemic stroke. Participants were randomly assigned to an intervention group (n=16), receiving adaptive working memory training, or an active control group (n=16), engaged in non-adaptive cognitive activities. Independent variables included the type of intervention (adaptive vs. standard), while dependent variables measured instrumental activities of daily living (Lawton-Brody Scale) and working memory (Working Memory Questionnaire, Working Memory Index, Corsi Block Tapping Test). The intervention entailed 25 sessions over 12 weeks, tailored to participant performance to maximize cognitive engagement. Results: The intervention group demonstrated a significant improvement in Working Memory Index compared to the control group, suggesting a stronger effect of adaptive training on cognitive outcomes. However, no significant differences were observed in instrumental activities of daily living performance between groups, raising questions about the transferability of cognitive gains to functional tasks. Discussion: These findings support the theoretical premise that adaptive working memory training enhances cognitive performance post-stroke but highlight limitations in its direct impact on functional independence. Future research should explore the conditions under which such interventions effectively translate cognitive improvements into practical gains, considering factors such as intervention duration, intensity, and individual differences (e.g., baseline performance, motivation, and genetic predispositions). The study underscores the need for refined intervention designs to bridge the gap between cognitive training and functional rehabilitation outcomes. Clinical Trial registration: RIDIE-STUDY-ID-5e61da9608f23.