{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:42:04Z","timestamp":1790401324171,"version":"4.1.0"},"reference-count":33,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T00:00:00Z","timestamp":1683158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Psychiatry at Weill Cornell Medicine","award":["UL1TR002384"],"award-info":[{"award-number":["UL1TR002384"]}]},{"name":"National Center for Advancing Translational Sciences of the National Institutes of Health","award":["UL1TR002384"],"award-info":[{"award-number":["UL1TR002384"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Executive dysfunction after stroke is associated with limitations in daily activities and disability. Existing interventions for executive dysfunction show inconsistent transfer to everyday activities and require frequent clinic visits that can be difficult for patients with chronic mobility challenges to access. To address this barrier, we developed a telehealth-based executive function intervention that combines computerized cognitive training and metacognitive strategy. The goal of this study was to describe intervention development and to provide preliminary evidence of feasibility and acceptability in three individuals who completed the treatment protocol. The three study participants were living in the community and had experienced a stroke &gt;6 months prior. We assessed satisfaction (Client Satisfaction Questionnaire-8 [CSQ-8]), credibility (Credibility and Expectancy Questionnaire), and feasibility (percent of sessions completed). All three subjects rated the treatment in the highest satisfaction category on the CSQ-8, found the treatment to be credible, and expected improvement. Participants completed a median of 96% of computerized cognitive training sessions and 100% of telehealth-delivered metacognitive strategy training sessions. Individuals with chronic stroke may find a remotely delivered intervention that combines computerized cognitive training and metacognitive strategy training to be feasible and acceptable. Further evaluation with larger samples in controlled trials is warranted.<\/jats:p>","DOI":"10.3390\/ijerph20095714","type":"journal-article","created":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T02:03:18Z","timestamp":1683165798000},"page":"5714","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Feasibility and Acceptability of a Remotely Delivered Executive Function Intervention That Combines Computerized Cognitive Training and Metacognitive Strategy Training in Chronic Stroke"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4307-5742","authenticated-orcid":false,"given":"Abhishek","family":"Jaywant","sequence":"first","affiliation":[{"name":"Departments of Psychiatry & Rehabilitation Medicine, Weill Cornell Medicine, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah","family":"Mautner","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Waldman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"O\u2019Dell","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faith M.","family":"Gunning","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6902-6853","authenticated-orcid":false,"given":"Joan","family":"Toglia","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY 10065, USA"},{"name":"School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY 10522, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1017\/S1355617717000728","article-title":"Domain-Specific Cognitive Recovery after First-Ever Stroke: A 2-Year Follow-Up","volume":"24","author":"Turunen","year":"2018","journal-title":"J. Int. Neuropsychol. Soc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1080\/09638280701355694","article-title":"Relationship between Executive Functions and Productivity Outcomes Following Stroke","volume":"30","author":"Ownsworth","year":"2008","journal-title":"Disabil. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1111\/ene.13854","article-title":"Executive Function Subdomains Are Associated with Post-stroke Functional Outcome and Permanent Institutionalization","volume":"26","author":"Laakso","year":"2019","journal-title":"Eur. J. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1016\/j.clinph.2019.04.004","article-title":"Brain Networks and Their Relevance for Stroke Rehabilitation","volume":"130","author":"Guggisberg","year":"2019","journal-title":"Clin. Neurophysiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1038\/jcbfm.2013.238","article-title":"Altered Functional Organization within and between Resting-State Networks in Chronic Subcortical Infarction","volume":"34","author":"Wang","year":"2014","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.neuroimage.2018.12.003","article-title":"Adaptive Task Difficulty Influences Neural Plasticity and Transfer of Training","volume":"188","author":"Flegal","year":"2019","journal-title":"NeuroImage"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1080\/09602011.2020.1831555","article-title":"Effectiveness of Computer-Based Training on Post-Stroke Cognitive Rehabilitation: A Systematic Review and Meta-Analysis","volume":"32","author":"Mingming","year":"2022","journal-title":"Neuropsychol. Rehabil."},{"key":"ref_8","first-page":"150","article-title":"Computer-Based Cognitive Training for Executive Functions after Stroke: A Systematic Review","volume":"10","author":"Murre","year":"2016","journal-title":"Front. Hum. Neurosci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1016\/j.apmr.2019.02.011","article-title":"Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature from 2009 through 2014","volume":"100","author":"Cicerone","year":"2019","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_10","unstructured":"Toglia, J., and Foster, E.R. (2021). The Multicontext Approach to Cognitive Rehabilitation: A Metacognitive Strategy Intervention to Optimize Functional Cognition, Gatekeeper Press."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1177\/1545968314562113","article-title":"Strategy Training Shows Promise for Addressing Disability in the First 6 Months After Stroke","volume":"29","author":"Skidmore","year":"2015","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1080\/09602011.2020.1786410","article-title":"Evaluation of an Occupation-Based Metacognitive Intervention Targeting Awareness, Executive Function and Goal-Related Outcomes after Traumatic Brain Injury Using Single-Case Experimental Design Methodology","volume":"31","author":"Doig","year":"2021","journal-title":"Neuropsychol. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1080\/09602011.2020.1810710","article-title":"Feasibility and Acceptability of the Multicontext Approach for Individuals with Acquired Brain Injury in Acute Inpatient Rehabilitation: A Single Case Series","volume":"32","author":"Jaywant","year":"2022","journal-title":"Neuropsychol. Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"70","DOI":"10.3389\/fnagi.2016.00070","article-title":"Effects of Cognitive Training on Resting-State Functional Connectivity of Default Mode, Salience, and Central Executive Networks","volume":"8","author":"Cao","year":"2016","journal-title":"Front. Aging Neurosci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1093\/cercor\/bht234","article-title":"Neural Mechanisms of Brain Plasticity with Complex Cognitive Training in Healthy Seniors","volume":"25","author":"Chapman","year":"2015","journal-title":"Cereb. Cortex"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2720","DOI":"10.1017\/S0033291717001234","article-title":"A New Generation Computerised Metacognitive Cognitive Remediation Programme for Schizophrenia (CIRCuiTS): A Randomised Controlled Trial","volume":"47","author":"Reeder","year":"2017","journal-title":"Psychol. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1080\/02699052.2018.1458335","article-title":"Searching for Effective Components of Cognitive Rehabilitation for Children and Adolescents with Acquired Brain Injury: A Systematic Review","volume":"32","author":"Resch","year":"2018","journal-title":"Brain Inj."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s41983-018-0037-8","article-title":"Effect of Transcranial Direct Current Stimulation on Cognitive Function in Stroke Patients","volume":"54","author":"Shaker","year":"2018","journal-title":"Egypt. J. Neurol. Psychiatry Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2487","DOI":"10.1589\/jpts.27.2487","article-title":"Effect of Computerized Cognitive Rehabilitation Program on Cognitive Function and Activities of Living in Stroke Patients","volume":"27","author":"Yoo","year":"2015","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.apmr.2003.05.002","article-title":"Community Ambulation after Stroke: How Important and Obtainable Is It and What Measures Appear Predictive?","volume":"85","author":"Lord","year":"2004","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"620","DOI":"10.2522\/ptj.20110217","article-title":"Participation in Community Walking Following Stroke: The Influence of Self-Perceived Environmental Barriers","volume":"93","author":"Robinson","year":"2013","journal-title":"Phys. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1161\/01.STR.0000195180.69904.f2","article-title":"Susceptibility to Deterioration of Mobility Long-Term After Stroke: A Prospective Cohort Study","volume":"37","author":"Kwakkel","year":"2006","journal-title":"Stroke"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1080\/02699052.2022.2140832","article-title":"Functional Improvement in Chronic Stroke Patients When Following a Supervised Home-Based Computerized Cognitive Training","volume":"36","author":"Solana","year":"2022","journal-title":"Brain Inj."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1001\/jamaneurol.2019.1604","article-title":"Efficacy of Home-Based Telerehabilitation vs In-Clinic Therapy for Adults After Stroke A Randomized Clinical Trial","volume":"76","author":"Cramer","year":"2019","journal-title":"JAMA Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1017\/S1355617719000651","article-title":"Telehealth Delivery of Memory Rehabilitation Following Stroke","volume":"26","author":"Lawson","year":"2020","journal-title":"J. Int. Neuropsychol. Soc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"n2061","DOI":"10.1136\/bmj.n2061","article-title":"A New Framework for Developing and Evaluating Complex Interventions: Update of Medical Research Council Guidance","volume":"374","author":"Skivington","year":"2021","journal-title":"BMJ"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e029954","DOI":"10.1136\/bmjopen-2019-029954","article-title":"Guidance on How to Develop Complex Interventions to Improve Health and Healthcare","volume":"9","author":"Croot","year":"2019","journal-title":"BMJ Open"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1080\/10400435.2021.1934608","article-title":"Effect of RehaCom Cognitive Rehabilitation Software on Working Memory and Processing Speed in Chronic Ischemic Stroke Patients","volume":"35","author":"Amiri","year":"2023","journal-title":"Assist. Technol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"664","DOI":"10.3109\/02699051003610474","article-title":"A Multicontext Approach to Promoting Transfer of Strategy Use and Self Regulation after Brain Injury: An Exploratory Study","volume":"24","author":"Toglia","year":"2010","journal-title":"Brain Inj."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/0149-7189(82)90074-X","article-title":"The Client Satisfaction Questionnaire","volume":"5","author":"Attkisson","year":"1982","journal-title":"Eval. Program Plann."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S0005-7916(00)00012-4","article-title":"Psychometric Properties of the Credibility\/ Expectancy Questionnaire","volume":"31","author":"Devilly","year":"2000","journal-title":"J. Behav. Ther. Exp. Psychiatry"},{"key":"ref_32","unstructured":"Toglia, J. (2015). Weekly Calendar Planning Activity (WCPA): A Performance Test of Executive Function, AOTA Press."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1001\/jamapsychiatry.2021.0620","article-title":"Effectiveness, Core Elements, and Moderators of Response of Cognitive Remediation for Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Clinical Trials","volume":"78","author":"Vita","year":"2021","journal-title":"JAMA Psychiatry"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/9\/5714\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:28:51Z","timestamp":1760124531000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/9\/5714"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,4]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["ijerph20095714"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20095714","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,4]]}}}