Executive dysfunction and balance function post-stroke: a cross-sectional study


Dear Editor,

I found the article “Executive dysfunction and balance function post-stroke: A cross-sectional study” written by Hayes, Donnellan, and Stokes, very intriguing. The study gives an understanding about the many factors that are associated with the continuation of executive dysfunction (ED) with post-stroke patients, including the correlation between executive function (EF) and balance issues. Balance issues result in patients’ difficulty to follow physical post-stroke home treatments, inevitably increasing their executive dysfunction. Further research is possible about implementing new physical post-stroke home treatments that can help patients with balance issues when performing post-stroke treatments [1].

The authors acknowledge the need for new physical interventions but do not discuss the need for cognitive interventions. According to Semenov, Bigelow, Xue, du Lac, and Agrawal, the vestibular system projects proprioceptive input to help a person maintain “balance and postural control” [2]. The article recognizes the essence of cognitive function when it is related to balance, but does not associate it with executive function nor the effects it has on a patient's physical function. However Bilgrei states a vestibular disorder can affect a person's cognition, or ability to think, “specifically to pay attention and concentrate, to remember, to reason and to problem solve” [3]. It is also stated by Hayes and others that post-stroke patients have “difficulty in following physiotherapy home exercise program” [1]. In order to improve one's physical function, one needs to also develop a specific home cognition intervention plan for post-stroke patients.

Patients with a vestibular disorder, as a result from a stroke, have lower cognition stamina where routine activities become more and more difficult; they also exhibit decreased sequencing [3]. Following a step by step process for physiotherapy exercises becomes more and more of a challenge for post-stroke victims. Strengthening one's cognition will help increase one's cognitive stamina to perform everyday tasks, which includes sequencing. Some cognitive exercises that can be implemented are “memory card games, massage, proprioceptive practices, visual attention training, stringing beads to match specific models to help with sequencing and figure-ground discrimination” [4]. Further research to combine a cognitive and physical intervention for post-stroke patients would result in optimum rehabilitation within executive function.

Lastly, I would like to thank the authors for their time and efforts towards their study to further increase the rehabilitation program for post-stroke patients.Ethical approval: None required.Conflict of interest: None.


Executive dysfunction and balance function post-stroke: a cross-sectional study.