Lesion location may attenuate response to strategy training in acute stroke.

Background: Strategy training, a rehabilitation intervention, reduces disability and improves functional skills associated with goal-directed behavior. Stroke lesions impacting selected ventromedial regions of interest associated with initiation of goal-directed behavior may attenuate intervention response. If so, strategy training may not be optimal for people with stroke lesions in these regions.

Objective: To examine whether ventromedial regions of interest attenuate changes in disability status attributed to strategy training.

Design: Secondary analysis of data from two randomized controlled clinical trials.

Setting: Inpatient stroke rehabilitation.

Participants: People with acute stroke diagnosis and available diagnostic studies enrolled in inpatient rehabilitation randomized controlled studies between 2009 and 2017.

Intervention: Participants were randomized to strategy training or a control condition in addition to the usual care during inpatient rehabilitation.

Main Outcome Measures: Diagnostic magnetic resonance imaging studies were retrieved from electronic medical records, and stroke lesion location was characterized by a neuroradiologist. Intervention response was defined by Functional Independence Measure change scores of 22 points or greater.

Results: Only 186 of 275 participants had diagnostic studies available; 13 patients showed no apparent lesion on their diagnostic study. Among 173 cases, 156 had complete data at discharge (strategy training n = 71, control n = 85). Twenty-five cases had a lesion within a region of interest (strategy training n = 14, control n = 11). Intervention response was attenuated in the strategy training group for those with lesions in regions of interest [χ (1, n = 71) = 4.60, P = .03], but not for those in the control group [Fisher exact test, n = 85, P = .19).

Conclusions: Lesions in the ventromedial regions of interest may attenuate response to strategy training.