Stroke telerehabilitation: cognition-first care delivered at home

13.02.2026

Stroke rehabilitation often requires long travel and is concentrated in urban centers, limiting access for rural patients. A study from the Medical University of South Carolina tested a cognition-first telerehabilitation model that pairs brief cognitive sessions with occupational therapy delivered by video at home. The approach aims to support daily functioning and improve engagement in recovery.

Person taking part in a telerehabilitation session after stroke via video call

Remote stroke rehabilitation at home: a video visit with a clinician supports cognitive strategies and everyday activities, illustrating how telerehab can reduce travel burdens while keeping therapy tied to real-life tasks. © Medical University of South Carolina

In the United States, a stroke occurs roughly every 40 seconds and remains a leading cause of death and long-term disability. Recovery can be complex: many survivors face cognitive, functional and motor impairments that affect everyday life. While stroke rehabilitation programs can help, they are often based in urban areas, which can restrict access for people in rural regions. In addition, many programs focus primarily on physical symptoms and language problems, leaving other cognitive challenges less addressed.

A team at the Medical University of South Carolina (MUSC) is evaluating a combined approach called COG-OT. In an NIH-funded Phase 1 feasibility study the team paired cognitive treatment (COG) with occupational therapy (OT) and delivered the care remotely via video visits in patients’ homes.

Why cognition-first matters after stroke

Traditional stroke rehab often begins with physical issues such as balance problems, paralysis, numbness or pain. However, cognitive problems after stroke can affect up to 70 per cent of survivors and may limit how much they benefit from physical rehabilitation.

"Cognitive and motor impairments go hand in hand and really affect real-life function," explained clinical neuropsychologist Stephanie Aghamoosa. "Yet they’re often treated separately."

COG-OT aims to provide a short cognitive primer at the start of treatment and connect it directly to occupational therapy strategies. The goal is to help patients build skills to re-engage in day-to-day activities.

What COG-OT includes

The cognitive portion consists of four brief one-on-one sessions focused on commonly affected skills:

attention
memory
organization
problem-solving

The content is adapted from an established, evidence-based program and simplified for telehealth. Occupational therapists then help patients apply these strategies to real tasks at home, linking cognition and daily living skills.

The program is designed to be tailored to individual needs. "A central feature of COG-OT is that it can be adapted and personalized," explained Aghamoosa. "For example, if someone doesn’t have memory impairment, we won’t spend time on the memory interventions for them. If they have more trouble with problem-solving, that’s where the therapist is going to home in. So, it’s highly personalized."

Telerehab delivery and early feasibility results

Providing care at home can reduce travel burdens and allow therapy to focus on realistic environments, such as cooking with a patient’s own appliances, doing laundry, working around the home or managing a calendar. Woodbury also cited prior NIH trial experience indicating telerehabilitation can be as effective as in-clinic therapy and more accessible.

REHACARE.com; Source: Medical University of South Carolina