Date Presented 04/22/2023

This study explores how social support mediates the relationship between an individual’s abilities and their participation. Results indicate that social support is a mediator for people with aphasia to participate in cognitively demanding activities.

Primary Author and Speaker: Melissa Anthony

Additional Authors and Speakers: Lisa Connor

Contributing Authors: Carolyn Baum, Marjorie Nicholas, Chaitali Dagli

PURPOSE: Both people with aphasia (PWA) and without aphasia (PWOA) who return to the community experience a 20-50% decrease in participation post-stroke (Nicholas et al., 2020). This study examines the relationship among physical ability, cognitive ability, and social support, and how they are associated with the percent retained in mobility- and cognitively-demanding activities for PWA and PWOA.

DESIGN: A cross-sectional design was used. Participants (N=109) were at least 18 years of age, six or more months post-stroke, could withstand at least five hours of testing, and could travel to testing site. An additional 254 participants were recruited through Amazon Cloud Research to make ratings of the demands of twelve different dimensions for the Activity Card Sort (ACS).

METHOD: Items with high demand for cognitive skills and mobility based on the Amazon Cloud Research data were extracted from the ACS (Baum & Edwards, 2008) and comprised two new participation scales. The National Institute of Health Stroke Scale (NIHSS) measured residual neurological impairment and the Delis Kaplan Executive Function System-Trail Making Test measured cognitive ability. The Medical Outcomes Study Social Support Scale (MOS-SS) measured social support.

RESULTS: MOS-SS mediated the relationship between cognition and participation for cognitively-demanding activities for PWA (β=0.17, 95% CI=0.04∼0.29) but not for PWOA. MOS-SS did not mediate the relationship between residual neurological impairment and participation in mobility-demanding activities for PWA or PWOA.

CONCLUSION: Social support plays a key role in supporting PWA to participate in cognitively-demanding activities post-stroke. Occupational therapy practitioners should advocate for PWA to have social support in participating in cognitively-demanding activities.

IMPACT STATEMENT: Future research should examine factors that affect participation in mobility-demanding activities between PWOA and PWA post-stroke.


Baum, C. M., & Edwards, D. (2008). Activity Card Sort, 2nd Edition. Bethesda, MD: American Occupational Therapy Association, Inc.

Nicholas, M. L., Burch, K., Mitchell, J. R., Fox, A. B., Baum, C. M., & Connor, L. T. (2020). Self-perception of physical function contributes to participation in cognitively- and physically-demanding activities after stroke. Frontiers in Neurology, 11, 474.