Abstract
Background. Intracerebral haemorrhage (ICH) accounts for more than a quarter of incident strokes worldwide and carries the highest burden of death and disability among stroke subtypes. In survivors, executive dysfunction rather than motor deficit is a principal barrier to return to work, yet it is rarely the focus of post-neurosurgical care. The Feuerstein Instrumental Enrichment (FIE) programme, based on the theory of Structural Cognitive Modifiability and Mediated Learning Experience, explicitly targets transfer of strategies to daily life but has seldom been reported in stroke.
Case presentation. A 57-year-old man with hypertension, type 2 diabetes mellitus and dyslipidaemia, previously employed in a technical-administrative role, presented with a right temporo-parietal intraparenchymal hematoma with mass effect and was treated neurosurgically. Postoperative neuropsychological assessment showed a predominant dysexecutive profile: impulsivity, execution without planning, anticipation errors and difficulty maintaining spatial constants, with preserved locomotor autonomy. He completed a 12-week mediated programme (2–3 sessions/week) using four sequential FIE instruments: Organisation of Dots, Comparisons, Orientation in Space and Analytic Perception.
Results. At 12 weeks, the patient showed reduced impulsivity, longer response latency, systematic anticipatory planning, greater decisional autonomy and resumed part-time organisational and administrative work.
Conclusion. Motor recovery does not guarantee occupational reintegration after ICH. Structured, mediated cognitive rehabilitation is a feasible, low-cost adjunct to neurosurgical care; controlled studies with standardised outcomes are warranted.
