DÉTERMINANTS SOCIO-ÉCONOMIQUES ET CULTURELS ASSOCIÉS À LA RÉCUPÉRATION NEUROPSYCHOLOGIQUE POST-AVC : ÉTUDE CLINIQUE LONGITUDINALE À CAS UNIQUE D’UN PROGRAMME DE REVALIDATION COGNITIVE À LUBUMBASHI, RÉPUBLIQUE DÉMOCRATIQUE DU CONGO / SOCIOECONOMIC AND CULTURAL FACTORS ASSOCIATED WITH POST-STROKE NEUROPSYCHOLOGICAL RECOVERY: A LONGITUDINAL SINGLE-CASE CLINICAL STUDY OF A COGNITIVE REHABILITATION PROGRAM IN LUBUMBASHI, DEMOCRATIC REPUBLIC OF THE CONGO

Abstract

L’accident vasculaire cérébral (AVC) peut entraîner des séquelles cognitives, émotionnelles, comportementales et fonctionnelles persistantes susceptibles de compromettre l’autonomie et la qualité de vie. Cette étude clinique longitudinale à cas unique décrit les séquelles neuropsychologiques, leur évolution au cours d’un programme de revalidation cognitive de dix séances ainsi que les facteurs socio-économiques, culturels et familiaux susceptibles d’accompagner cette trajectoire chez un patient suivi à Lubumbashi. Les données provenaient de l’observation clinique, d’entretiens, du dossier médical et d’une batterie de tests neuropsychologiques. Le participant, âgé de 35 ans, marié, enseignant et détenteur d’un diplôme d’État, avait présenté deux épisodes d’AVC. Le bilan initial indiquait un score de 18/30 au Montréal Cognitive Assessment (MoCA), compatible avec une performance cognitive globale diminuée dans ce contexte clinique, ainsi que des difficultés principalement attentionnelles, mnésiques et exécutives. Les valeurs numériques utilisées pour suivre les séances dans ces domaines et pour l’autonomie sont des indices cliniques intra-individuels de suivi issus du protocole de revalidation ; elles ne constituent ni des scores normatifs standardisés ni des seuils diagnostiques et doivent être interprétées uniquement comme des trajectoires relatives au sein de ce cas. Une progression a été observée dans plusieurs domaines, particulièrement l’attention et certaines composantes mnésiques, tandis que d’autres fonctions sont demeurées fragiles. L’instabilité financière, l’accès limité aux soins et les conditions de vie défavorables ont coexisté avec cette trajectoire, alors que le niveau d’instruction et le soutien familial constituaient des ressources potentielles. En raison du devis à cas unique, ces observations n’établissent aucune relation causale ni généralisation statistique. Elles illustrent l’intérêt d’une lecture biopsychosociale et contextualisée de la revalidation post-AVC.

Stroke may result in persistent cognitive, emotional, behavioral, and functional impairments that affect autonomy and quality of life. This longitudinal single-case clinical study describes neuropsychological sequelae, their course during a ten-session cognitive rehabilitation program, as well as socioeconomic, cultural, and family factors that may have accompanied this trajectory in a patient receiving care in Lubumbashi. Data were obtained from clinical observation, interviews, medical-record review, and a neuropsychological test battery. The participant was a 35-year-old married male teacher with a secondary-school diploma who had experienced two strokes. Initial assessment yielded a Montreal Cognitive Assessment (MoCA) score of 18/30, consistent with reduced global cognitive performance in this clinical context, with predominant attention, memory, and executive difficulties. Numerical values used to monitor rehabilitation sessions in these domains and autonomy are within-patient clinical follow-up indices derived from the rehabilitation protocol; they are not standardized normative scores or diagnostic cut-offs and should be interpreted only as relative trajectories within this case. Improvement was observed in several domains, especially attention and some memory components, whereas other functions remained vulnerable. Financial instability, limited access to care, and adverse living conditions coexisted with this trajectory, while educational background and family support represented potential resources. Because of the single-case design, these observations do not establish causality or statistical generalizability. They illustrate the value of a biopsychosocial and context-sensitive approach to post-stroke rehabilitation.

Stroke may result in persistent cognitive, emotional, behavioral, and functional impairments that affect autonomy and quality of life. This longitudinal single-case clinical study describes neuropsychological sequelae, their course during a ten-session cognitive rehabilitation program, as well as socioeconomic, cultural, and family factors that may have accompanied this trajectory in a patient receiving care in Lubumbashi. Data were obtained from clinical observation, interviews, medical-record review, and a neuropsychological test battery. The participant was a 35-year-old married male teacher with a secondary-school diploma who had experienced two strokes. Initial assessment yielded a Montreal Cognitive Assessment (MoCA) score of 18/30, consistent with reduced global cognitive performance in this clinical context, with predominant attention, memory, and executive difficulties. Numerical values used to monitor rehabilitation sessions in these domains and autonomy are within-patient clinical follow-up indices derived from the rehabilitation protocol; they are not standardized normative scores or diagnostic cut-offs and should be interpreted only as relative trajectories within this case. Improvement was observed in several domains, especially attention and some memory components, whereas other functions remained vulnerable. Financial instability, limited access to care, and adverse living conditions coexisted with this trajectory, while educational background and family support represented potential resources. Because of the single-case design, these observations do not establish causality or statistical generalizability. They illustrate the value of a biopsychosocial and context-sensitive approach to post-stroke rehabilitation.