Accessibility features in executive function apps and user performance post-stroke

Executive functions are key cognitive processes that enable planning, organization, and problem-solving, and they are often impaired after stroke, limiting independence in daily life. Digital tests offer innovative ways to assess these functions, but their accessibility may influence performance. This study compared performance on accessible versus less-accessible versions of three digital executive function applications among 32 post-stroke individuals and 32 matched healthy adults. The assessments included a virtual shopping task (Four-Item Tablet Test, 4ITT), a medication-sorting task (Medicine Arrangement Test for Occupational Therapy, MATOT), and a digital Trail Making Test (TMT). Accessible versions incorporated features such as voiceover, high contrast, or multi-page layout, while less-accessible versions omitted these features. Stroke participants performed better on the single-page version of the shopping task and on the voiceover version of the medication-sorting task. No significant differences were observed between versions in the control group, although they reported greater difficulty with the low-contrast TMT. These results indicate that accessibility features can support or hinder cognitive performance after stroke, depending on task demands. Between-group differences may partly reflect residual confounding by education and technological proficiency, alongside stroke-related factors. Overall, the findings emphasize the need to design digital executive function assessments that address stroke-related cognitive challenges.