New Alertness Training  (ALTA) Module for RehaCom

A brand new module is now part of RehaCom from version 6.4.  Alertness training was developed for neurological or psychiatric disorders of attention activation. The module aims to train both the tonic and phasic aspects of alertness.

Tonic alertness refers to intrinsic arousal that fluctuates on the order of minutes to hours. It is intimately involved in our ability to sustain attention as well as providing the cognitive tone for more complicated functions such as working memory and executive control.  In contrast to tonic alertness, phasic alertness is about the rapid change in attention due to a brief event and is the basis for operations such as orienting and selective attention.

Tonic and phasic alertness deficits interact with patients’ spatial deficits. For example, tonic and phasic deficits predict the overall severity and chronicity of patients’ spatial symptoms, in many cases better than the level of impairment shown on measures of spatial attention.

The aim of Alertness training is to improve the speed and accuracy of the user’s reactions to visual and auditory stimuli.  The user trains with some presented reaction tasks and his or her reactions are developed in a simulation of traffic situations that are close to reality.

Recent research gives support for a differential training approach, dealing with specifically targeted disturbances in attention. This is because theoretically based or unspecific procedures have not been successful in all aspects of attention. (Gray & Robertson, 1989; Sohlberg & Mateer, 1987; Poser et al., 1992; Sturm et al., 1994; Sturm et al., 1997).

This module also places demands on the user’s visual performance.  In addition, as with all cognitive tasks, demands are also placed on the user’s continuous attention capabilities with the passage of time.

Experience shows that performance improvements with computer-supported training are expected in particular in the post-acute phase after a stroke.

Along with the functional training offered by the working with the computer, through systematic performance assessments the user also has the chance to improve self-perception.

From a therapeutic point of view, it is desirable that along with confronting existing deficiencies in information processing and individual coping and compensation strategy development; (for example the prevention of particular stresses or the use of external help by association with specific standard situations) relatives could also assist in order to reduce stress levels.

On the basis of the initial results - and/or ongoing assessment it should be decided whether the training module Alertness training (ALTA) is used alone or in conjunction with other training modules. (e.g. Reaction behaviour (REVE), Attention & Concentration (AUFM) Divided Attention (GEAU), Vigilance (VIGI), etc.).

Operation of the software

The patient’s task is to press the “answer” button just as he or she registers the stimulus. The program detects from the response of the patient if he or she is able to work with other stimuli, scenarios and / or inter-stimulus intervals.

Execution

The module uses real image material to train the alertness functions in many close to everyday life scenarios. For example, the user is observing a traffic situation - An object, e.g. an animal, vehicle or person, pops up suddenly on the road. The user must respond as quickly as possible by pressing the OK-Button, once he has recognised the object.

There are 16 levels of challenge available for the training and 20 objects are presented successively per level. Depending upon of the stimulus processing quality of the user they may reach the next higher level (if there is a timely reaction to 90% of all presented objects), stay at the current level (there is a timely reaction to 75 - 90% of all objects) or step down a level. These default settings for the sensitivity of software response can be changed at any time by the therapist.

The training starts with tasks to improve phasic alertness. Before the object pops up the user will be warned by a sound. The object will be presented on the screen in a stochastically (varied unpredictably) calculated timeframe (250 - 750 ms).  Some 9000 milliseconds are available for a timely reaction of the user working at the first level. The maximum reaction time decreases automatically as the user progresses through the training levels.

In the proper sense of the tonic alertness the patient will get not a warning sound from level 7 onwards. For all levels the stochastic element changes the inter-stimulus intervals between presenting the objects.

A total of 32 scenarios, 62 different objects and 6 different traffic signs are available for the training.  Optionally the therapist can choose a cockpit view within the parameter menu.