RehaCom Screening Tests

The RehaCom Screening Test Set was designed in cooperation with Dr. Laco Gaál –
a member of the German Association for Neuropsychologists.  It consists of 5 modules for screening the cognitive status of patients with neurological and/or psychiatric diseases.

Data from 200 healthy people are included as normalized values.  At the end of each screening there is a recommendation of which training modules should be chosen for this particular client.  All 5 screening tests take the client about 20-30 minutes to complete. Leading neuropsychologists suggest that this is an optimal time for a client to do such a test.

RehaCom remains a tool for cognitive therapy and the screening modules are now offered as a way of using the application more effectively.  In contrast to a complex assessment, a screening just gives a hint based on the observed deviation from the norm.  These specially adapted screenings can help to identify those cognitive areas which are suspected to exhibit a deficit. This area can be assessed with further specific diagnostic tools.

The Screening Tests and their paradigms

Alertness
Task:
The first stage of the test is to measure the response time while the user has to push the button as fast as possible, when a fully filled square appears on the screen. For the second condition response time to the same visual stimulus is measured while a signal sound was played before the square appears. The client has to wait until the square appears on the screen to push the button (not reacting on the sound).

Background:
In this module three different skills are measured. The first one is tonic alertness,
which is measured as the response time to a visual stimulus.(1)  The second skill is phasic alertness, which can be described as the improvement of the response time through an acoustic warning signal.(2)  Under the guidance of Sturm et al (3) there is a third part called intrinsic alertness. This skill describes the maintaining of reaction attendance during a longer period of time.
Literature:
(1)Posner, M.L & Boies, SJ. (1971). Components of attention. Psychological Review, 78, 391-408.;  Posner, M.l. (1975). Psychobiology of Attention. In M.S. Gazzaniga & C. Blackmore (Hrsg.), Handbook of Psychobiology. New York: Academic Press.
(2) Posner, M.l. & Petersen, S.E. (1990). The attention system of the human brain. Annual Review of Neuroscience, 13, 25-42.
(3) Sturm W., de Simone A., Krause BJ., Specht K , Hesselmann V., Radermacher 1., Herzog H., Tellmann L., Müller-Gärtner H.W. & Willmes K (1999). Functional anatomy of intrinsic alertness: evidence for a fronto-parietal-thalamic-brainstem network in the right hemisphere. Neuropsychologia, 37, 797-805. ;
Sturm, W. & Willmes, K. (2001). On the functional neuroanatomy of intrinsic and phasic alertness. Neuroimage, J 4, 76-84.

Divided Attention (GEAT)
Task:
In this test the client has to solve a visual and an auditory task simultaneously.  In the visual task the person has to push the button if a closed circle appears amongst a group of 5 partial circles. The circles have the same position in every new set, only the position of the opening changes for every set.  A new set appears every 2 seconds. One trial contains 80 visual stimuli with about 15% relevant stimuli. The auditiory task is to push the button if the person hears a discontinuity in the sequence of the sounds. The sounds are changing from high to low and low to high, in synch with the changing visual stimulus. If two sounds of the same kind (high-high or low-low) appear one after another, the person has to push a button. The sounds will be played every second synchronously with the appearance of a visual stimulus. One trial contains 160 auditory stimuli with approximately 10% relevant stimuli.  For a visual as well as an auditory stimulus, the client has to push the same button on the keyboard. Both tasks start at the same time.

Background:
Empirical studies have shown that attention is not an easy construct. In fact, the four
aspects are mainly independent from each other and can be distinguished as
follows:1,2,3
1. Periodic activation, Alertness
2. Selective attention
3. Divided attention
4. Tonic activation

If divided attention abilities are required in cognitive tasks, then it is necessary that those tasks include at least two stimuli which have be looked out for, simultaneously. This aims to encourage the client to respond both to relevant simultaneous stimuli and to relevant sequential stimuli. When there are many stimuli appearing and disappearing quickly, they interfere with each other. Thus, mistakes are likely to be made, and the performance decreases.
Literature
1) Fimm, B. (1997): Microanalyse von Aufmerksamkeitsprozessen. In: Gauggel, S. & Kerkhoff, G. : Fallbuch der Klinischen Neuropsychologie. Practice of neurorehabilitation. Göttingen, Germany: Hogrefe. 25-38.
2) Sturm, W. (1990): Neuropsychologische Therapie von hirnschädigungsbedingten Aufmerksamkeitsstörungen. Zeitschrift für Neuropsychologie, 23-31.
3) Sturm, W.; Hartje, W.; Orgaß, B. & Willmes, K. (1994): Effektivität eines
computergestützten Trainings von vier Aufmerksamkeitsfunktionen. Zeitschrift für Neuropsychologie, 15-28.

Response Control (GONT)
Task:
The test starts with a short introduction and one exercise.  During the task a fixation stimulus is displayed in the middle of the screen. In random order one of two different stimuli appears. In case of the vertically striped square no response is required, in case of the horizontal stripes a response is required as quickly as possible. Response should be to press a certain button.

Background:
The ability to react in an appropriate way is examined under time pressure and with a need to simultaneously control behavioural impulses. It is essential to suppress a triggered reaction by an external stimulus in favour of internally controlled behaviour.  The focus of attention is directed to a predictable appearance of stimuli and the corresponding reaction, for example to react or not to react.
Literature:
1) Fimm, B. (1997): Microanalyse von Aufmerksamkeitsprozessen. In: Gauggel, S. & Kerkhoff, G. : Fallbuch der Klinischen Neuropsychologie. Practice of neurorehabilitation. Göttingen, Germany: Hogrefe. 25-38.
2) Sturm, W. (1990): Neuropsychologische Therapie von hirnschädigungsbedingten Aufmerksamkeitsstörungen. Zeitschrift für Neuropsychologie, 23-31.
3) Sturm, W.; Hartje, W.; Orgaß, B. & Willmes, K. (1994): Effektivität eines computergestützten Trainings von vier Aufmerksamkeitsfunktionen. Zeitschrift für Neuropsychologie, 15-28.

Working Memory and Orientation (PUME)
Task:
During the task, 10 dots in one circle will be presented on the screen. Single dots will  light up in red and change again to white. The sequence to memorize starts with two dots.  After the pattern is shown to the user the same sequence has to be marked in the correct order by the user.  This module is adaptive.  After two correct reproductions of the sequence, the number of dots which are to remember will be raised. If the user fails, the number of dots which are to memorize will be reduced. The test will end after seven minutes or by the time the maximum number of mistakes is reached.

Background:
In this module, the visual-spatial memory span and the visual-spatial memory function are examined. It is also used for testing implicit visual-memory learning and working memory.
Literature:
Thöne-Otto, A., George, S., Hildebrandt, H., Reuther, P., Schoof-Tams. K., Sturm, W., & Wallesch, C.-W. (2010). Leitlinie zur Diagnostik und Therapie von Gedächtnisstörungen. Zeitschrift für Neuropsychologie, 21, 271-281.
Sturm, W. (2002). Diagnostik von Aufmerksamkeitsstörungen in der Neurologie. Aktuelle Neurologie, 29, 25-29. Published by the Comission "Guidlines" the DGN. Leitlinien fur Diagnostik und Therapie in der Neurologie; 4. revised edition; Georg Thieme Verlag Stuttgart
Thöne-Otto, A., George, S., Hildebrandt, H., Reuther, P., Schoof-Tams. K., Sturm, W., & Wallesch, C.-W. (2010). Leitlinie zur Diagnostik und Therapie von Gedächtnisstörungen. Zeitschrift für Neuropsychologie, 21, 271-281.
Sturm, W. (2002). Diagnostik von Aufmerksamkeitsstörungen in der Neurologie. Aktuelle Neurologie, 29, 25-29.
Published by the Comission "Guidlines" the DGN. Leitlinien fur Diagnostik und Therapie in der Neurologie; 4. revised edition; Georg Thieme Verlag Stuttgart

Visual Exploration (NUQU)
Task:
The numbers on the screen are randomly spread in a matrix and the user has to look for the numbers and mark these in ascending order. Below the matrix of numbers the current number to find is displayed.

Background:
In this module basal cognitive performance and selective attention will be tested. In addition the test can be used for screening a visual neglect. The basal cognitive performance is associated in literature with the ability which is called perceptual speed. By selective attention is meant the ability to turn to the relevant stimulus of a stimuli constellation and ignore irrelevant stimuli of this constellation, over a short time period. This task depends on the well-known “Digits- Connection-Test” developed by Oswald and Roth 1987.
Literature:
1 Oswald, W. D., & Roth, W. (1987). Der Zahlen-Verbindungs-Test (ZVT) [Digits-Connection-Test]. Göttingen, Germany: Hogrefe.
Thöne-Otto, A., George, S., Hildebrandt, H., Reuther, P., Schoof-Tams. K., Sturm, W., & Wallesch, C.-W. (2010). Leitlinie zur Diagnostik und Therapie von Gedächtnisstörungen. Zeitschrift für Neuropsychologie, 21, 271-281.
Sturm, W. (2002). Diagnostik von Aufmerksamkeitsstörungen in der Neurologie. Aktuelle Neurologie, 29, 25-29. Published by the Comission "Guidlines" the DGN. Leitlinien fur Diagnostik und Therapie in der Neurologie; 4. revised edition; Georg Thieme Verlag Stuttgart

Result evaluation
· The results sheet consists of 2 sections, a graph at the top, and a text section further down.
· The graph consists of a red and a yellow part as well as 3 different green parts.
Imagine a Gauss curve on top of the graph. The very light green section represents 68 % of the tested persons (most of the healthy people). The division between the yellow and the light green part represents one standard deviation. The division between the red and the yellow part represents two standard deviations.
· The numbers surrounded by circles represent the first, second, third (… ) test session.
One screening test, e.g. (NUQU) Visual Exploration, can contain 1, 2, or 3 parameters,
e.g. Working Speed, Sustained Attention, and Neglect/Hemianopia. Always the latest test session will be commented in the texts further down.
· When clicking on one of the lines in the graph, e.g. (NUQU) Visual Exploration: Working Speed, the line will light up in blue and the corresponding text further down will light up as well. If the result of the latest test session is within the red or yellow section, then the text below will announce a recommendation, e.g. It is recommended to work with the following training module: “Attention and Concentration (AUFM)”.

How to generate your own normalized values?
· Find healthy people of all kinds of different ages and let them do the screening tests all one after another.
· Set up those people as clients in RehaCom and name them with numbers (e.g. Test_Person_001 and so on). Then click on File in the client data and choose (healthy) test person from the drop-down box on the right.
· The test persons should all do the testing with totally the same conditions:

  •  same room
  •  same computer
  •  same table, same chair
  •  same surroundings (ideally no noises and no interruptions)
  •  instructed by the same person
  •  same distance to the computer

· After the testing let them all fill in the RehaCom test person questionnaire, ideally in English.  Don´t write the names of the persons on that sheet, only their numbers from the testing.
· After the testing send us all the questionnaire sheets as well as the file
REHACOMDB.GDB from the (standard) directory C:\RehaComDB.
· We will then mplement the normalized values.