Can RehaCom help with cognition issues after brain injury?

Im sure you would expect us to say “Yes of course it helps!” because, after all, we have been offering RehaCom for some years now.  The fact is, the question deserves a more rounded answer.

Having worked with many different technologies in rehabilitation I always expect to hear two questions when something new is being introduced into healthcare - the first is “What’s the evidence for this?” and secondly “How much does it cost?”

There is now a body of robust research that has been accumulated over the years since RehaCom was first launched in Germany back in 1992.  RehaCom is now being applied with Stroke, TBI, Schizophrenia, MS, ADHD, Dementia, Alzheimer’s and a range of other conditions and there is now some supportive research publications across this broad spectrum of conditions.  

Does this mean that RehaCom is some form of “silver bullet”? Of course not.  Before we get into the evidence lets take a look at RehaCom's history

Origins of RehaCom

In 1988 researchers in Germany were developing computerised systems for the diagnosis
of the cognitive impairments that so often follow a Stroke or TBI (traumatic brain injury).
This was in the early days of personal computing as well as the first attempt to apply this
type of technology to cognitive rehabilitation. Research in the area of computer-aided
diagnosis led to the desire to create a complete therapy tool to be able to treat cognitive
impairments with computer technology. This is how RehaCom® started.

In 1992, RehaCom® became reality as a product with the first clinically tried and tested
training modules. It became the foundation for the company Hasomed GmbH which has
now grown to employ almost a hundred people. Today, RehaCom® is accepted as Europe’s
leading system for computerised cognitive rehabilitation and millions of patients around
the world have used it.

But let's get back to the question "Does it work"?

Many of the “conventional” approaches for designing research studies and implementing research methodologies do not work well in rehabilitation where the clinical conditions are far from homogeneous, sample sizes are typically small and clinical interventions are highly customised.  

It would be great if we could easily identify a clear unbiased link between a cause, for example using RehaCom, and an effect - an improvement in cognition and real-world function.  Unfortunately such a cause-effect link is complicated and potentially influenced by many factors. Even for medicines, for which many research methodologies were originally designed, we know that research is often simply very hard to do.

RehaCom is a tool to help with cognition but you cant judge it's effectiveness like a medicine

RehaCom is a tool to help with cognition but you cant judge it's effectiveness like a medicine

Initial questions about RehaCom® are usually testing the strength of the research
evidence base and upon whether improvements in training performance can convert into “real world” gains.

My personal view is that you should not think of RehaCom in the same way as a medicine.  When someone is ill and they take their medicine you expect the medicine to do it’s magic and the person gets better primarily because they took the medicine. Of course there is the little complication of the placebo effect - when the patient believes something works this can have a positive effect and clouds our judgement of where the benefit came from.  A mentor of mind often said, “if you are going to have beliefs better make them useful ones”.  Personally speaking if I were ill I would welcome a dose of positive belief - anything that stacks up the chances of recovery.

RehaCom on the other hand is not something you can “just take”.  RehaCom is a powerful set of tools which the clinician can use in cognitive rehabilitation.  The clinician determines the approach and utilises a strategy of which RehaCom is just a part.  

In general the intervention types we have available to bring about positive change are as
follows: (Cicerone 2000)

  • Restitution - to reinforce, strengthen or re-establish previously learned patterns of behaviour
  • Internal compensation - to establish new patterns of cognitive activity through compensatory cognitive mechanisms for impaired neurological systems
  • External compensation - establishing new patterns of of activity through the use of external aids
  • Adaptation - enabling patients to adapt to their disability in order to improve their overall level of functioning and quality of life.

Of course RehaCom® does not impact on all the positive threads of intervention types, but
neither does anything else we have available.   Surely it’s the clinician’s role to apply a
range of interventions based on the best available evidence and clinical judgment - blending compensation and restitution approaches as appropriate.

It appears that historical approaches to the management of cognitive deficits differed
between the UK and Germany.  For example, in Germany, clinical practice accepted the
premise that restitution was often possible (and embraced RehaCom to the extent that 96% of clinicians involved in brain injury rehabilitation have used RehaCom) whilst in the UK greater weight was placed on compensation strategies.  In effect though, therapy in Germany doesn’t rely on one approach any more than therapists in the UK would.

So what can we say about evidence? Well this is very hard in a formal sense as I said above because there are so many factors that make research in this area a challenge. For example, we don't fully know how the "dose" of training impacts on efficacy - but then we don't know this in many other types of intervention either.

Here is an interesting comment on evidence and effectiveness.

Derek Jones

“Half of all diseases can be considered untreatable and for the other half the drugs only
work half the time and with major side-effects - imagine a car that starts only half the
time and whose brakes often don’t work.”
— Severin Schwan, CEO of Roche in “Roche Digests Genentech: Back to the Lab” writing in the Economist, December 10, 2009

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