Impairment in cognitive function is common in patients with acquired brain injury and this significantly impacts upon such persons potential for rehabilitation. Around the world technology is now found in the therapists tool kit as this is increasingly seen as the key to efficient, effective and intensive focus in cognitive rehabilitation.
Cognitive rehabilitation is the collective label for interventions that aim to reduce the adverse effects that cognitive impairments can have on every aspect of a person’s life. In most countries, cognitive rehabilitation is provided by psychologists and occupational therapists or their assistants, although other professionals are also involved. Such rehabilitation needs to be intensive, specific and personalised which often means that time and staff pressures prevent it's optimal delivery. Technology such as RehaCom is best used to complement and support therapy.
A recent study, published in 2017, aimed to investigate the effectiveness of RehaCom cognitive rehabilitation software (compared to a creative activities program in neuropsychiatric parameters) in patients with cognitive deficits due to acquired central nervous system disorders.
The study included 96 subjects with different neurological conditions: cerebrovascular accident, hemiplegia, multiple sclerosis and traumatic brain injury.
Fifty-six patients participated in the RehaCom cognitive rehabilitation program whilst controls performed a program of creative activities. Both groups participated in a comprehensive rehabilitation program including physical therapy, occupational therapy and psychological support. In admission and at discharge a cognitive skill evaluation was performed in the patients of both groups based on the Montreal Cognitive Assessment (MoCA) psychometric screening test.
Patients included in the intervention group patients attended RehaCom program sessions of neuropsychological intervention for 30 minutes, 3 times per week for >3 weeks mean 123 days (range 30-372).
The RehaCom program has 20 different therapeutic activities to improve cognitive function disorders in attention, perception, memory, executive functions, etc. Specific activities were selected, depending on each patient’s deficit, as follows: attention and concentration (n=42), reaction behaviour (n=45), visuo-constructive ability (n=6), verbal memory (n=30), topological memory (n=33), visuo-motor coordination (n=9) and exploration (n=30)
During the first session of an activity, the patient started from a minimum level of difficulty, whilst consequently, the program itself adjusted and increased automatically the level, depending on the patient’s answers in the activity tasks. In each of the following sessions, the patient would continue from the level he or she had reached.
The software automatically adjusts the difficulty level of each session on the basis of performance and recorded numerous individual performance parameters. The therapist was in each case providing encouragement and support instruction.
Finally, a psychometric reevaluation was conducted, using the MoCA test by a specialised psychologist (AP). As an additional rehabilitation progress measure, the modification of the last session’s level of difficulty was evaluated compared to the one of the first session for each activity. Statistical analysis of the data was performed using the SPSS version 20.0 (SPSS, Inc., Chicago, Illinois). All subjects’ characteristics were quantitative variables and they were expressed as the mean ± standard deviation. Descriptive statistics were used (percentage, mean and standard deviation). To assess intervention effect, differences between pre- and post-training measures of attention and concentration, reaction behaviour, visuo-constructive ability, topological memory, visuo-motor coordination and exploration test performance were analysed using the Student t test. All tests were two tailed and statistical significance was considered for p<0.05.
The average RehaCom intervention participation time was 115 ± 70 days. It was observed that the treatment group’s MoCA score upon exit was statistically significantly higher than upon admission in assessment tasks of attention and concentration, reaction behaviour, visuo-constructive ability, verbal memory, topological memory, visuo-motor coordination and exploration, compared with the control group (p<0.001). The sub-group that seemed to have derived the most advantage was the CVA, Right Hemiplegia group.
The authors concluded that computerised cognitive rehabilitation with the RehaCom program results in improvement in cognitive function and can be used as a treatment tool beneficial to patients presenting with cognitive impairment.
Pantzartzidou, A; Dionyssiotis, Y; Stefas, E; Samlidi, E; Georgiadis, T and Kandylakis, E (2017)
Rehacom software application is effective in cognitive rehabilitation of patients with brain injuries
Phys Med Rehabil Res, 2017, Volume 2(1): 1-4