Computer aided training aimed a recovering aspects of cognition is not new. The first versions of RehaCom were developed in Germany in the late 1980's and have evolved significantly over the years. In Germany more than 90% of organisations involved in brain injury rehabilitation use RehaCom but the level of adoption of RehaCom as a tool varies significantly from country to country. This is due to differences in training of therapists and neuropyschlogists and views about the validity of training as a means of recovering cognitive function.
Cognitive deficits are very common following brain damage with the most frequently observed deficits being in:-
- attention and concentration
- executive function
- visual field deficits
In addition to acquired brain damage, there are other factors that can affect cognitive performance. These include ageing, depression and other psychiatric disorders, but also chronic stress and addiction.
Cognitive deficits can have a huge impact on the lives of patients and relatives so there has been long term interest in the effectiveness of rehabilitation strategies. The main choices come down to
- Restitution approaches
- Compensation/Adaptation approaches
One can try to restore lost function by training and repetition, relying the plasticity of the brain. Lost cognitive functions can also be compensated for by other measures, e.g. by writing down important information that one does not want to forget. Finally, one can also try to adapt the environment to the impairment.
The main objection to restitution approaches like RehaCom in the past was that there was not enough evidence to support their effectiveness. Evidence has grown significantly to support the use of restitition approaches.
For example, Campbell et al examined 38 patients with MS and evidence of cognitive impairment. The patients were assigned to a treatment or a control group. The treatment group trained 3 times a week for 6 weeks with RehaCom. At the end they not only did better on the neuropsychology test, but they also showed increased activation in the parietal and frontal regions of the brain whilst carrying our a working memory task in a FMRI scanner. This can be seen as direct evidence of neuronal plasticity.
There are now a number of metaanalysis studies on the effectiveness of computerised cognitive training. The first well-know metastudy was conducted by Cicerone et al.
In 2009, Rohling and colleges made a reexamination of this study which showed
- Effectiveness of attention training after traumatic brain injury
- Effectiveness of language training for aphasia
- Effectiveness of visuospatial training for neglect syndromes
Leung et al carried out a meta-analysis which suggests that cognitive training leads to measurable improvements in cognitive performance in individuals with Parkinsons Disease, particularly in working memory, executive functioning, and processing speed, which are typically impaired in the disease.
Hill et al studies studied older adults with mild cognitive impairment or dementia and found that computerised cognitive training is efficacious on global cognition, memory, working memory, and attention and helps improve psychosocial functioning, including depressive symptoms.
Modern physical rehabilitation techniques rely on exploiting the fact of neuroplasticity. Evidence supports that cognitive rehabiitation can also take advantage of restitution approaches to maximise recovery. Of course a blend of restitution and compensation strategies can be usefully used.
J Campbell, D Langdon, M Cercignani and W Rashid (2016).
A Randomised Controlled Trial of Efficacy of Cognitive Rehabilitation in Multiple. Sclerosis: A Cognitive, Behavioral and MRI Study. Neural Plasticity doi: http://dx.doi.org/10.1155/2016/4292585
Leung IH, Walton CC, Hallock H, Lewis SJ, Valenzuela M, Lampit A. (2015)
Cognitive training in Parkinson disease: A systematic review and meta-analysis.
Neurology. 24;85(21):1843-51. doi: 10.1212/WNL.0000000000002145. Epub 2015 Oct 30.
N.T.M. Hill, L. Mowszowski, S. L. Naismith, M. Valenzuela, A. Lampit (2016).
Computerized Cognitive Training in Older Adults With Mild Cognitive Impairment or Dementia: A Systematic Review and Meta-Analysis.
Published Online:14 Nov 2016 https://doi.org/10.1176/appi.ajp.2016.16030360
Rohling ML, Faust ME, Beverly B, Demakis G. (2009).
Effectiveness of cognitive rehabilitation following acquired brain injury: a meta-analytic re-examination of Cicerone et al.'s (2000, 2005) systematic reviews. Neuropsychology. Jan;23(1):20-39. doi: 10.1037/a0013659.