Evidence-based practice is embodied in how RehaCom has developed since it's origins in the 1990'2 in Germany. More than 95% of German rehabilitation clinics now use RehaCom. As awareness of neuroplasticity has grown in recent times there has been a growing acceptance of restitution as a strategy for cognitive rehabilitation - in fact we would support both restitution and compensation as valid strategies.
Below are a few abstracts of research articles related directly or indirectly to the application of RehaCom,
1. Amonn F, Frölich J, Breuer D, Banaschewski… T. Evaluation of a computer-based neuropsychological training in children with Attention-Deficit Hyperactivity Disorder (ADHD). NeuroRehabilitation. 2013; 32, No 3: 555-562.
BACKGROUND: We report the effects of a computer-based neuropsychological training in children with Attention-Deficit Hyperactivity Disorder (ADHD). We hypothesised that a specific training focusing on attentional dysfunction would result in an improvement of inattention, observable in test performance, behaviour and performance during experimental school lessons and in parent and teacher ratings of the related core symptom. METHOD: We chose a within-subject-control-design with a 4 week baseline period and subsequent 12 to 15 weekly training-sessions. 30 children (6 to 13 years old) with a diagnosis of ADHD (ICD 10: F 90.0) and no other co-morbidities participated in the study. RESULTS: The training revealed significant improvement in training parameters of the neuropsychological training and in the symptoms of inattention and deportment as rated during experimental school lessons. However, generalisation of training effects as measured by parent and teacher ratings was not detected. CONCLUSIONS: We conclude that neuropsychological training could be helpful as one adjunct module in the complex treatment of ADHD but to prove clinical value, similar training programs must focus more strongly on individually existing neuropsychological deficits. Training programs should be more intensive and should eventually be combined with home based training access.
2. An SK, Oh BH, Hyun MH, Yoo KJ. The effect of attention training using computer-aided cognitive rehabilitation program (REHACOM) in chronic schizophrenics. Journal of Korean Neuropsychiatric Assoc. 1997; Jan; 36: 72-79.
OBJECTIVE: The authors study evaluated the effect of a cognitive rehabilitation program designed to enhance the attention skill of chronic schizophrenics. METHODS: Dependent variables included measures of perceptual sensitivity and response criterion derived from the Vigilance test of Vienna test system. Each of 10 subjects received 10 sessions of repeated training with computer-aided cognitive rehabilitation program(REHACOM). Eleven subjects were assigned to a control group. All subject were rated on measures of positive and negative symptoms before training. RESULTS: Significant changes on the outcome measures were observed following attention training. CONCLUSION: It is suggested that cognitive rehabilitation with chronic schizophrenics should stress the possibility of remediating deficiencies in basic abilities, such as attention.
3. Bellucci DM, Glaberman K, Haslam N. Computer-assisted cognitive rehabilitation reduces negative symptoms in the severely mentally ill. Schizophr Res. 2003; 59: 225-232.
Thirty-four-day treatment program clients diagnosed with schizophrenia or schizoaffective disorder were randomly assigned to a computer-assisted cognitive rehabilitation (CACR) group or a wait-list Control group. CACR clients received 16 CACR sessions over an 8-week period. Measures of cognitive functioning, negative symptoms and self-esteem were administered at the beginning and end of this period. CACR clients showed greater improvement in cognitive functioning (verbal memory and attention) and negative symptoms. Symptom reduction was not mediated by raised self-esteem. CACR’s effects may go beyond cognitive remediation to include some of the most disabling and refractory clinical features of schizophrenia.
4. Bor J, Brunelin J, d’Amato T et al. How can cognitive remediation therapy modulate brain activations in schizophrenia? An fMRI study. Psychiatry Res. 2011; 192: 160-166.
Cognitive remediation therapy (CRT) is a non biological treatment that aims to correct cognitive deficits through repeated exercises. Its efficacy in patients with schizophrenia is well recognised, but little is known about its effect on cerebral activity. Our aim was to explore the impact of CRT on cerebral activation using functional magnetic resonance imaging (fMRI) in patients with schizophrenia. Seventeen patients and 15 healthy volunteers were recruited. Patients were divided into two groups: one group received CRT with Rehacom(R) software (n=8), while a control group of patients (non-CRT group) received no additional treatment (n=9). The three groups underwent two fMRI sessions with an interval of 3months: they had to perform a verbal and a spatial n-back task at the same performance level. Patients were additionally clinically and cognitively assessed before and after the study. After CRT, the CRT group exhibited brain over-activations in the left inferior/middle frontal gyrus, cingulate gyrus and inferior parietal lobule for the spatial task. Similar but nonsignificant over-activations were observed in the same brain regions for the verbal task. Moreover, CRT patients significantly improved their behavioural performance in attention and reasoning capacities. We conclude that CRT leads to measurable physiological adaptation associated with improved cognitive ability. Trial name: Cognitive Remediation Therapy and Schizophrenia. http://clinicaltrials.gov/ct2/show/NCT01078129. Registration number: NCT01078129.
5. Bußmeier B. Studies on vigilance in psychotic patients of a day-care clinic. dissfu-berlinde. 2007; Doctoral Thesis
Studies on vigilance were conducted in 83 psychotic patients, who took part in the computer-assisted vigilance training RehaCom of the company Hasomed within the scope of a naturalistic study during their psychiatric treatment at a day-care clinic. This training, which takes the form of the simulation of work on an assembly line in a factory, aims to train the patient to be able to maintain attention over a longer period while having to respond to items under time-critical conditions. In the process, the level of difficulty is adapted according to the patients performance. The patients underwent a total of six sessions of vigilance training three times per week in two consecutive weeks. All patients improved their training performance during the six training days. In accordance with the adapted performance targets, four different progression types were differentiated: 16 patients (19 %) showed an optimal progression, in the case of 44 patients (53 %) there was an average progression, 16 patients (19 %) showed a below average progression and seven patients (8 %) were assessed as a fluctuating progression type. 84.34 % reached the maximum possible level of difficulty within the six training days. There were clear differences with regard to the point in time at which the highest level of difficulty was reached. Differentiated analysis was possible by assessing the speed of the increase in performance. Within the scope of criteria set by the patients themselves, 47 % showed no problems in vigilance and 53 % showed moderate to severe problems in vigilance. Gender, age, educational level, diagnosis, negative symptomatology and general psychopathology had no significant effect on the results. Positive symptomatology and neuroleptic medication did have a significant effect on the results. Patients with high to very high positive symptomatology achieve their best result significantly later than patients with low positive symptomatology. Patients who were receiving a conventional neuroleptic drug alone or in combination with an atypical drug achieved poorer results than patients who were receiving only an atypical neuroleptic drug. The computer-assisted vigilance training RehaCom of the company Hasomed is suitable for training and for diagnosing problems in vigilance in psychotic patients, although it would be advisable to raise the level of difficulty of the vigilance training.
6. Cerasa A, Gioia MC, Valentino… P. Computer-Assisted Cognitive Rehabilitation of Attention Deficits for Multiple Sclerosis A Randomized Trial With fMRI Correlates. Neurorehabil Neural Repair. 2013; 27: 284-295.
Background. Although a growing body of evidence has highlighted the role of cognitive rehabilitation (CR) in the management of cognitive dysfunctions in multiple sclerosis (MS), there is still no evidence for a validated therapeutic approach. Objective. We propose a new therapeutic strategy characterised by a computer-based intensive attention training program in MS patients with predominant attention deficits. We aim to investigate the effectiveness of our rehabilitation procedure, tailored for those with impaired abilities, using functional magnetic resonance imaging (fMRI). Methods. Using a double-blind randomised controlled study, we enrolled 12 MS patients, who underwent a CR program (experimental group), and 11 age-gender–matched MS patients, who underwent a placebo intervention (control group). fMRI was recorded during the execution of a cognitive task broadly used for assessing attention abilities in MS patients (paced visual serial addition test). Results. Significant effects were detected both at a phenotypic and at an intermediate phenotypic level. After CR, the experimental group, in comparison with the control group, showed a specific enhanced performance in attention abilities as assessed by the Stroop task with an effect size of 0.88, which was associated with increased activity in the posterior cerebellar lobule and in the superior parietal lobule. Conclusions. Our study demonstrates that intensive CR tailored for those with impaired abilities affects neural plasticity and improves some aspects of cognitive deficits in MS patients. The reported neurophysiological and behavioural effects corroborate the benefits of our therapeutic approach, which might have a reliable application in the clinical management of cognitive deficits in MS.
7. Cha YJ, Kim H. Effect of computer-based cognitive rehabilitation (CBCR) for people with stroke: A systematic review and meta-analysis. NeuroRehabilitation. 2013; 32, No 2: 359-368.
OBJECTIVE: We conducted a systematic review and meta-analysis to identify the effect of computer-based cognitive rehabilitation (CBCR) on improving cognitive functions in patients with stroke. METHODS: Researchers performed a literature search using computerised databases such as the Cochrane Database, EBSCO (CINAHL), PsycINFO, PubMed and Web of Science. The following keywords were used: stroke, computer-based, cognitive rehabilitation, and others. The methodological quality was evaluated. Statistical heterogeneity and standardised mean difference were used to compute the overall effect size and that of subgroups. Also publication bias of the selected studies was analysed. RESULTS: Twelve studies met the inclusion criteria including a total of 461 stroke survivors. Among studies, six RCT studies were rated as high methodological quality. Overall effect size was medium 0.54, and the 95 % confidence interval was 0.33–0.74. The effect sizes of acute and chronic phase of stroke were both 0.54. They can be interpreted as medium effect size and were statistically significant. The statistical heterogeneity and publication bias were not significant. CONCLUSION: The present study provides evidence that CBCR is effective on improving cognitive function after stroke. We recommend conducting meta-analysis on subgroups of CBCR programs in further studies.
8. Cherniack EP. Not just fun and games: applications of virtual reality in the identification and rehabilitation of cognitive disorders of the elderly. Disabil Rehabil Assist Technol. 2011; 6: 283-289.
PURPOSE: To outline the evidence in the published medical literature suggesting the potential applications of virtual reality (VR) for the identification and rehabilitation of cognitive disorders of the elderly. METHOD: Non-systematic literature review. RESULTS: VR, despite its more common usage by younger persons, is a potentially promising source of techniques useful in the identification and rehabilitation of cognitive disorders of the elderly. Systems employing VR can include desktop and head-mounted visual displays among other devices. Thus far, published studies have described VR-based applications in the identification and treatment of deficits in navigational skills in ambulation and driving. In addition, VR has been utilised to enhance the ability to perform activities of daily living in patients with dementia, stroke, and Parkinson’s Disease. Such investigations have thus far been small, and unblinded. CONCLUSIONS: VR-based applications can potentially offer more versatile, comprehensive, and safer assessments of function. However, they also might be more expensive, complex and more difficult to use by elderly patients. Side effects of head-mounted visual displays include nausea and disorientation, but, have not been reported specifically in older subjects.
9. Cicerone KD, Dahlberg C, Kalmar… K. Evidence-based cognitive rehabilitation: recommendations for clinical practice. Archives of Physical Med Rehabil. 2000; 81: 1596.
Objective: To establish evidence-based recommendations for the clinical practice of cognitive rehabilitation, derived from a methodical review of the scientific literature concerning the effectiveness of cognitive rehabilitation for persons with traumatic brain injury (TBI) or stroke.
Conclusions: Overall, support exists for the effectiveness of several forms of cognitive rehabilitation for persons with stroke and TBI. Specific recommendations can be made for remediation of language and perception after left and right hemisphere stroke, respectively, and for the remediation of attention, memory, functional communication, and executive functioning after TBI. These recommendations may help to establish parameters of effective treatment, which should be of assistance to practicing clinicians.
10. Cicerone KD, Dahlberg C, Malec… JF. Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. Archives of Physical Med Rehabil. 2005
11. Łojek E, Bolewska A. The effectiveness of computer-assisted cognitive rehabilitation in brain-damaged patients. Polish Psychological Bulletin. 2013; vol. 44: 31-39.
This study examined the effects of computer-assisted cognitive rehabilitation in a group of 16 brain-damaged patients. Therapeutic effectiveness was assessed by improvement on computer tasks, the results of neuropsychological tests and quality of life ratings. Participants suffered from mild to moderate attention and memory problems or aphasia. The procedure involved baseline assessment (pretest), a 15-week course of therapy conducted twice a week (30 hours in total) and post-test. Neuropsychological tests assessing attention, memory and language problems and quality of life ratings were administered twice: in pre- and post-tests. Twelve healthy controls were also examined twice (with a 15-week interval) using the same battery of neuropsychological tests. The RehaCom program and the Polish computer therapy program for aphasics called Afa-System were used for rehabilitation. The computer-assisted rehabilitation tasks were selected individually for each patient. The results showed significant improvement on computer-assisted tasks in all brain damaged subjects. However, none or very little improvement was observed on neuropsychological tests and quality of life ratings. The results of the study confirm the importance of using different types of measures to estimate the effectiveness of computer-assisted neuropsychological rehabilitation as well as the necessity of applying various kinds of therapy to improve cognitive, emotional and social functioning in brain-damaged patients.
12. Yu CH, Mathiowetz V. Systematic review of occupational therapy–related interventions for people with multiple sclerosis: Part 2. Impairment. American Journal of Occupational Therapy. 2014
..home-based intervention. Solari et al. (2004) compared the effects of 8 wk of RehaCommemory and attention retraining with RehaCom visuo-constructional and visuo-motorcoordination retraining. Both groups showed immediate….
13. Sturm W, Longoni F, Weis S et al. Functional reorganisation in patients with right hemisphere stroke after training of alertness: a longitudinal PET and fMRI study in eight cases. Neuropsychologia. 2004; 42: 434-450.
In patients with alertness deficits due to right hemispheric vascular brain damage, training induced changes in the individual functional networks involved in intrinsic alertness were assessed in a longitudinal positron emission tomography (PET)/fMRI activation study. Patients were trained by administering the alertness routine of the AIXTENT computerised attention training or, in the control condition, by using a computerised training of verbal and topological memory. Before and after the training, both a PET/fMRI and a neuropsychological assessment were carried out. In this paper, we are presenting four patients after alertness training: three, whose alertness performance improved significantly after training, and one, who did not improve. In the patients showing behavioural improvement, the PET/fMRI activation after training revealed partial restitution of the right hemisphere (RH) functional network known to subserve intrinsic alertness in normal subjects, especially in the right dorsolateral or medial frontal cortex. For the patient without behavioural improvement, the PET activation after training showed an increase of activation only in the left hemisphere. Out of the four patients in the memory training control group only one showed significant improvement of alertness. Another patient had an increase of right frontal activation after the training but this did not correspond to behavioural improvement. In a control group of six normal participants, repetition of the alertness activation paradigm in fMRI revealed a decrease of right frontal and parietal activation from the first to a second measurement after 3 weeks, in contrast to the observed training induced effects in the patients.
14. Sturm W, Fimm B, Cantagallo A, Cremel… N. Specific computerized attention training in stroke and traumatic brain-injured patients. Zeitschrift für Neuropsychologie. 2003; Vol. 14, No 4: 283-292.
In a multicenter European approach, the efficacy of the AIXTENT computerised training programs for intensity aspects (alertness and vigilance) and selectivity aspects (selective and divided attention) of attention was studied in 33 patients with brain damage of vascular and traumatic aetiology. Each patient received training in one of two most impaired of the four attention domains. Control tests were performed by means of a standardised computerised attention test battery (TAP) comprising tests for the four attention functions. Assessment was carried out at the beginning and at the end of a four week baseline period and after the training period of 14 one-hour sessions. At the end of the baseline phase, there was only slight but significant improvement for the most complex attention function, divided attention (number of omissions). After the training, there were significant specific training effects for both intensity aspects (alertness and vigilance) and also for the number of omissions in the divided attention task. The application of inferential single case procedures revealed a number of significant improvements in individual cases after specific training of alertness and vigilance problems. On the other hand, a non specific training addressing selectivity aspects of attention lead either to improvement or deterioration of alertness and vigilance performance. The results corroborate the findings of former studies with the same training instrument but in patients with different lesion aetiologies
URL: http://www.limef.com/Downloads/Sturm et al German Pub 2003.pdf
15. Spahn V, Kulke H, Kunz M, Thöne-Otto… A. Is the Neuropsychological Treatment of Memory Specific or Unspecific? Zeitschrift für Neuropsychologie. 2010; 21: 239-245.
Primary objective and research design: In order to analyse whether neuropsychological memory therapy acts specifically on the memory domain or in a more generalised fashion on further cognitive domains, 27 patients with organic memory deficits due to different aetiologies (cerebrovascular, traumatic, infectious, etc.) were randomly assigned to two different memory treatment programs and investigated for changes in memory and attention. Methods and procedures: Patients treated by a specific computer-based training of story recall (Training of Verbal Memory, TVM) were compared to a group in which compensational strategies for everyday memory problems were trained (Memory Therapy in Groups, MTG). Both therapies were conducted over 12 to 15 sessions, 4–5 times per week, in addition to standard program of neurorehabilitation. Training effects were assessed for verbal and figural memory (Verbal Learning Test, Nonverbal Learning Test) and for attention (Alertness and Divided Attention in Test Battery of Attentional Performance). Results and conclusions: Both treatment groups resulted in improvement in tests of memory but not attention. This finding provides good evidence for the assumption of specificity of effects in neuropsychological treatment of memory.
16. Schuster B. Rehabilitation of TBI using RehaCom. EUROPA MEDICOPHYSICA. 2002; 38, Issue 1: 39-44.
As cognitive disorders are the most frequent consequences of brain damage, the need of therapeutic instruments for patients with traumatic head and brain injuries is rather great. Special computer-aided therapeutic procedures have been particularly developed for this area with the aim to influence cognitive deficiencies, above all, in the fields of attention, memory, and problem solving. RehaCom dates back to 1986. The training with a computer brings about the following advantages: individualisation, adaptation, continuity, case control, flexibility, disorders specific training, confirmation/feedback, standardised conditions, efficiency and economy, appropriate input device. The possible training dimensions are: Attention, ability to concentrate and vigilance. Memory and learning ability. Log¬ical thinking. Spatial imagination. Reactive behaviour. Visual-motor coordination. Visual-constructive abilities. Problem solving and strategy development. Field of vision. Studies of effectiveness shows transfer effect of first order (Training effect: Pre-post-comparison with tests measuring the same function as the training procedure), transfer effect of second order (Generalisation effect: Pre-post-comparison with tests measuring other function as have been trained), transfer effect of third order (effect on activities of daily life).
17. Sablier J, Stip E, Franck N. [Cognitive remediation and cognitive assistive technologies in schizophrenia]. Encephale. 2009; 35: 160-167.
BACKGROUND: Cognitive impairments are a core feature in schizophrenia. They impact several cognitive abilities but most importantly attention, memory and executive functions, consequently leading to great difficulties in everyday life. Most schizophrenia patients need assurance and require assistance and help from care workers, family members and friends. Family members taking care of a patient have additional daily work burden, and suffer psychological anguish and anxiety. Therefore, improving cognitive functions in schizophrenia patients is essential for the well-being of patients and their relatives. Reducing these deficits may decrease the economic burden to the health care system through lower numbers of hospital admissions and shorter hospitalisation periods, for example. Cognitive rehabilitation was developed to address the limited benefits of conventional treatments on cognitive deficits through the use of assistive technology as a means of enhancing memory and executive skills in schizophrenia patients. OBJECTIVE: To provide clinicians with comprehensive knowledge on cognitive trainings, programs of remediation, and cognitive assistive technologies. METHOD: Literature review. A search in the electronic databases (PubMed, EMBASE, Index Medicus) for recent articles in the last 10 years related to cognitive remediation published in any language using the words: cognitive and remediation or rehabilitation and schizophrenia, and a search for chapters in psychiatry and rehabilitation textbooks. RESULTS: We found 392 articles and 112 review paper mainly in English. First, we identified cognitive remediation programs that were beneficial to schizophrenia patients. Programs available in French (IPT, RECOS, and RehaCom) and others (CET, NET, CRT, NEAR, APT and CAT) were identified. In addition, since memory and executive function impairments could be present in people without schizophrenia, we reviewed inventories of cognitive assistive technologies proven to enhance cognitive skills in other populations. Finally, we present a review of recent studies testing innovative devices developed to assist schizophrenia patients. DISCUSSION: First, we found several cognitive programs proven to be effective with schizophrenia patients, but only three were validated in French. It could be useful to adapt other programs for French-speaking populations. Unfortunately, we found that very few of the existing cognitive assistive technologies are proposed to be used with schizophrenia patients. In fact, most of the available cognitive orthoses were tested primarily in people with neurological injuries (for example, various memory impairments caused by traumas), and in elderly illnesses (like Alzheimer disease). Devices for patients with mental deficits (e.g., mental retardation) were developed later, and only very recently explored for use in schizophrenia. As a result of an international collaboration between France and Canada, currently a tool called MOBUS is being tested. This technology aims at improving the autonomy of schizophrenia patients, by helping them plan and remember their daily activities. Furthermore, it encourages patient-caregiver communication, and permits monitoring patients’ subjective reports of their symptoms. The use of cognitive assistive technologies is not meant to isolate patients by replacing the human element of relatives and caregivers by a machine. On the contrary, they offer a sense of security and they improve interpersonal relationships by permitting enhanced autonomy and greater self-confidence. Finally, a literature review of cognitive remediation in schizophrenia emphasises the importance of a structured application of the technique in order for it to succeed. First, it is crucial to detect the impairments that will be targeted in each patient presenting a specific pattern of impairments. For this purpose, validated and customised neuropsychological tests are required. Then, cognitive remediation programs must be customised to each patient’s needs in order to motivate the patient to participate. Finally, long-term effects must be assessed in order to verify whether reinforcement is needed. Following these steps, most of the studies show an improvement in the well-being of patients with schizophrenia. These recommendations are also suitable for the cognitive remediation programs, as for treatments with cognitive assistive devices. An important hurdle facing the advance of cognitive assistive technology programs is that different research groups work individually without a coordinated effort to improve and validate the existing programs. CONCLUSION: Schizophrenia treatments must take into account not only patients’ symptoms, but also the associated cognitive deficits which constitute an important factor in their social problems. It has been shown that several cognitive remediation programs are efficient in schizophrenia. New technologies complement the benefits of such programs, and support pharmacological treatments and psychotherapies.
18. Rosti-Otajärvi EM, Hämäläinen PI. Neuropsychological rehabilitation for multiple sclerosis. Cochrane Database Syst …. 2014
Main results - Twenty studies (986 participants; 966 MS participants and 20 healthy controls) fulfilled the inclusion criteria. The mean age of the participants was 44.6 years,mean length of education was 12.3 years and 70%of the participants were women.Most of the participants had a relapsing-remitting course of disease. The mean Expanded Disability Status Scale score was 3.2 and the mean duration of disease was 14.0 years. On the basis of these studies, we found low-level evidence that neuropsychological rehabilitation reduces cognitive symptoms in MS. Cognitive training was found to improve memory span (standardised mean difference (SMD) 0.54, 95% confidence interval (CI) 0.20 to 0.88, P = 0.002) and working memory (SMD 0.33, 95% CI 0.09 to 0.57, P = 0.006). Cognitive training combined with other neuropsychological rehabilitation methods was found to improve attention (SMD 0.15, 95% CI 0.01 to 0.28, P = 0.03), immediate verbal memory (SMD 0.31, 95% CI 0.08 to 0.54, P = 0.008) and delayed memory (SMD 0.22, 95% CI 0.02 to 0.42, P = 0.03).
There was no evidence of an effect of neuropsychological rehabilitation on emotional functions. The overall quality, as well as the comparability of the included studies, was relatively low due to methodological limitations and heterogeneity of interventions and outcome measures. Although most of the pooled results in the meta-analyses yielded no significant findings, 18 of the 20 studies showed some evidence of positive effects when the studies were individually analysed.
This review found low-level evidence for positive effects of neuropsychological rehabilitation in MS. The interventions and outcome measures included in the review were heterogeneous, which limited the comparability of the studies. New trials may therefore change the strength and direction of the evidence.
19. Rego P, Moreira PM, Reis LP. A Survey on Serious Games for Rehabilitation. 5th DSIE’10 Doctoral Symposium in …. 2010
A presentation on the topic of “serious games for rehabilitation”. Includes a section on RehaCom
URL: http://paginas.fe.up.pt/~dsie10/presentations/session 7/A Survey on Serious Games for Rehabilitation.pdf
20. García-Molina A, Rajo… PR. Clinical program of cognitive tele-rehabilitation for traumatic brain injury. eChallenges. 20101-10.
The purpose of this study was to clinically validate a new modality of cognitive rehabilitation services based on telemedicine systems (PREVIRNEC platform) for persons with moderate or severe traumatic brain injury (TBI). Patients and Methods. Eighty patients with moderate or severe TBI; mean age: 36.1 years (SD= 18.19 years) received a 10-week cognitive rehabilitation (5 sessions-week). Differences between pre- and post-treatment neuropsychological test scores were used to measure patient’s improvements in the domains of attention, memory and executive functions. Patients were divided in two groups based on the Competency Rating Scale (PCRS; adequate or inadequate everyday competence) post-rehabilitation score. Results. Patients showed significant cognitive improvement after the application of the computerised cognitive rehabilitation program. Significant differences were observed between both groups on the number of highly-performed tasks during cognitive treatment, in the attention (p=0.026) and executive (p=0.040) execution. Conclusions. The cognitive rehabilitation program based on telemedicine systems (PREVIRNEC platform) improves attention, memory, and executive functions, as well as in patient’s everyday competence.
21. Grynszpan O, Perbal S, Pelissolo A et al. Efficacy and specificity of computer-assisted cognitive remediation in schizophrenia: a meta-analytical study. Psychol Med. 2011; 41: 163-173.
BACKGROUND: Cognitive remediation is frequently based on computerised training methods that target different cognitive deficits. The aim of this article was to assess the efficacy of computer-assisted cognitive remediation (CACR) in schizophrenia and to determine whether CACR enables selective treatment of specific cognitive domains. METHOD: A meta-analysis was performed on 16 randomised controlled trials evaluating CACR. The effect sizes of differences between CACR and control groups were computed and classified according to the cognitive domain assessed. The possible influences of four potential moderator variables were examined: participants’ age, treatment duration, weekly frequency, and control condition type. To test the domain-specific effect, the intended goal of each study was determined and the effect sizes were sorted accordingly. The effect sizes of the cognitive domains explicitly targeted by the interventions were then compared with those that were not. RESULTS: CACR enhanced general cognition with a mean effect size of 0.38 [confidence interval (CI) 0.20-0.55]. A significant medium effect size of 0.64 (CI 0.29-0.99) was found for Social Cognition. Improvements were also significant in Verbal Memory, Working Memory, Attention/Vigilance and Speed of Processing with small effect sizes. Cognitive domains that were specifically targeted by the interventions did not yield higher effects than those that were not. CONCLUSIONS: The results lend support to the efficacy of CACR with particular emphasis on Social Cognition. The difficulty in targeting specific domains suggests a ‘non-specific’ effect of CACR. These results are discussed in the light of the possible bias in remediation tasks due to computer interface design paradigms.
22. Guerin Langlois C, Mondoloni, A., Uzan, S., Laffy-Beaufils, B. Early treatment of schizophrenia: Links between insight and cognitive disorders. European Psychiatry. 2009; Vol 24, Supplement 1: S1142.
In the early treatment of schizophrenia, insight and cognitive disorders are key components in the observance and the functional prognosis of patients. This study aims to evaluate the impact of neurocognitive rehabilitation and psycho information programs on the quality of insight in a population of 20 schizophrenic patients. Results show a correlation between the extent of cognitive disorders and the quality of insight as well as with the efficiency of specific treatment programs. The study emphasizes close links between improvement of cognitive skills and the quality of insight in this population.
23. Kim SC, Lee MH, Jang C, Kwon… JW. The Effect of Alpha Rhythm Sleep on EEG Activity and Individuals’ Attention. Jnl Phys Ther Sci. 2013; Vol 25: 1515-1518.
Rehacom (HASOMED GmbH, Germany), which is a Cognitive Rehabilitation/Brain PerformanceTraining system, was also used to assess Attention and concentration in the behavioural task performance. This study had a randomised controlled trial design.
Purpose] This study examined whether the alpha rhythm sleep alters the EEG activity and response time in the attention and concentration tasks. [Subjects and Methods] The participants were 30 healthy university students, who were randomly and equally divided into two groups, the experimental and control groups. They were treated using the Happy-sleep device or a sham device, respectively. All participants had a one-week training period. Before and after training sessions, a behavioural task test was performed and EEG alpha waves were measured to confirm the effectiveness of training on cognitive function. [Results] In terms of the behavioural task test, reaction time (RT) variations in the experimental group were significantly larger than in the control group for the attention item. Changes in the EEG alpha power in the experimental group were also significantly larger than those of the control group. [Conclusions] These findings suggest that sleep induced using the Happy-sleep device modestly enhances the ability to pay attention and focus during academic learning
24. Kimhy D, Jobson-Ahmed L, Ben-David S, Ramadhar L, Malaspina D, Corcoran CM. Cognitive insight in individuals at clinical high risk for psychosis. Early Interv Psychiatry. 2014; 8: 130-137.
AIM: Reduced cognitive insight has been associated with psychotic symptoms, in particular with the presence of delusions; however, there is little information about whether such reductions are present in at-risk individuals prior to the onset of threshold psychotic symptoms. METHOD: We conducted a cross-sectional comparison of cognitive insight (as indexed by the Beck Cognitive Insight Scale) in 62 help-seeking individuals at clinical high risk for psychosis, Fifty-nine individuals with schizophrenia-spectrum disorders and 37 healthy controls (HC). In patients, we evaluated associations of insight with positive symptoms, including later transition to psychosis in high-risk patients. RESULTS: Individuals with schizophrenia reported significantly higher self-certainty scores than the at-risk patients and HCs, with the at-risk patients scoring intermediate to the individuals with schizophrenia and controls. Similarly, individuals with schizophrenia scored significantly higher on self-reflectiveness, with no differences between the at-risk patients and controls. In individuals with schizophrenia, delusions were significantly correlated with self-certainty. In at-risk patients, cognitive insight was not associated with positive symptom severity and did not differentiate those at-risk patients who later developed psychosis from those who did not. However, post hoc analyses suggested that at-risk patients with marked unusual thought content (approaching threshold psychosis) had lower self-reflectiveness; whereas those with high suspiciousness had significantly higher self-certainty. CONCLUSIONS: The findings are discussed in the context of normal developmental processes occurring during adolescence, their putative links to neurobiological functioning, and their implications for treatment and future research.
25. Lee Y, Lee CR, Hwang B. Effects of Computer-aided Cognitive Rehabilitation Training and Balance Exercise on Cognitive and Visual Perception Ability of the Elderly. Jnl Phys Ther Sci. 2012; 24: 885-887.
[Purpose] This study examined the effects of computer-aided cognitive rehabilitation (CACR) training and balance exercise on elderly individuals’ cognitive and visual perception. [Subjects] Thirty healthy subjects aged between 65 and 80 participated in this study. They were randomly and equally assigned to either a CACR training group (TG) or a balance exercise group (BEG). [Methods] Subjects’ cognitive functions and visual perception were measured using the Korean mini-mental state examination (MMSE-K) and the motor-free visual perception test (MVPT-3), respectively. For intervention methods, the TG received interval vision training using the RehaCom program, a Cognitive Rehabilitation Computer Program derived the Vienna Test System, and vision composition training with attention training programs for 30 minutes, 3 times per week, for 6 weeks. The BEG training consisting of warm-up exercises, main exercises, and cool-down exercises, for 50 minutes, 3 times per week, for 6 weeks. [Results] Both the TG and the BEG saw their MMSE-K and MVPT-3 scores significantly increase after the interventions, but the two groups showed no significant differences. [Conclusion] Given that the effects of CACR training were similar to those of the balance exercise training, we consider CACR training is a viable treatment method for preventing the decrease of cognitive function among the elderly.
26. Lee YM, Jang C, Bak IH, Yoon JS. Effects of Computer-assisted Cognitive Rehabilitation Training on the Cognition and Static Balance of the Elderly. Jnl Phys Ther Sci. 2013; 25: 1475-1477.
[Purpose] The purpose of this study was to investigate the effects of a six-week-long computer-assisted cognitive rehabilitation training program on the improvement of cognition and balance abilities of the elderly. [Subjects] Thirty healthy elderly people, aged 65 to 80, were randomly assigned either to the training group (n=15) or the control group (n=15). [Methods] Cognitive functions were evaluated using MMSE-K, and the BioRescue AP 153 (RMINGENIERIE, France) was used to examine subjects’ changes in static balance. [Results] The MMSE-K score showed a significant change over the course of the treatment period in the training group, but not in the control group. The sway area and sway path length decreased significantly in the training group, but it did not show any changes in the control group. [Conclusion] Computer-assisted cognitive rehabilitation training is an effective intervention method for the improvement of the cognition and balance abilities of the elderly.
27. Luca RD, Calabrò RS, Gervasi G, Salvo… SD. Is computer-assisted training effective in improving rehabilitative outcomes after brain injury? A case-control hospital-based study. Disability and Health Journal. 2014; Vol 7: 356-360.
Background - Rehabilitation of impaired cognitive functions begins to be considered a standard component of medical care after acquired brain injury. Indeed, many evidences support the effectiveness of the two major categories of techniques, i.e. the traditional and computer-assisted ones, which are widely used in cognitive rehabilitative treatment.
Objective - Aim of this study is to evaluate the effects of pc – cognitive training in brain injury patients.
Methods - We studied 35 subjects (randomly divided into two groups), affected by traumatic or vascular brain injury, having attended from January 2010 to December 2012 the Laboratory of Robotic and Cognitive Rehabilitation of IRCCS Neurolesi of Messina. Cognitive impairment was investigated through psychometric battery, administered before (T0) and two months (T1) after the cognitive pc-training, which was performed only by the experimental group, in addition to conventional treatment. Statistical analysis was performed using Wilcoxon test with a p < 0.01.
Results - At time T0, all patients showed language deficits and cognitive alterations in visual attention and memory abilities. After the rehabilitation program we noted a global improvement in both the groups. However, at T1, the experimental group showed a greater cognitive improvement than the control group, with significant differences in nearly all the neuropsychological tests performed.
Conclusions - Our data suggest that cognitive pc-training may be a promising methodology to optimise the rehabilitation outcomes following brain injury.
28. Mak M, Samochowiec J, Tybura P et al. The efficacy of cognitive rehabilitation with RehaCom programme in schizophrenia patients. The role of selected genetic polymorphisms in successful cognitive rehabilitation. Ann Agric Environ Med. 2013; 20: 77-81.
INTRODUCTION: Schizophrenic patients present cognitive dysfunctions which are regarded to be one of endophenotypical markers predisposing to schizophrenia. Currently, schizophrenia can be treated as a neurodegenerative and neuro-developing disease with genetic background. OBJECTIVE: Assessment of the possible positive effect of neuropsychological rehabilitation in schizophrenia, in patients presenting cognitive dysfunctions. An additional aim was to verify the hypothesis that some genetic polymorphisms can be a prognostic factor for success in neuropsychological rehabilitation. MATERIAL AND METHODS: 41 participants and 40 control subjects were randomly selected. Both groups had the diagnosis of paranoid schizophrenia. Cognitive functions were checked with the Wisconsin Card Sorting Test, Trail Making Test, and Stroop Test at the beginning and end of the experiment. In the research group, each patient trained with the rehabilitation programme RehaCom, whereas the control group did not receive such training. Genes COMT rs4680 and BDNF rs6265 were analysed in the genetic part of study. RESULTS: RehaCom procedures appear to be useful in the neuropsychological rehabilitation of cognitive dysfunctions in patients diagnosed with schizophrenia. The research group showed a moderate improvement in the training programmes. Analysis of parameters obtained in the neuropsychological tests showed a slight improvement in both groups. At the present time, analysis of the polymorphisms of genes cannot be treated as a prognostic factor for the success of neuropsychological rehabilitation because statistical analyses showed few dependences with little statistical significance. CONCLUSIONS: Cognitive rehabilitation produces moderate improvement in cognitive functioning.
29. Mangone G, Cerasa… A. Blind randomised controlled study of the efficacy of attentional cognitive rehabilitation in multiple sclerosis as measured by fMRI. Multiple Sclerosis Journal. 2012; 18, Issue 4 SUPPL. 1: 483-484
30. Mattioli F, Stampatori C, Zanotti D, Parrinello G, Capra R. Efficacy and specificity of intensive cognitive rehabilitation of attention and executive functions in multiple sclerosis. J Neurol Sci. 2010; 288: 101-105.
OBJECTIVE: To evaluate the efficacy of a computer-based intensive training program of attention, information processing and executive functions in patients with clinically-stable relapsing-remitting (RR) multiple sclerosis (MS) and low levels of disability. DESIGN, PATIENTS AND INTERVENTIONS: A total of 150 patients with RR MS and an Expanded Disability Status Scale (EDSS) score of < or =4 were examined. Information processing, working memory and attention were assessed by the Paced Auditory Serial Addition Test (PASAT) and executive functions by the Wisconsin Card Sorting Test (WCST). Twenty patients who scored below certain cut-off measures in both tests were included in this double-blind controlled study. Patients were casually assigned to a study group (SG) or a control group (CG) and underwent neuropsychological evaluation at baseline and after 3 months. Patients in the SG received intensive computer-assisted cognitive rehabilitation of attention, information processing and executive functions for 3 months; the CG did not receive any rehabilitation. SETTING: Ambulatory patients were sent by the MS referral center. OUTCOME MEASURES: Improvement in neuropsychological test and scale scores. RESULTS: After rehabilitation, only the SG significantly improved in tests of attention, information processing and executive functions (PASAT 3’’ p=0.023, PASAT 2’’ p=0.004, WCSTte p=0.037), as well as in depression scores (MADRS p=0.01). Neuropsychological improvement was unrelated to depression improvement in regression analysis. CONCLUSIONS: Intensive neuropsychological rehabilitation of attention, information processing and executive functions is effective in patients with RR MS and low levels of disability, and also leads to improvement in depression.
31. Mellfeldt Milchert S. Datoriserad kogntiv rehabilitering psykiatrisk öppenvård (Västra Stockholms psykiatriska sektor Spånga psykiatriska område). Newsletter. (No. 9).
32. Moreno J, Saldana D. Use of a computer-assisted program to improve metacognition in persons with severe intellectual disabilities. Research in Developmental Disabilities. 2005; Vol 26 (4) July-Aug 2005
Metacognition and self-regulation are processes extremely relevant to education of persons with intellectual disabilities. They play a central role in specific limitations, such as outer-directedness and lack of strategy transfer, and are related to desirable educational objectives such as self-determination. Although computer-assisted training has shown to be successful in training specific abilities and general cognitive processes, interventions of this nature centering on metacognitive development are rare. A computer-assisted program aimed in this direction is presented. It was applied to 21 adolescents and young adults with a mean IQ of 36. Metacognitive scores improved for this group at posttest relative to pretest to a degree significantly different from gains found in an equivalent control group. Improvement was clear from the first sessions of the intervention and was maintained at a 6-month follow-up.
33. Oh BH, Kim YK, Kim JH, Shin YS. The effects of cognitive rehabilitation training on cognitive function of elderly dementia patients. Journal of Korean Neuropsychiatric Assic. 2003; 42: 514-519.
OBJECTIVES: This study was to evaluate the effects of cognitive rehabilitation training on the cognitive decline of elderly dementia patients. METHODS: Each of 20 subjects received 16 session of repeated training with computer-aided cognitive rehabilitation program (REHACOM). Cognitive function of all subjects were evaluated by K-DRS, K-BNT, K-MMSE and GDS before and after the training. RESULTS: Significant improvement of attention and memory was observed following REHACOM. There was no significant change in visuospatial memory, executive function, and conceptualisation. CONCLUSION: It is suggested that cognitive rehabilitation training with elderly dementia patients can be useful to ameliorate the cognitive decline and to enhance motivation and self-esteem.
34. Rego PA, Moreira PM, Reis LP. Natural user interfaces in serious games for rehabilitation. Information Systems and …. 20111-4.
This paper addresses research development regarding the adoption of natural user interfaces (NUI) in the Serious Games for Rehabilitation area of application. From previous studies, we identified as a research opportunity the potential benefits of the adoption of more natural interaction modalities. This paper describes the main problems and how serious games and NUI can benefit the process of rehabilitation. We describe our recent work on this subject, including the design of a game prototype using alternative (in respect to the conventional WIMP) interaction. We conducted a playability study in order to make it possible to evaluate and measure the benefits of the newer forms of interaction. From the results study, we concluded that the introduction of the natural interaction modalities has increased the attractiveness and intuitiveness of the prototyped Serious Game. Lastly, we report some conclusions and identify research opportunities and open problems in this area.
35. Cicerone KD, Langenbahn DM, Braden… C. Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Archives of Physical Med Rehabil. 2011; 92: 519-530.
Objective: To update our clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI)and stroke, based on a systematic review of the literature from 2003 through 2008.
Data Sources: PubMed and Infotrieve literature searches were conducted using the terms attention, awareness, cognitive, communication, executive, language, memory, perception, problem solving, and/or reasoning combined with each of the following terms: rehabilitation, remediation, and training for articles published between 2003 and 2008. The task force initially identified citations for 198 published articles.
Study Selection: One hundred forty-one articles were selected for inclusion after our initial screening. Twenty-nine studies were excluded after further detailed review. Excluded articles included 4 descriptive studies without data, 6 nontreatment studies, 7 experimental manipulations, 6 reviews, 1 single case study not related to TBI or stroke, 2 articles where the intervention was provided to caretakers, 1 article redacted by the journal, and 2 reanalyses of prior publications. We fully reviewed and evaluated 112 studies.
Data Extraction: Articles were assigned to 1 of 6 categories reflecting the primary area of intervention: attention; vision and visuospatial functioning; language and communication skills; memory; executive functioning, problem solving and awareness; and comprehensive-holistic cognitive rehabilitation. Articles were abstracted and levels of evidence determined using specific criteria.
Conclusions: There is substantial evidence to support interventions for attention, memory, social communication skills, executive function, and for comprehensive-holistic neuropsychologic rehabilitation after TBI. Evidence supports visuospatial rehabilitation after right hemisphere stroke, and interventions for aphasia and apraxia after left hemisphere stroke. Together with our prior reviews, we have evaluated a total of 370 interventions, including 65 class I or Ia studies. There is now sufficient information to support evidence-based protocols and implement empirically-supported treatments for cognitive disability after TBI and stroke.
36. Cochet A, Saoud M, Gabriele S et al. [Impact of a new cognitive remediation strategy on interpersonal problem solving skills and social autonomy in schizophrenia]. Encephale. 2006; 32: 189-195.
INTRODUCTION: Despite recent developments, the impact of pharmacotherapy on social autonomy and interpersonal problem solving skills in patients with schizophrenia remains limited, with consequences in terms of socio-professional functioning. Indeed, independently of the positive, negative and/or disorganization symptoms, functional deficits in patients with schizophrenia rely mainly on various cognitive impairments. OBJECTIVES: To determine the impact of a new Cognitive Remediation Strategy on interpersonal problem solving skills, social autonomy and symptoms in patients with schizophrenia. METHODS: Thirty patients with schizophrenia were enrolled in a program consisting of 14 training sessions of 4 cognitive functions (attention/concentration, topological memory, logical reasoning, executive functions) using the REHACOM software. Measurements of attention (Continuous Performance Test, CPT), memory (Rivermead Behavioural Memory Test, RBMT) and executive functions (Wisconsin Card Sorting Test, WCST) as well as interpersonal problem solving skills (Assessment of Interpersonal Problem-Solving Skills, AIPSS) and social autonomy (Social Autonomy Scale, EAS) and finally schizophrenia symptoms (Positive And Negative Syndrom Scale, PANSS) were undertaken at the beginning and the end of the 14 remediation meetings. RESULTS: Cognitive functions, interpersonal problems solving skills, social autonomy and symptoms were significantly improved by the Cognitive Remediation Strategy. CONCLUSION: Our results confirm the therapeutic impact of a Cognitive Remediation Strategy among 30 schizophrenic patients stabilised on clinical, therapeutic and functional levels. The question of the long-term maintenance of such improvements still requires further investigation.
37. d’Amato T, Bation R, Cochet A et al. A randomized, controlled trial of computer-assisted cognitive remediation for schizophrenia. Schizophr Res. 2011; 125: 284-290.
OBJECTIVE: There is considerable interest in cognitive remediation for schizophrenia. Our study aimed to evaluate, in a large sample of patients with schizophrenia, the interest of a computer-assisted cognitive remediation program on cognitive performances of patients as well as in clinical and functional outcome. METHOD: Seventy-seven patients with remitted schizophrenia were randomly assigned to 14 2-hours individual sessions of computer-assisted cognitive remediation (n=39) or a control condition (n=38). Remediation was performed using RehaCom (R) software. Four procedures were chosen to train four cognitive functions involved in different stages of the information processing: attention/concentration, working memory, logic, and executive functions. Primary outcomes were remediation exercise metrics, neuropsychological composites (episodic memory, working memory, attention, executive functioning, and processing speed), clinical and community functioning measures. RESULTS: Cognitive performances concerning Attention/vigilance, verbal working memory and verbal learning memory and reasoning/problem solving improved significantly in the remediation condition when no difference was reported in the control condition between the 2 assessments. However, there were no significant benefits of cognitive remediation on non-verbal working memory and learning and speed of processing or functional outcome measures. CONCLUSIONS: Cognitive remediation for people with schizophrenia was effective in improving performance, but the benefits of training did not generalize to functional outcome measures. Long term follow-up studies are needed to confirm the maintenance of such improvements.
38. Dellagi L, Ben Azouz O, Johnson I, Kebir O, Amado I, Tabbane K. [Cognitive remediation therapy in schizophrenia: a case report]. Tunis Med. 2009; 87: 660-663.
BACKGROUND: Despite progress in chemo-therapeutics, schizophrenia remains a chronic disease with occurrence of residual symptoms and drug resistance in 60% of the cases. Besides, cognitive impairment is frequent and highly correlated to social dysfunction seen in patients with schizophrenia. Several cognitive remediation programs have been elaborated. REHACOM is one of such programs. Aim of the study is to evaluate through a case control the efficiency of REHACOM towards cognitive functions. METHODS: This program has been administered to a patient suffering from undifferentiated schizophrenia which was ameliorated after drug therapy considering positive symptoms but still was complaining from cognitive deficits causing social withdrawal. RESULTS: After following the remediation program, the patient was ameliorated considering its negative symptoms as attested by an amelioration of the PANSS negative score and considering its cognitive performances on memory, attention and executive functions. We have also noticed an improvement in his self-esteem and his quality of life. CONCLUSION: This first trial of a cognitive remediation program among our patients suffering from schizophrenia using REHACOM was encouraging. Enlarging its use and designing controlled studies will be the next step of our study.
39. El-Shennawy W, Raouf ERRA. Predictability of Hand Skills after Cognitive Remediation Therapy in Down Syndrome. Bull Fac Ph Th Cairo Univ. 2014; Vol. 19
Background: Cognitive remediation therapy (CRT) is a non biological treatment that aims at correcting cognitive deficits through repeated exercises. Its efficacy in patients with Down syndrome is not well recognised yet, as children with Down syndrome have visual-perceptual dysfunction as a result of limited sensory experience from the lack of normal motor control. Objective: The purpose of the present study was to assess the impact of the RehaCom software as a cognitive remediation therapy in performance of fine motor skills in children with Down syndrome. Methods: Twenty-six children with Down syndrome with age ranged between seven and ten years participated in this study. All those children showed average intelligence level. First, evaluation of fine motor dysfunction by Peabody Developmental Measuring Scale 2 (PDMS-2) and the visual perceptual test reaction duration (maximal and minimal) was detected for each child. Then, children were divided into two equal groups: a control and a study group. Therapy program for enhancing fine-motor skills was given to the two groups. In addition, children within the study group received Visual-perceptual integrative therapy program (Rehacom). Post treatment evaluation was done after three months. Results: At the end of treatment, children within the study groups showed significant improvement with regard to grasping, fine-motor quotient and maximum and minimal reaction time of visual perceptual test performance (P<0.05). Conclusion: Visual-perceptual training improves fine-motor skills performance in children with Down syndrome. Key words: Visual perception, Cognition, Hand skills, Down syndrome.
URL: http://lib.pt.cu.edu.eg/2-Eman jan 2014.pdf
40. Eriksson M, Dahlin-Ivanoff S. How adults with acquired brain damage perceive computer training as a rehabilitation tool: A focus-group study. Scandinavian journal of Occupational Therapy. 2002; Vol. 9, No 3: 119-129.
The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.
41. Fernandez E, Bringas ML, Salazar S, Rodriguez D, Garcia ME, Torres M. Clinical impact of RehaCom software for cognitive rehabilitation of patients with acquired brain injury. MEDICC Rev. 2012; 14: 32-35.
We describe the clinical impact of the RehaCom computerised cognitive training program instituted in the International Neurological Restoration Center for rehabilitation of brain injury patients. Fifty patients admitted from 2008 through 2010 were trained over 60 sessions. Attention and memory functions were assessed with a pre- and post-treatment design, using the Mini-Mental State Examination, Wechsler Memory Scale and Trail Making Test (Parts A and B). Negative effects were assessed, including mental fatigue, headache and eye irritation. The program’s clinical usefulness was confirmed, with 100% of patients showing improved performance in trained functions.
42. Friedl-Francesconi H, Binder H. [Training in cognitive functions in neurologic rehabilitation of craniocerebral trauma]. Z Exp Psychol. 1996; 43: 1-21.
This study evaluates a new cognitive rehabilitation therapy for patients after severe head injury. In addition to the standard neurological rehabilitation therapy, one group was trained by the Wiener Determinationsgerat (WDT), a second group was treated by the new program REHACOM, while a third group received only conventional neurological rehabilitation therapy. The three groups each consisted of 12 patients; two groups received 20 sessions of training, each lasting 40 minutes. At the beginning as well as after the therapy a psychological test battery was applied, consisting of HAWIE, TULUC, AACHENER APHASIETEST, and BENTON-Test. They were also tested by a specific neuropsychological battery regarding hemispheric specialization. REHACOM showed significantly higher values on the HAWIE as well as on BENTON-Test than the other two groups. REHACOM also improved in right-hemispheric dimensions while WDT group did not improve in attention. Right-hemispheric training was more effective than attentional stimulation.
43. FriedlFrancesconi H, Binder H. Functional cognitive training in neurological rehabilitation of severe head injury. Zeitschrift fur …. 1996
44. Aimola L, Lane AR, Smith DT, Kerkhoff G, Ford GA, Schenk T. Efficacy and feasibility of home-based training for individuals with homonymous visual field defects. Neurorehabil Neural Repair. 2014; 28: 207-218.
BACKGROUND: Homonymous visual field defects (HVFDs) are one of the most common consequences of stroke. Compensatory training encourages affected individuals to develop more efficient eye movements to improve function. However, training is typically supervised, which can be time consuming and costly. OBJECTIVE: To develop and evaluate the efficacy and feasibility of an unsupervised reading and exploration computer training for individuals with HVFDs. METHODS: Seventy individuals with chronic HVFDs were randomly assigned to 1 of 2 groups: intervention or control. The former received 35 hours of reading and exploration training, and the latter received 35 hours of control training. Visual and attentional abilities were assessed before and after training using perimetry, visual search, reading, activities of daily living, the Test of Everyday Attention, and a Sustained Attention to Response task. RESULTS: Eighteen individuals failed to complete the training; analyses were conducted on the remaining 28 intervention and 24 control group participants. Individuals in the intervention group demonstrated significant improvements in the primary outcomes of exploration (12.87%, 95% confidence interval [CI] = 8.44% to 17.30%) and reading (18.45%, 95% CI = 9.93% to 26.97%), which were significantly greater than those observed following the control intervention (exploration = 4.80%, 95% CI = 0.09% to 9.51%; reading = 1.95%, 95% CI = -4.78% to 8.68%). Participants in the intervention group also reported secondary subjective improvements, although these were not matched by objective gains in tasks simulating activities of daily living. CONCLUSIONS: Home-based compensatory training is an inexpensive accessible rehabilitation option for individuals with HVFDs, which can result in objective benefits in searching and reading, as well as improving quality of life.
45. Byong KM, Mödden C, Eling… P. Working Memory Training and Semantic Structuring Improves Remembering Future Events, Not Past Events. Neurorehabil Neural Repair. 2014
Objectives. Memory training in combination with practice in semantic structuring and word fluency has been shown to improve memory performance. This study investigated the efficacy of a working memory training combined with exercises in semantic structuring and word fluency and examined whether training effects generalise to other cognitive tasks.
Methods. In this double-blind randomised control study, 36 patients with memory impairments following brain damage were allocated to either the experimental or the active control condition, with both groups receiving 9 hours of therapy. The experimental group received a computer-based working memory training and exercises in word fluency and semantic structuring. The control group received the standard memory therapy provided in the rehabilitation center. Patients were tested on a neuropsychological test battery before and after therapy, resulting in composite scores for working memory; immediate, delayed, and prospective memory; word fluency; and attention. Results. The experimental group improved significantly in working memory and word fluency. The training effects also generalised to prospective memory tasks. No specific effect on episodic memory could be demonstrated. Conclusion. Combined treatment of working memory training with exercises in semantic structuring is an effective method for cognitive rehabilitation of organic memory impairment.
46. Flavia M, Stampatori C, Zanotti D, Parrinello… G. Efficacy and specificity of intensive cognitive rehabilitation of attention and executive functions in multiple sclerosis. J Neurol Sci. 2010; Vol 288: 101-105.
OBJECTIVE: To evaluate the efficacy of a computer-based intensive training program of attention, information processing and executive functions in patients with clinically-stable relapsing–remitting (RR) multiple sclerosis (MS) and low levels of disability. DESIGN.
47. Modden C, Behrens M, Damke I, Eilers N, Kastrup A, Hildebrandt H. A randomized controlled trial comparing 2 interventions for visual field loss with standard occupational therapy during inpatient stroke rehabilitation. Neurorehabil Neural Repair. 2012; 26: 463-469.
BACKGROUND AND PURPOSE: Compensatory and restorative treatments have been developed to improve visual field defects after stroke. However, no controlled trials have compared these interventions with standard occupational therapy (OT). METHODS: A total of 45 stroke participants with visual field defect admitted for inpatient rehabilitation were randomised to restorative computerised training (RT) using computer-based stimulation of border areas of their visual field defects or to a computer-based compensatory therapy (CT) teaching a visual search strategy. OT, in which different compensation strategies were used to train for activities of daily living, served as standard treatment for the active control group. Each treatment group received 15 single sessions of 30 minutes distributed over 3 weeks. The primary outcome measures were visual field expansion for RT, visual search performance for CT, and reading performance for both treatments. Visual conjunction search, alertness, and the Barthel Index were secondary outcomes. RESULTS: Compared with OT, CT resulted in a better visual search performance, and RT did not result in a larger expansion of the visual field. Intra-group pre-post comparisons demonstrated that CT improved all defined outcome parameters and RT several, whereas OT only improved one. CONCLUSIONS: CT improved functional deficits after visual field loss compared with standard OT and may be the intervention of choice during inpatient rehabilitation. A larger trial that includes lesion location in the analysis is recommended.
48. Byoung-Hoon O, Young-Kec K, Ji-IIyc K, Yoon-Sik S. The effects of cognitive rehabilitation training on cognitive function of elderly dementia patients. J Korean Neuropsychiatr Assoc. 2003; 42: 514-519.
OBJECTIVES : This study was to evaluate the effects of cognitive rehabilitation training on the cognitive decline of elderly dementia patients.
METHODS • Each of 20 subjects received 16 session of repeated training with computer-aided cognitive rehabilitation program (REHACOM). Cognitive function of all subjects were evaluated by K-DRS, K-BNT, K-MMSE and GDS before and after the training.
RESULTS : Significant improvement of attention and memory was observed following REHACOM. There was no significant change in visuo spatial memory, executive function, and conceptualisation.
CONCLUSION : It is suggested that cognitive rehabilitation training with elderly dementia patients can be useful to ameliorate the cognitive decline and to enhance motivation and self-esteem.