Cognitive Retraining Research Articles

Human Experience Modeler: Context-Driven Cognitive Retraining to Facilitate Transfer of Learning

We describe a cognitive rehabilitation mixed-reality system that allows therapists to explore natural cuing, contextualization, and theoretical aspects of cognitive retraining, including transfer of training. The Human Experience Modeler (HEM) mixed-reality environment allows for a contextualized learning experience with the advantages of controlled stimuli, experience capture and feedback that would not be feasible in a traditional rehabilitation setting. A pilot study for testing the integrated components of the HEM is discussed where the participant presents with working memory impairments due to an aneurysm.

Audiology Telepractice Moves From Theory to Treatment

Audiology Telepractice Moves From Theory to Treatment

Development of guidelines for rehabilitation of patients with stroke: analysis of therapeutic procedures

The Federal Insurance Institute for Salaried Employees (BfA, Bundesversicherungsanstalt für Angestellte) in Berlin took the initiative to develop evidence-based guidelines for rehabilitation including stroke rehabilitation. In the present study we performed a systematic survey of the scientific literature on stroke rehabilitation and deduced 8 evidence-based therapeutic modules. They were supplemented by 5 practice-based modules to cover the full range of interventions currently applied in stroke rehabilitation. Modules are clusters of various interventions which were aggregated according to the rehabilitative goal they have in common. Data were analysed from 8,876 BfA patients, the total population of "neuro"-patients in 2001 and 2002 with 142,951 interventions and 1,071,885 appointments. Stroke diagnoses covered ICD-10 codes I60, I61, I62, I63, I64 or were coded by G45, G81 and one of these I-codes. Stroke rehabilitation as provided in daily practice was found to be a complex multimodal treatment programme in all hospitals which were studied. On average, patients receive treatments from 7.3 therapeutic modules. A dominating role is played by "motor modules". Obviously, they play a major role in acute stroke rehabilitation in all hospitals compared to cognitive retraining, language therapy and especially improvement of psychic functions, which were significantly less applied. A dramatic variation could be shown to exist between the rehabilitation hospitals (1) with respect to the number of patients who were treated with a given module (e. g., some modules showed variations between 18 % and 100 %), and (2) with respect to treatment intensity and treatment duration per week. Several factors can be taken into account for interpretation of this high variance. Intrinsically, the high variation in symptomatology after stroke can play a major role, as both the deficit profile and the level of severity of a given deficit and the combined severity level can vary from patient to patient. On the other hand, extrinsic factors such as lack of staff may also account for some of the differences. In any case, the results show the necessity to optimize stroke rehabilitation by development and implementation of guidelines. Yet, they also point to a need for further research into rehabilitation interventions and procedures to yield evidence for the approximately 30 % of "only" practice-based interventions.

Stroke and neurodegenerative disorders. 3. stroke: rehabilitation management

Bogey RA, Geis CC, Bryant PR, Moroz A, O’Neill BJ. Stroke and neurodegenerative disorders. 3. Stroke: rehabilitation management. 2004;85(3 Suppl 1):S15–20. This self-directed learning module highlights common rehabilitation issues in stroke survivors. Topics include spasticity, constraint-induced movement therapy, partial body weight-supported treadmill training, virtual reality training, vestibular retraining, aphasia treatment, and cognitive retraining. It is part of the study chapter on stroke and neurodegenerative disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Overall article objectives (a) To identify and review the treatment options for poststroke spasticity; (b) to review the use of body weight-supported treadmill training in stroke patients; (c) to describe virtual reality training as an adjunct in stroke rehabilitation; (d) to review vestibular rehabilitation; (e) to discuss advances in aphasia treatment; (f) to discuss cognitive retraining; and (g) to provide an update on treatment of neglect syndromes.

Durability of cognitive remediation training in schizophrenia: performance on two memory tasks at 6-month and 12-month follow-up

Patients with schizophrenia have consistently been found to exhibit cognitive deficits, particularly in memory, which have been suggested to mediate functional outcomes. Several recent reviews of cognitive retraining have concluded that these deficits respond to training, although the sustainability of cognitive improvement following completion of training has not been adequately evaluated. Most studies had small samples and very short follow-up periods. As part of a larger study, we examined performance on two memory tasks in two groups of participants: those who received computerized cognitive remediation training in addition to work therapy ( n=45), vs. those who only received work therapy ( n=49). Computerized cognitive remediation included hierarchical training on a computerized digit span task and a computerized words serial position task. Assessments using the same computerized tasks were made at three time points: baseline, end of active intervention, and 6-month follow-up. Compared to the active control condition (work therapy only), the group receiving computerized cognitive remediation in addition to work therapy showed significantly greater improvements on the trained digit span task following training. These improvements were maintained at the 6-month follow-up. There were no significant group differences on the word serial position task at any time point. Results indicate that computerized training can lead to sustained improvements on some, but not all, training tasks.

Article 10: Effect of cognitive retraining on reorganization of attention network in patients with traumatic brain injury

Objective: To identify the areas of reorganization in the neural network for attention after cognitive retraining in the patients with traumatic brain injury (TBI) using functional MRI (fMRI). Design: Controlled clinical trials. Setting: Department of physical medicine and rehabilitation in general hospital. Participants: Ten TBI patients and 12 healthy volunteers participated. Interventions: Patients had received computer-assisted cognitive retraining to practice diverse attention skills for 3 to 4 weeks. Main Outcome Measures: fMRI was performed on a 3T ISOL Forte scanner with single-shot echoplanar imaging sequences before and after the intervention using a modified Posner paradigm as an activation task. Data were analyzed using Statistical Parametric Mapping 99. Results: The accuracy was lower and reaction time was slower in the patient group ( P<.001). fMRI results showed more activation in the right prefrontal and less activation in the cingulate, occipitotemporal, and cerebellar regions in the patients than in the normal group. After cognitive retraining, reaction time improved significantly ( P<.05). fMRI analysis showed a decrease in activation of the bilateral frontal and an increase in activation of the medial frontal areas after cognitive retraining. Conclusion: The effect of cognitive retraining was accompanied by reorganization of attention networks in frontal areas.

Poster 32: Evaluating program effectiveness and outcome in an educationally based cognitive retraining program with demographic changes in admission versus graduation groups

Objective: To evaluate program effectiveness and outcome in an educationally based cognitive rehabilitation program comparing the demographic variables of students with acquired brain injury at admission with the demographic variables of students with acquired brain injury who have successfully completed the program on average 2 years later. Design: Retrospective cohort study. Setting: Community college special programs and services. Participants: 525 students at admission with medically verifiable acquired brain injuries compared with 72 students who successfully completed the program. Interventions: Not applicable. Main Outcome Measures: We analyzed various demographic factors of each group looking for changes in demographics in the population that successfully completed the educational intervention program. Results: There was a higher incidence of change in the following demographics of students who finished the structured 2-year educationally based cognitive retraining program: students whose injury occurred within 1 year before admission; students with left hemisphere strokes; students between the ages of 18 and 29 years; students with severe traumatic brain injury; and students with premorbid education of 16 to 17 years. Conclusions: Demographics do change when comparing students with acquired brain injury before starting and completing a 2-year educationally based cognitive retraining program. Students who complete the program tend to be younger, have severe or left hemisphere-focused brain injuries, have had their injuries within 1 year of admission, and have a bachelor’s degree.

Cognitive retraining in epilepsy

Epilepsy is the commonest neurological disorder, so there is a need to establish more effective remedial programmes for the deficits in cognitive functioning associated with epilepsy. The present paper studies the relative change in the targeted skill areas as a consequence of cognitive retraining. For this purpose, a pre- and post-multiple baseline design was adopted with the intention of treating specific deficient skill. The measures of neuropsychological functioning adopted were a composite of tests/tasks, with specific emphasis on attention, memory and emotional status. The subject was targeted to a special neuro-rehabilitation programme comprised of cognitive retraining, supportive therapy and a deep breathing relaxation exercise. A regular home intervention programme was conducted simultaneously. Cognitive retraining included both paper and pencil tasks and real life activities. The training programme covered a 6-week period and each weekly session lasted ~1 hour. The results showed an overall improvement in cognitive performance across sessions, and the regular home intervention sessions were found to have enhanced the subject's performance. In conclusion, it was noted that by identifying cognitive deficits, effective training programmes can be devised that will be of substantial benefit to patients with epilepsy

Historical review of computer-assisted cognitive retraining.

This article details the introduction and development of the use of microcomputers as adjuncts to traditional cognitive rehabilitation of persons with acquired brain injury. The initial application of video games as therapeutic recreation in the late 1970s was soon followed in the early 1980s by the use of the first personal computers and available educational software. By the mid-1980s, both the IBM PC and Macintosh platforms were established, along with simplified programming languages that allowed individuals without extensive technical expertise to develop their own software. Several rehabilitation clinicians began to produce and market specially written cognitive retraining software for one or the other platform. Their work was detailed and reviewed, as was recently released software from commercial sources. The latter discussion included the latest developments in the rehabilitation applications of personal digital assistants and related organizing, reminding, and dictation devices. A summary of research on the general and specific efficacy of computer-assisted cognitive retraining illustrated the lingering controversy and skepticism that have been associated with this field since its inception. Computer-assisted cognitive retraining (CACR) can be an effective adjunct to a comprehensive program of cognitive rehabilitation. Training needs to be focused, structured, monitored, and as ecologically relevant as possible for optimum effect. Transfer or training or generalizability of skills remains a key issue in the field and should be considered the key criterion in evaluating whether to initiate or continue CACR.

Neuropsychological technologies in rehabilitation.

To provide an introduction and a conceptual context for the articles presented in this special edition of the Journal of Head Trauma Rehabilitation on neuropsychological technologies. Many clinical assessments in neuropsychology are metamorphosing from a psychometric search for a lesion to a functional image of the working brain. Behavioral probes increasingly employ technology to provide more ecologically valid stimuli to elicit diagnostically relevant responses. Intervention strategies include an expanding range of assistive devices and technologically based treatments. The advent of the microprocessor and discipline specific programming have allowed certain aspects of rehabilitation practice to incorporate these new assessment and intervention strategies. For example, the development of neuropsychological technologies has already lead to computer based prosthetics and orthotics, cognitive probes with millisecond accurate links to functional imaging, virtual reality managed ecological assessments, cognitive retraining, assistive devices, and online, and "real-time" database-driven evaluations. Emerging technologies offer the potential for personal, portable, everyday brain imaging and rehabilitation systems. Few psychologists, physiatrists, or allied health professionals are formally trained in technological development. What has emerged thus far is a collection of individual efforts that remain to be integrated into more comprehensive tools for the rehabilitation professions. The selective history of neuropsychological technologies presented here is meant to illustrate past difficulties in the emergence of this sub-specialty and point to new applications and technological integration that may prove fruitful. The convergence of neuroengineering, adaptive assessments, everyday neuroimaging, neuroinformatics, and educational neuroimaging, presage such future developments in neuropsychological technologies.

The Executive Brain: Frontal Lobes and the Civilized Mind

The Executive Brain: Frontal Lobes and the Civilized Mind

Computerized approaches to communication retraining after stroke.

Augmentative and alternative communication (AAC) strategies traditionally have been designed for individuals for whom oral speech is not a viable option. Common clinical practice has expanded AAC use to a tool for cognitive retraining or remediation. Although technologic developments offer the potential for vastly improved communication and inclusion for some individuals with severe communication disorders, technology alone does not result in successful communication. Although AAC interventions have become increasingly common across the age range, the research base underlying the design of AAC technology, intervention strategies, and treatment potential across communication disorders remains quite limited. To move beyond the traditional application of AAC strategies as a communication modality for persons with severe motor disorders to applications for persons with cognitive/linguistic disorders, three interrelated areas of research requiring further investigations are discussed. These include the following: use of AAC as a research tool to provide theoretical insights into the nature of normal and impaired language and cognition; development of AAC strategies as treatment tools to facilitate language recovery and use (production and comprehension); and studies that evaluate the efficacy of applying AAC strategies as communication modalities for individuals with acquired cognitive/linguistic communication disorders.

A comparison of subject characteristics for a matched sample of cognitive retraining patients with nontreatment patients : H.M. Sena, D.A. Sena, L.A. Becker and D. Bracken (Colorado Springs Nueropsychology Laboratory and Brain Training Center)

A comparison of subject characteristics for a matched sample of cognitive retraining patients with nontreatment patients : H.M. Sena, D.A. Sena, L.A. Becker and D. Bracken (Colorado Springs Nueropsychology Laboratory and Brain Training Center)

Changes After EEG Biofeedback and Cognitive Retraining in Adults with Mild Traumatic Brain Injury and Attention Deficit Hyperactivity Disorder

Introduction. Adults diagnosed with mild traumatic brain injury (mTBI) or Attention Deficit Hyperactivity Disorder (ADHD) were treated with EEG Biofeedback and cognitive retraining. Methods. Psychological and neuropsychological tests were completed at pre-treatment and post-treatment and compared to a normal control group that did not receive training, but tested on two occasions. Results. The results found significant improvement on full scale attention and full scale response accuracy of a continuous performance task in the mTBI and ADHD groups compared to the control group. A self report showed a significant decline in symptoms in the mTBI and ADHD groups compared to the control group. Errors on a problem solving task decreased only in the mTBI group. Discussion. The treatment model used in this study showed significant improvement in the sustained attention of individuals diagnosed with mTBI and ADHD after twenty treatment sessions.

The rehabilitation of attention in individuals with mild traumatic brain injury, using the APT-II programme

Traumatic brain injury (TBI) is a prevalent cause of cognitive impairments and dysfunctions and affects over 2 million individuals each year. Mild traumatic brain injury (MTBI) is generally defined by a brief loss of consciousness, and post-traumatic amnesia that lasts for less than 24 hours. One region of the brain that is likely affected in patients with MTBI is the pre-frontal cortex. This region mediates several functions, including those required for adequate attention. Three individuals, diagnosed with MTBI and difficulties with attention, volunteered to participate in the study. Individuals were presented with 10 weeks of cognitive retraining with the Attention Process Training-II (APT-II) programme, followed by 6 or 7 weeks of educational and applicational programmes. Cognitive tests were administered both pre- and post-training to assess the effectiveness of the programme. Analysis of the results showed that the APT-II programme improved attention and performance speed in each of the three individuals. In addition, any rehabilitated cognitive skills remained stable in each individual in the absence of the rehabilitation programme for at least 6 weeks.

Shaping Procedures as Cognitive Retraining Techniques in Individuals with Severe and Persistent Mental Illness

Abstract Many persons with schizophrenia are characterized by cognitive impairments that interfere with their ability to benefit from traditional rehabilitation interventions, including some forms of cognitive rehabilitation. To date, shaping procedures, a form of social-learning based intervention, have demonstrated effectiveness in several reports in improving the attention spans and lengths of continuous work performance among people severely impaired by schizophrenia. Despite this encouraging data, shaping as a form of cognitive rehabilitation remains underutilized. In this paper, we review the conceptual foundations for shaping, the rationale for the use of shaping as a form of cognitive rehabilitation, and future tasks necessary to refine this intervention.

Software update 1998: commercial programs useful in cognitive retraining.

Software update 1998: commercial programs useful in cognitive retraining.

The role of cognition in the risk--benefit and safety analysis of antipsychotic medication.

Conventional neuroleptics can further reduce cognitive function, which is already impaired in most patients with schizophrenia. Although some areas of cognition may remain relatively well preserved in schizophrenia, it has been suggested that the origins of a neurocognitive decline in schizophrenia may be related to a reduction in dopamine activity in the prefrontal cortex. If this is the case, dopamine D2 blockade would be expected to impair some aspects of neurocognitive function further. The level of neurocognitive function in schizophrenia is related to vocational and social ability, and the course of cognitive decline appears to be consistent with a static encephalopathy, rather than progressive dementia. Intensive cognitive retraining in patients with schizophrenia may improve, but not normalize, some aspects of cognitive performance. Most cognitive deficits remain stable, even when improvements in symptoms are obtained with antipsychotic treatment. Drugs such as risperidone, one of the newer serotonin-dopamine antagonists (SDAs), have a better effect on cognitive function than conventional antidopaminergic neuroleptics, and are therefore more likely to enable the patient to benefit from cognitive and other forms of training. Anticholinergic drugs used to treat EPS, or drugs with anticholinergic activity, also impair cognitive function. Consequently, because the need to use anticholinergic drugs is less with the SDA antipsychotics, the cognitive function of patients treated with drugs such as risperidone is likely to be better than it would be if they took a conventional neuroleptic.

Brain-injured adults' verbal memory: Implications for cognitive retraining

Brain-injured adults' verbal memory: Implications for cognitive retraining

Brain-injured adults' verbal memory: Implications for cognitive retraining

Brain-injured adults' verbal memory: Implications for cognitive retraining