Project Description

Computer Assisted Cognitive Rehabilitation

Therapeutic Intervention

Computer Assisted Cognitive Rehabilitation (CACR) is based on the principals of cognitive rehabilitation. Therapists use CACR to increase or improve your capacity to process and use incoming information. CACR can be used in a three-tier manner.

The tiers include:

  1. Specific target training – targeting a discreet deficit area
  2. Targeting commonly impaired activities of daily living – driving, daily math skills, name and face recall
  3. Cognitive prosthesis – reminder systems, recording/storing systems, electronic scheduling

Prior to beginning CACR, several steps must be considered to help ensure positive change/success with CACR. Therapists must evaluate whether the software specifically addresses the cognitive weakness.  The clinician must understand what the program addresses and how it will directly relate to your outcome.  And finally, the program must undergo a clinical merit evaluation.  A clinical merit evaluation looks at clinical and administrative considerations when deciding on implementation and choice of a CACR program.

Clinical Considerations

  • Does the accompanying literature clearly define the objectives of the program?
  • Does the program address what it claims to address?
  • Is the reinforcement and feedback immediate, friendly and appropriate?
  • Is the programming interesting?
  • Are the instructions easy to follow?
  • Are appropriate and useful data collected and analyzed?
  • Where would the program fit within the treatment model?
  • How much supervisions is needed?

Administrative Considerations

  • Is the program free of bugs and technological problems?
  • Is extra equipment needed to run the programs?
  • Can screen advance be controlled?
  • Can the clinician add unique content to the program so that additional stimuli will be available?
  • Can software be returned after an initial review period?

Reason for Intervention

The most successful programs are those that address attention, visual processing and reasoning/problem solving due to ease of skill transfer and the ability to test and re-test abilities.  Programs that address memory have variable outcomes.  Memory is shown to improve on the specific task, but does not generalize to everyday tasks well.  Language skills such as confrontation naming, reading, and grammatical knowledge are appropriately targeted using CACR; however, skill sets such as pragmatics and motor speech disorders are not amenable.

CACR targeted areas can include:

  • Attention/concentration
  • Working memory
  • Impulsivity
  • Distractibility
  • Eye-hand coordination
  • Processing speed
  • Cognitive endurance
  • Sequencing
  • Problem solving
  • Reasoning/abstraction
  • Visual perceptual skills
  • Self-monitoring

Implications

CACR has been shown to not be superior to traditional therapy but rather on par; however certain advantages can be seen with implementing a CACR program.  The advantages are noted both for the clinician and you.

Advantages of CACR for the client:

  • Increased self-esteem
  • Help prepare for employment
  • Provide leisure activity
  • Provide ways for injured individuals to interact with peers
  • Opportunity to work independently
  • Tend to pay attention for longer periods of time
  • Report feeling the computer is less critical of poor performance

Advantages of CACR for the clinician:

  • Consistent, often adjustable, rate of stimulus presentation
  • Automatic collection and tabulation of performance data
  • Efficient administration of tedious practice tasks
  • Objective feedback
  • Frees the clinician to observe and record valuable qualitative data