RehaCom computer-assisted cognitive rehabilitation - brain performance training
Plan A Day
www.rehacom.com
RehaCom 速 computer-assisted cognitive rehabilitation by HASOMED GmbH
This manual contains information about using the RehaCom therapy system. Our therapy system RehaCom delivers tested methodologies and procedures to train brain performance . RehaCom helps patients after stroke or brain trauma with the improvement on such important abilities like memory, attention, concentration, planning, etc. Since 1986 we develop the therapy system progressive. It is our aim to give you a tool which supports your work by technical competence and simple handling, to support you at clinic and practice.
Idea and conception Prof. Dr. Joachim Funke Ruprecht-Karls-University Heidelberg, Germany chair in general and theoretical psychology
HASOMED GmbH Paul-Ecke-Str. 1 D-39114 Magdeburg Germany Tel. +49-391-6230112
Content
I
Table of contents Part I Description of the training
1
1 Training tasks...................................................................................................................................
1
2 Performance ................................................................................................................................... feedback
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3 Structure of the ................................................................................................................................... level of difficulty
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4 Training parameters ...................................................................................................................................
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5 Evaluation
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Part II Theoretical concept
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1 Basic foundations ...................................................................................................................................
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2 Aim of the training ...................................................................................................................................
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3 Target groups ...................................................................................................................................
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4 Bibliography...................................................................................................................................
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Index
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Plan A Day
1
Description of the training
1.1
Training tasks The procedure Plan a day is used to train the patient's ability to organize and plan a day. This is carried out in a very realistic manner, in that particular tasks have to be dealt with at specific places and must be completed within a given point in time. The basic idea of the procedure was conceived by Prof. Dr. Joachim Funke, Chairman of General and Theoretical Psychology at the University of Heidleberg. The adaptive RehaCom version was then developed in co-operation with his colleagues at the University. Every planning task consists of two stages which can be dealt with in continuous alternation - the task and the city map. In the task stage: the patient is shown a list of appointments on the screen, which he has to deal with (figure 1). The patient must make sense of each individual task and develop their of solution strategies.
Figure 1: Task stage at level 10.
In the city map stage the computer takes over the previously trained strategy. A
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Description of the training
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small city map appears with nine buildings which are connected by several streets (figure 2). In order to enter the solution into the computer, the patient can use the keys of the RehaCom panel, the mouse or the touch screen. An explanation of the use of the mouse will follow shortly. The position of the mouse on the screen is highlighted by a grey arrow(cursor).
Figure 2: City map stage at level 10. The buildings to be attended are marked in
contrast to the others by light red writing. On the left, either the appointments (task stage) or the city map can be seen. On the right, the appointment calander with appointments as well as the list of the still to be completed appointments can be seen. The brown function keys are situated below these dates. If the cursor is placed on one of these function keys, the text becomes red. The patient can switch, as desired, between the task stage and city map stage, by clicking(with the mouse) on the function keys with the same name. How does the patient operate the procedure? At first, the patient must establish which buildings have to be visited and in which order. By clicking on the function keys, the patient can then change
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Plan A Day
their position on the city map. The current position is indicated by a waving, red flag. All buildings which have to be visited are highlighted with light red writing - all others are designated with yellow writing. The first destination is chosen by a mouse click on the red point below a building or onto a building itself.The red flag then moves to this building. In order to confirm the choice the patient must press on the building again the building is then entered - symbolically. The mouse pointer then changes into a green door. Alternatively, the function keys can be activated with the mouse. The appointment then appears in the appointment book on the upper right and is removed from the list of appointments still to be completed. Buildings, which should not be visited (yellow writing), can not be entered. After completion of the task at hand the patient can then click on to the nearest building or activate the next task with the function keys, for example, in order to consider the next move. All further tasks are finished in this manner. The therapists should provide the patients with suitable solution strategies. The function key RETURN appears on the upper right with the entry of the first appointment into the appointment book . If this press button is pressed (clicking with the mouse), the red flag is moved back a step (the current site). Similarly the previous appointment is removed from the appointment book and entered again into the list of the still to be completed appointments. In this way, a decision can be corrected. If the function key time plan is activated, then a heading appears (figure 3) in which the dates, duration and the roadways of the appointments, in the appointment book, are set in relation to a time axis. In this way the overlapping of appointments becomes obvious. This function also helps the patient to develop strategies (to visualize the appointments and of the times). The importance of the colors is explained in the instruction stage before each task.
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Description of the training
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Figure 3: Time planning - graphic representation of the appointments with an explanation in the instruction stage of level 36.
From Level 26 on, a taxi can be used to shorten journey times. If the patient wishes to use the taxi, he should activate the function key taxi "before starting the journey". A green car then appears, which is also the symbol used in the relevant appointment in the calendar and in the time graphic (figure 4). The current journey time appears at each individual location. This is to help the patient improve and reduce journey time time (figure 4). This changes from location to location. The use of the taxi halves the journey time. The patient instructions gives clearer explanation before such a task. attention
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Figure 4: Taxi symbol and journey time at level 30.
The patient should press the finished function key on completing the task. A detailed error report is then shown if the solution is incorrect. The patient is given the option of correcting their errors. When the patient selects the "yes" key the previous task reappears (by activating the function key return. Otherwise, the task is evaluated, as it stands, in relation to the closest level of difficulty. When using the RehaCom panel, some special features should be taken into consideration. The patient can switch between screens, right and left, by pressing the '+' key. The active screen has a light green frame. If the right screen is active, the function keys on the screen can be manipulated with the arrow keys and the patient confirms his choice by pressing the OK key. If the left screen is active, the red flag can be manipulated with the arrow keys is moved in order to move to the next building and/or up to the next crossroads in the city map. When the patient presses the OK key the patient can enter the virtual building and the appointment is placed in the appointment book. Operation with the mouse is a lot easier and is highly recommended. Experience tells us that it is easier for patients to familiarize themselves with the task when using the mouse. If patients suffer from movement disabilities in their
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Description of the training
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fingers, the mouse can be moved with the one hand and the patients can confirm their choice (with the other) by pressing the OK key on the RehaCom panel. The easiest method of operation is, of course, the touch screen. Before every new task, the patient is given lengthy instructions on the practice method (learning by doing).
1.2
Performance feedback No feedback occurs while during each task. The solution and the errors made are analyzed only after the patient presses the finished key and differentiated as follows: · The number of the completed appointments does not match those required for the solution. · The order of completion was incorrect. · The taxi was not used in the case of specific tasks.
1.3
Structure of the level of difficulty The procedure operates in an adaptive manner. The structure of the level of difficulty incorporates 3 types of heuristics:
· Consideration of priorities, · Minimizing the journey times and · Maximizing the completion of tasks. Within the given heuristics, the levels of difficulty are varied according to further criteria. These parameters were determined within the framework of a pre-study. The difficulty does not increase in a linear manner. Consolidation phases change with levels which require additional levels of decision. In total 55 levels are available. In the case of the first heuristic, considering priorities, the dates are characterized explicitly or implicitly as very important or important. It is these priorities which have to be considered.valid to consider it. It is referred in the task as to how many tasks have to be completed. The following parameters are used: · Clarity of statement: IMPORTANT or VERY IMPORTANT (salient=clear, not salient= statement packed in the text e.g., "It is very important for you to participate in this event."). · Information about times: kind of time described, whether there is no time
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Plan A Day
shown, a point in time or a period of time - in relation to the appropriate task which has to carried out. · Number of the appointments: Groups from appointments (pairs and threes) which have no bearing on the time. The column "No. solution" shows the number appointments which can be chosen. Level salient time 1 yes without 2 yes without 3 no without 4 no without 5 yes point in time 6 yes point in time 7 yes point in time 8 yes point in time 9 yes point in time 10 no point in time 11 no point in time 12 no point in time 13 no point in time 14 no point in time 15 yes period of time 16 yes period of time 17 yes period of time 18 yes period of time 19 yes period of time
No. Pairs 1 0 1 0 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1
No. threes 0 1 0 1 0 0 0 2 2 0 0 0 2 2 0 0 0 2 2
No. solutions 1 1 1 1 2 3 4 2 3 2 3 4 2 3 2 3 4 2 3
In the case of heuristic - minimization of journey time - the task is to chose the appointment constellation with the least amount of journey time. This is why a taxi should be used for the longest way in some tasks. The parameters vary · Number of tasks. · Journey time display: In the planning of time stage- By selecting "yes" the journey times are specified in relation to the respective places. By selecting "no", the journey times must be estimated. · Information about the final destination: By selecting "no" no final destination is indicated, the task is then less complex. By selecting "yes" a final destination is selected. On the way to the destination, the patient has to consider different combinations. · Use of the taxi: A taxi must be used for long journeys. The number of possible
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Description of the training
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combinations then increases. Level 20 21 22 23 24 25 26 27
No. tasks 2 2 2 2 3 3 3 3
journey time yes no yes no yes no yes no
destination no no yes yes no no no no
Taxi no no no no no no yes yes
In the case of the heuristic - maximizing the completion of tasks, the patient has to complete as many appointments as possible, being careful not to overlap appointments. There appointments which have to be finished at specific points in time and there are ones which have to be dealt with over a period of time. As levels increase the number of appointments and the variety of appointments also increases (those which perfectly or partly overlap). The taxi may also be used. The patient's task is to find the optimal selection of appointments. It should be pointed that the tasks at the higher levels of difficulty would be demanding for non-suffers and so it is probable that the patients may not be able to solve them. The following parameters featured in this heuristic are: 路 Number of the fixed tasks: Tasks with a fixed time (e.g. "She must be at the doctor at 2 o'clock."). 路 Number of the variable tasks: Tasks which have to be completed over a period of time. There is a variety of ways to complete the appointments and therefore it is more difficult to classify them into the time schedule. 路 Number of the unsolvable appointments: These appointments can not be put into the appointment book (leads to incompletion of tasks) Level 28 29 30 31 32 33 34
No. Tasks 3 3 3 3 4 4 4
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fixed 3 2 1 0 3 2 1
variable 0 1 2 3 1 2 3
unsolvable 0 0 0 0 0 0 0
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Plan A Day
35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55
1.4
4 4 4 4 4 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6
0 3 2 1 0 3 2 1 0 3 2 1 0 3 2 1 0 3 2 1 0
4 1 2 3 4 2 3 4 5 2 3 4 5 3 4 5 6 3 4 5 6
0 1 1 1 1 0 0 0 0 1 1 1 1 1 1 1 1 2 2 2 2
Training parameters In the manual RehaCom basic foundations, general notes and references on the training parameters and their effect are given. These references should be taken into further consideration. Picture 5 shows the parameter menu:
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Description of the training
Picture 5: Parameter menuĂź
Current level of difficulty: The level of difficulty can be set up from level 1 to 55. Duration of training/Cons. in mins: A training period of 30 minutes is recommended. Heuristics: The Heuristics were described in the section on the structure of the level of difficulty. These have been further broken down into sections. The sections of the heuristics can be used separately or in combination with one another. Number of corrections: If the patient has input an incorrect solution (ending the task by pressing the function key - finished), the patient can once again attempt to process the task correctly. The maximum number of these attempts is determined by the parameter "number of corrections" (0..9). In this way, the patient has the chance to learn from their mistakes. Number of repetitions: The patient moves on to a higher level when the correct number of tasks have been solved, in relation to the amount of repetitions used and vice
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versa. In this way, the difficulty is only modified if a positive or negative performance consolidation occurred. If the parameter is set at 0, the level can be increased and/or reduced after each correctly and/or incorrectly solved task. Corrections of erroneous solutions (see parameter "number of corrections") are not considered here. Appointment display: A display of the appointments still to be completed are shown on right edge of the screen below the appointment book. This is to help those patients who have difficulty with their memory. It also places the focus of the training strictly on the planning of a day. This display should be switched off if one wishes to asses the patient's memory. Input modus: The procedure can be operated by using the RehaCom panel, the mouse or the touch screen. With each individual set up of the procedure the following default values are set up: Current level of difficulty Duration of training Heuristics Number of corrections Number of reputations Appointments shown Input modus
1.5
1 30 Minutes all 2 2 yes Mouse
Evaluation The diverse possibilities of the data analysis for the determination of the further training strategies are described in the RehaCom basic foundations. In the graphics as well as in the tables, and along with the set up in the Trainings parameters, the following information is also available: Level Training time (effective) Pause Solution
Tasks
current level of difficulty training time Number of pauses Quality of the solution (OK, Number, incorrect (Number of wrong appointments), incorrect appointment (wrong appointment fill in), incorrect order (appointments in the wrong order), Taxi incorrect) Amount of work in the task stage
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Description of the training
Planning Time Corrections Appointments Solutions Total duration
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Amount of work in the planning stage (Window city map) Amount of work in the time window continuous number of corrections, beginning at 0 Nu umber of appointments in the task Number of completed appointments/ Number still to do Duration of planning in min:s the current task including previous corrections
In the result menu there is an additional key - show the way - which shows possible ways available. A picture appears along with the solution for the current task. The key 'starting point' returns the flag to the start position. The key 'run' moves the flag along the way chosen by the patient. The therapist can determine whether the task was solved precisely or through trial and error.
2
Theoretical concept
2.1
Basic foundations Everyday tasks usually require both a motoric and cognitive capability profile, which consists of a combination of several independent skills. The underlying ability to develop plans and then implement them is one of the most complex of all cognitive human abilities. A reasonable and independent course of action is only then possible, if behaviour is planned and organized over a long period of time.....and considered in conjunction with priority tasks. It requires the capability, behaviour to initiate, supervise, reflect and if necessary to be flexible and adaptive (Alderman & Ward, 1991; Burgess & Alderman, 1990; cf. Wilson et al., 1998). The term planning means - a type of provisional presentation of a course of action - in which all the shared conditional variables are explored and coordinated in order to reach a specific target. Simultaneously mental planning sequences are conceptual courses of action with flexible and reversible process components, in which, individual actions are examined and checked for their consequences and connections to different possible courses of action and for their part once again checked for theses additional possible consequence.(DĂśrner, 1990; cp. von Cramon & von Cramon, 1993). Extensive problem analyses demands the generation of hypotheses as well as the recollection of various heuristics: an wealth of information, which must be simultaneously held (memory functions) and processed.
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The ability to plan and carry out actions is assigned to the so-called executive functions. Lezak(1983; cf.von Cramon & von Cramon, 1993) defines these as every capability which enables a person to pursue work and to partake in a social life and to a certain degree be able to look after themselves. For this purpose, the following are necessary: · the ability to formulate goals alone, · to execute plans with a particular goal in mind and · to have control over one's motor skills, so that a particular goal can be achieved. Stuss & Benson (1984) have limited the executive functions of basal cognitive systems like attention, visual-spatial performance, memory, natural language, movement e.t.c and they have subdivided them into the components anticipation, goal selection, planning and checking. In their hierarchically organized Feedback-Feed forward-Model of brain functions (Stuss, 1992) three functional levels exist: · sensory-perceptual level (perception, automatic processes), · level for the frontal controlled executive control, level for self reflection and ones relationship with one's environment. The model of the working memory from Baddeley & Hitch suggests a central executive, just like Shallice's supervisory system (1982; cf., 1991) and the analogy of the functions of the executive control and should be considered as Stuss considered them. Karnath (1992) considered the common characteristics of different theories about the participation of frontal structures in the mental planning process ( Pribram, 1987; Berstein 1975; Shallice,1988 and Luria 1966; cf.Karnath, in 1992) as follows: 1. Information analysis, exploration 2. The planning process a) Drafting models for courses of action/ structuring a sets of tasks b) Anticipation (if there is no hint as to the solution after the situation analysis) 3. Automatic re-call of currently available plans in routine situations 4. Executing actions 5. Checking the course of actions by means of feedback task, cf., planning of actions. To this day, we still cannot present a conclusive theoretical model of the
© 2008 HASOMED GmbH / Prof. J. Funke
Theoretical concept
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fundamental basics and functions of the frontal neural networks. However, as a result of empirical clinical experiences, we are able to presume that the human frontal part of the brain is involved in mental tasks, which generate (or are responsible for) the above mentioned skills (cf.Stuss & Benson, 1984). Based on the fact that these abilities are absolutely necessary for individuals to have some form of everyday independence; it then follows that patients with disturbances or impairments to their executive functions often suffer from considerable hindrances in both their private and public lives. To clinically define or locate such an impairment is often problematic and can affect, in a selective manner, certain cognitive, emotional and behavioural areas. Such symptom complex impairments to the planning of action, memory, problem solving thinking and the lack of obvious of signs of illness, can complicate the therapeutic process, as there is often an inadequate use of the therapeutic strategies available. Patients with impairments to their executive functions can achieve inconclusive results under standard diagnostics techniques. Usually patient first become aware of these problems in everyday life situations. Recently, a lot more procedures have been developed which represent standard everyday situations of planning and orientation. Therefore these procedures clearly have a higher ecological validity. Das Behavioural Assessment of the Dysexecutive Syndrome (BADS - Wilson et al., 1998) contains tasks, which - in combination with behavioral observation during the examination - registers the above mentioned symptoms in a highly differentiated manner. In particular the tasks "Zoo visit" and "Six-element tests" provides the therapist with important information, with regard to the patients impairments to planning. Therapeutic extensions to the treatment of impairments to the executive functions should also take the following into consideration: · · · ·
Re-establishing lost functions Learning internal strategies (e.g. Self instruction ) The use of external aids (e.g. Notes, Quix, Psyx Memophon) Behaviour examined in relation to the patients environment (e.g. therapeutic behavioural extensions)
In a therapy program developed by Cramon & Cramon both cognitive as well as behavioural aspects of this type of impairment have been taken into consideration. The sections on aim of the training and target groups contain additional
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Plan A Day
information.
2.2
Aim of the training The aim of the training is to improve the executive functions, in particular planning of actions and competence in everyday life The procedure puts demand on memorizing specific sequences as well as a continuing observation of individual steps. The procedure offers the therapists the possibility to interact with the patients, to help them develop strategies to improve the cognitive functions and their self-control. In the case of disorders to self control and the planning of ones actions (Monitoring) therapeutic behavioural techniques can be established and practiced in parallel with the procedure (for example self expression). In this way complex planning processes can be developed - like the possibility of non-structured everyday life situations, the aim of which is to locate different available components and to select the correct or most efficient one. Plan A Day is an everyday life oriented practice procedure which makes both demands on basic and more complex cognitive abilities. It can be set up to be either memory intensive or not (strictly planning of actions). An essential advantage is that consists individual sequences of action are followed and therefore the patient controls the process at all times. Before the patient begins training with this procedure the basic executive functions and abilities can also be trained with the following Attention & Concentration (AUFM), Verbal Memory (VERB), Word- and pictorial memory (WORT and BILD) or Shopping (EINK). In general, an extensive neuropsychological diagnostic is a better method to establish which therapeutic procedures are appropriate.
2.3
Target groups The training procedure Plan A Day was developed for patients with impariments to their executive functions, in particular for patients who have problems planning actions and solving logical problems. Disturbances to the planning of actions in patients who suffer from a form a brain damage may have many different sources. In particular, after uni or bilateral frontal injuries, the brain suffers cognitive, emotional and behavioural disturbances, which based on their functions is know as Dysexecutives
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Theoretical concept
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Syndrome (Baddeley & Wilson, 1988), (Stuss & Benson, 1984; Duncan, 1986; Baddeley & Wilson, 1988; Shallice & Burgess, 1991; von Cramon & von Cramon, 1992; Stuss, 1992). These may include: · · · · · · · · · · · · · · · · · · · ·
Attention disorders (selection, focusing), Vigilance disorders, Increased distraction/ interference vulnerability, Disturbances of memory, Decreased learning ability, Disorders in aim-oriented action, Disturbances to the logical problem solving ability, Decreased abstraction, Inability to distinguish important from unimportant (information selection), decreased ability for the initiating and the sequencing of actions, Rigidity Incorrect notion of temporal sequences, Impulsiveness or loss of initiative, Difficulties in using responses, Inability to locate error or correct, Dissociation between knowledge and action, Incorrect anticipation of consequences of action (foresighted thinking), Incorrect self regulation and self perception, inadequate social behaviour, lack of insight into the illness, Anosognosia.
Luria ( 1966, cf.von Cramon & von Cramon,, 1993) paraphrased this type of thinking and motoric impairments as a kind of disconnections syndrome :"... The patients have difficulties analyzing the conditions of a problem and recognizing important connections and relations. The sequence of precise operations appears to be dissolved into its parts and haphazard; they ignore the phase of the preliminary examination of the conditions and limitations of a problem and replace purely intellectual operations by unrelated, impulsive actions..." Along with frontal injuries of different genesis (vascular cerebral injuries and infarcts and hemorrhages, brain traumas, tumors) the above-mentioned disturbances can also be observed after numerous diffuse injuries to the brain (primary- and secondary-degenerative brain infections like Hypoxia, etc). Patients often have problems organizing their everyday life as a result deficient aspects to their abilities or as a result of the dysexecutive syndrome. As the syndrome is itself is a combination of impairments to attention, memory, behavioral and motor skills, it therefore constitutes a particular challenge to
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therapists in the field of neuropsychology. This is complicated by the fact that patients' basic cognitive functions(attention, visual spatial performance, memory, speech and motor skills) are often more or less severely impaired and these deficits lead to more complex types of impairments. The procedure can also quite easily be used with patients who suffer from memory problems, particularly those who suffer from short term memory and working memory disturbances. The training of relevant single components is worthwhile only when if specific abilities are no longer or only partly available (memory, ordering, adding and subtracting). In addition to neuropsychological rehabilitation, the procedure can also be applied for cognitive treatments at an educational level as well as in the field of geriatric study. The patient must have a standard unimpaired linguistic ability in order for the training to be worthwhile and must be in a position to deal with such tasks - i.e. the required level of attentive skills. Patients with serious deficits to their short term memory and working memory should seek a different type of therapeutic treatment or try working with less demanding procedures.
2.4
Bibliography Aktinson R.C., Shiffrin R.M. (1968): Human memory: a proposed system and its control process. Ub: Spence K, Spence J (Ed.): The psychology of learning and motivation, Vol. 2. New York: Academic Press. Baddeley, A.D. & Hitch, G. (1974): Working Memory. In: Bower, G.A. (Ed.): Recent Advances in learning and motivation, Vol. 8. New York: Academic Press. Baddeley, A. & Wilson, B.A. (1988): Frontal Amnesia and the Dysexecutive Syndrome. Brain and Cognition, 7, S. 212-230. Cramon, D.Y. von & Matthes- von Cramon, G. (1991): Problem-solving Deficits in Brain-injured Patients: A Therapeutic Approach. Neuropsychological Rehabilitation, 1 (1), S. 45-64. Cramon, D.Y. von & Matthes- von Cramon, G. (1992): Reflections on the Treatment of Brain-Injured Patients Suffering from Problem-solving Disorders. Neuropsychological Rehabilitation, 2 (3), S. 207-229. Cramon, D.Y. von & Matthes- von Cramon, G. (1993): ProblemlĂśsendes Denken. In: Cramon, D.Y. von; Mai, N. & Ziegler, W. (Hrsg.): Neuropsychologische
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Diagnostik. Weinheim: VCH. S. 123-152. Duncan, J. (1986): Disorganisation of Behaviour After Frontal Lobe Damage. Cognitive Neuropsychology, 3 (3), S. 271-290. Gauggel, S. & Konrad, K (1997): Amnesie und Anosognosie. In: Gauggel, S. & Kerkhoff, G. (Hrsg.): Fallbuch der Klinischen Neuropsychologie. Praxis der Neurorehabilitation. Göttingen: Hogrefe. S. 108-119. Hömberg, V. (1995): Gedächtnissysteme - Gedächtnisstörungen. Neurologische Rehabilitation 1, S.1-5. Karnath, H.-O. (1991): Zur Funktion des präfrontalen Cortex bei mentalen Planungsprozessen. Zeitschrift für Neuropsychologie, 2 (1), S. 14-28. Keller, I. & Kerkhoff, G. (1997): Alltagsorientiertes Gedächtnistraining. In: Gauggel, S. & Kerkhoff, G. (Hrsg.): Fallbuch der Klinischen Neuropsychologie. Praxis der Neurorehabilitation. Göttingen: Hogrefe. S. 90-98. Kerkhoff, G., Münßinger, U. & Schneider, U. (1997): Seh- und Gedächtnisstörungen. In: Gauggel, S. & Kerkhoff, G. (Hrsg.): Fallbuch der Klinischen Neuropsychologie. Praxis der Neurorehabilitation. Göttingen: Hogrefe. S. 98-108. Kohler, J. (1997): Das "Plan-A-Day"- Programm. In: Gauggel, S. & Kerkhoff, G. (Hrsg.): Fallbuch der Klinischen Neuropsychologie. Praxis der Neurorehabilitation. Göttingen: Hogrefe. S. 348-357. Kolb, B. & Whisaw, I. Q. (1985): Fundamentals of Human Neuropsychology. W. H. Freeman and Company. Reimers, K. (1997): Gedächtnis- und Orientierungsstörungen. In: Gauggel, S. & Kerkhoff, G. (Hrsg.): Fallbuch der Klinischen Neuropsychologie. Praxis der Neurorehabilitation. Göttingen: Hogrefe. S. 81-90. Schuri, U. (1988). Lernen und Gedächtnis. In Cramon, D. v. & Zihl, J.(Hrsg.). Neuropsychologische Rehabilitation. Berlin, Heidelberg, New York: Springer-Verlag. Schuri, U. (1993): Gedächtnis. In: Cramon, D.Y. von; Mai, N. & Ziegler, W. (Hrsg.): Neuropsychologische Diagnostik. Weinheim: VCH. S. 91-122. Shallice, T. & Burgess, P.W. (1991): Deficits in Strategy Application Following Frontal Lobe Damage in Man. Brain, 114, S. 727-41.
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Stuss, D.T. (1992): Biological and Psychological Development of Executive Functions. Brain and Cognition, 20, S. 8-23. Stuss, D.T. & Benson, D.F. (1984): Neuropsychological Studies of the Frontal Lobes. Psychological Bulletin, 95 (1), S. 3-28. Tulving, E. (1972): Episodic and semantic memory. In: Tulving E. & Donaldson, W. (eds.): Organisation of memory. New York: Academic Press, Wilson, B.A.; Alderman, N.; Burgess; P.W.; Emslie, H. & Evans, J.J. (1998): Behavioural Assessment of the Dysexecutive Syndrome. Suffolk:TVTC Thames Valley Test Company.
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Index
Index
Duration of trainingr/Cons. in min Dysexecutive Syndrom 15
-E-
-AAim of the training 15 Aims 12 Anosognosia 15 Anticipation 12, 15 Appointment display 9 Appointment summary 1 assosiative connections 15 atttention disorders 15
-BBehavioural Assessment of the Dysexecutive Syndrom 12 Behaviourial checks 12 Behaviourial disturbances 15 Bibliography 17
-Cclarity of the statement 6 cognitive functions 15 competence in actions 15 connections as per content 15 consequence of actions 15 Consideration of priorities 1, 9 consultation of training 11 continuous data analysis 11 control over ones actions 12 Correction 1, 6, 9 current level of difficulties 9
-Ddefined term 12 destination 6 Diagnostic 12 difficulty levels 11 Disconnections syndrom distraction 15
9
error 1 everyday situation 15 executive checks and controls executive functions 12, 15 external Strategies 12
-FFeedback 12 Feedback-Feedforward-Model 12 filling in of appointments 1 fixed appointments 6 frontal damage to the brain 15
-HHeuristic
1, 6, 9
-IImpulsive nature 15 Independence 12 Information analysis 12 Input mode 9 Instructions 1 internal Strategies 12
-JJourney plan journey time
1 6
-Llack of perception into the illness Level 6 logical thought 15 loss of iniative 15
15
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12
20
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-M-
-R-
Maximizing the completion of tasks Memory 12 memory disorders 15 mental process of planning 12 minumal learning ability 15 Motoric model 12
1, 9
-S-
-Nneuropsychologiscal Rehabilitation not-salient 6 not-the-optimal solution 6 number of appointments 11 number of corrections 11
15
-OOverlapping
1
-PPauses 11 Perception 12 performance feedback 6 period of time 6 Perseverence 15 Planning 11 planning /drafting of actions 12 Planning ability 1 planning actions 12 planning competence 15 planning of action disorders 15 Planning of actions 15 planning process 15 Plannning 1 Plans 12 point of time 6 practice 1 Priority 6 Problem solving thought 15 problem solving thought process Process components 12
reduction of journey time 1 Reduction of journey times 9 Rehabilitation 12 RehaCom-Procedure 15 Repetition 9
salient 6 self control 15 Self perception 15 self reflection 12 self regulation 15 sequence of actions 15 Social behaviour 15 solutions 11 still to be completed appointments 1 Strategies 15 strategies for memory 15 Structure of the level of difficulty 6 Supervisory System 12 Symptom complex 12
-T-
12
taking back of appointments Target groups 15 Task 1 Tasks 6 Taxi 1, 6 theoretical basic foundations Therapy 12, 15 time 11 Time graphic 1 total duration 11 Training mode 1 Training parameters 9 Training screen 1 Training summary 1 training time 11 Type od errors 6
1
12
Š 2008 HASOMED GmbH / Prof. J. Funke
Index
-Vvariable appointments
6
-WWorking memory
12, 15
Š 2008 HASOMED GmbH / Prof. J. Funke
22