Cognitive therapy and brain training
Working Memory
www.rehacom.com
Cognitive therapy and brain training 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.
HASOMED GmbH Paul-Ecke-Str. 1 D-39114 Magdeburg Tel: +49-391-6107650 www.rehacom.com
Inhalt
I
Inhaltsverzeichnis Teil I Training description
1
1 Training ................................................................................................................................... task 1 2 Performance ................................................................................................................................... feedback 2 3 Levels ................................................................................................................................... of difficulty 4 4 Training ................................................................................................................................... parameters 7 5 Data ................................................................................................................................... analysis 11 . . . . . . . . . . . . . . . . . . . . . . . . . .Data . . . . . . . ex . . . .por . . . . .t. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2
Teil II Theoretical concept
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1 F oundations ................................................................................................................................... 15 2 Training ................................................................................................................................... aim 16 3 Target ................................................................................................................................... groups 18 4 Bibliography ................................................................................................................................... 19
Index
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1
Training description
1.1
Training task The therapy method Working Memory was developed in cooperation with Dr. DP Angelika ThĂśne-Otto, medical faculty of the University of Leipzig, Dipl.-Psych. Juliane Weicker, Max Planck Institute for Human Cognitive and Brain Science, Leipzig and Dr. Stefan Frisch, clinic of the Johann Wolfgang Goethe-University Frankfurt am Main. Basic statements on the therapy of the Working Memory and the theoretical foundation of the present training method can be found in Basics. The Working Memory is trained everyday-life like and in a playful way by means of a card game. A full deck of cards (52 cards) with optional French, German or color deck is used. The training material is complemented by different modifiers (see chapter Training parameter) and by graphics to enhance the Performance feedback.
The training is divided into three different modules (see chapter Levels of Difficulty). Each module is represented by a concrete task type: memorize all cards, memorize certain cards selectively and sort cards. At the beginning of the training, the training program is introduced and the control is trained. The task of the trainee is to select the same cards, which were shown by the "Dealer" (upper edge), from the cards of the "Player" (bottom edge of the screen). They can be placed via double-click or "drag and drop" "on the table" (center of the screen). In the module "Memorize", the cards of the "Dealer" are hidden again after a short presentation time. So the "player" has to memorize the shown cards, select them from his own cards afterwards, and put them "on the table". In the module "Memorize selectively", the trainee only has to memorize cards of one or two colors which are newly announced by the narrator before every task (e.g. "Memorize only the heart cards"). The trainee has to put those cards in the center which correspond to the instructed color and were shown on the dealers side. The module "Sorting" is divided analogically to the typical test modules "Repeating numbers" forwards and backwards in two variations. In the task type "Sorting forward", the trainee has to put the cards on the table in the same order like the "Dealer". When the client has to "Sort backwards", he/she has to put the cards on the table in reversed order. Therefore, the dealer pulls the cards of the "Player"
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Training description
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consecutively in the stipulated order in the dark green marked area in the center of the screen.
Figure. 1 orking memory training in level 5. The task is to memorize the top three cards of the "Dealer", then select those from the "Players" cards and put them in the middle of the screen.
The card game "17+4" is implemented in the last level additionally. Here, the trainee has to memorize and add the values of the individual cards of the "Dealer". Afterwards, the client puts those cards of the "Player" in the center of the screen which all together reach more points than the dealers cards. But it is not allowed to place more than 21 points in total. The points are calculated as follows: the points on the number card correspond to the values of the cards; jack, queen and king count 10 points and as 11 points. The trainee wins, when he/she puts more points on the table than the "Dealer" and does not exceed 21 points.
1.2
Performance feedback The trainee receives a feedback on its performance in various ways. Level of difficulty. The current degree of difficulty is displayed at the top left on the screen. Performance bar. On the left edge of the screen, the performance bar is indicated. It shows the progress within a level. When the display of the performance bar reaches the upper limit, the trainee gets to the next level and the degree of difficulty
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increases. As soon as the display of the performance bar is empty and the trainee makes mistakes, the client gets to the previous level and the degree of difficulty is decreased (see chapter Degree of difficulty). Markers of the cards. After solving a task, the cards are marked. green checkmark: the correct card was die placed red cross: the incorrect card was placed red checkmark: this card was forgotten Text information. After solving a task, the trainee is informed about correct and incorrect cards by a text on the right side of the screen. Graphic information. The solving of the task is evaluated with a smiley. There are five representations of "good" and five representations of "bad". Solving a level at first try is rewarded e.g. with a "brightly laughing" smiley. If mistakes are repeated, the face becomes more sad and gets a red tint.
Figure. 2 Performance feedback in case of an error
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Training description
1.3
4
Levels of difficulty The training has 70 levels of difficulty. The setting of the level of difficulty is auto adaptive, that means the difficulty is automatically adjusted to the performance of the client. The adjustment is made via the parameter "Number points per level" (s. chapter Training parameters). In the beginning of each level the client has five points. If a task gets solved right at first try, the client gets five more points. If he/she finds the correct solution at second try, the patient receives only four points etc. If the task is not solved (despite several repetitions), five points are deduced. The total number of points is shown in the performance bar. When the "Number points per level" set by the therapist is achieved, the client reaches the next higher level of difficulty. If the client has less than 0 points (caused by point deduction), the level of difficulty gets reduced. The following chart shows the course of difficulty of the training : Level Module 1 2 3 4 5 6 7 8 9 10 11 12
Memorize all cards (open) Memorize all cards (open) Memorize all cards Memorize all cards Memorize all cards Memorize all cards Selective memorizing (1 color) Selective memorizing (1 color) Selective memorizing (1 color) Selective memorizing (2 colors) Selective memorizing (2 colors) Selective memorizing (2
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No. cards dealer 2
No. find No. additive (sending end) (players end) 2 2
3
3
2
2 2 3 3 5
2 2 3 3 3
2 3 2 3 3
5
3
4
6
3
4
5
3
2
5
3
3
6
3
3
Working M emory
5
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
colors) Selective memorizing (2 colors) Selective memorizing (2 colors) Sort (upward) Sort(upward) Sort(downward) Memorize all cards Memorize all cards Memorize all cards Memorize all cards Memorize all cards Selective memorizing (2 colors) Selective memorizing (2 colors) Selective memorizing (2 colors) Sort (upward) Sort (downward) Memorize all cards Memorize all cards Memorize all cards Memorize all cards Memorize all cards Memorize all cards Selective memorizing (2 colors) Selective memorizing (2 colors) Selective memorizing (2 colors) Selective memorizing (2 colors) Sort (upward) Sort(downward) Memorize all cards
6
3
4
6
3
5
0 0 0 4 4 4 4 4 7
3 4 3 4 4 4 4 4 4
0 0 0 1 2 3 4 5 3
7
4
4
7
4
5
0 0 5 5 5 5 5 5 8
5 4 5 5 5 5 5 5 5
0 0 1 2 3 4 5 6 3
8
5
4
8
5
5
8
5
6
0 0 6
6 5 6
0 0 3
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Training description
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67
Memorize all cards Memorize all cards Memorize all cards Selective memorizing (2 colors) Selective memorizing (2 colors) Selective memorizing (2 colors) Selective memorizing (2 colors) Sort (upward) Sort (downward) Memorize all cards Memorize all cards Memorize all cards Memorize all cards Selective memorizing (2 colors) Selective memorizing (2 colors) Selective memorizing (2 colors) Selective memorizing (2 colors) Sort (upward) Sort (downward) Memorize all cards Memorize all cards Memorize all cards Memorize all cards Selective memorizing (2 colors) Selective memorizing (2 colors) Selective memorizing (2 colors) Selective memorizing (2 colors)
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6 6 6 9
6 6 6 6
4 5 6 3
9
6
4
9
6
5
9
6
6
0 0 7 7 7 7 9
7 6 7 7 7 7 7
0 0 3 4 5 6 3
9
7
4
9
7
5
9
7
6
0 0 8 8 8 8 9
8 7 8 8 8 8 8
0 0 3 4 5 6 3
9
8
4
9
8
5
9
8
6
6
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68 69 70
Sort (upward) Sort (downward) Game
0 0
9 8
0 0
Chart 1 Difficulty structure of the working memory training Explanation of the chart: Module. Each module is represented by a concrete task type. For a detailed explanation of each task see chapter Training task, for the theoretical background of the modules see chapter Basic manual RehaCom. There are the following task types: introduction, „memorize“, „selective memorizing“ and „sort“ as well as the „Game 17+4“, which is offered to the regular working memory training to increase the motivation of the client (therefore it does not correspond to the highest level). Number cards "dealer". Number of the cards which the "dealer" shows. With an increasing level of difficulty the number of cards shown increases as well. Number to find. Number of the cards which are identical to the cards of the „dealer“ and therefore must be placed in the center of the screen. With an increasing level of difficulty the number of the cards to put on the table increases as well. Number additive. Number of the cards which are shown on the players end in addition to the target cards as a distractor. In order to achieve a finer difficulty structure the number of additional cards increases slowly with an increasing level of difficulty . There is a possibility to process all task types or to skip certain levels of a module. Appropriate settings for this can be made in the training parameters at "Training tasks" (s. chapter Training parameters). For further information about the structure of the training see chapter Training aim.
1.4
Training parameters In the Basic manual RehaCom general hints are given about the training parameters and their effects. These hints shall be taken into consideration subsequently.
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Training description
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Figure 3 Parameter menu of the working memory training
General settings Consultation time. The consultation time determines the length of the planned training session. We recommend a length of 40 min. The consultation duration should be decreased if clients have problems with attention and concentration. No. points per level. The parameter number of points per level indicates how many points are necessary to change to the next level. This setting influences the auto-adaptivity of the training (see chapter Levels of difficulty): The less points are set the faster the difficulty increases (if the solutions were correct). A high score enables a longer training at the same level of difficulty. 50 points per level are recommended as default. No. repetitions. If a task is solved incorrectly, the trainee gets the possibility to edit
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the same task again. The parameter number of repetitions indicates how often it is possible. The less repetitions are set, the better the degree of difficulty can be adapted to the performance level of the client (because points are awarded, too, for solutions after repetitions, see chapter Levels of difficulty). A higher number of repetitions strengthens the motivation. As a compromise, one repetition is recommended. Display time cards. The parameter display time cards regulates the presentation time in ms per card, before it is hidden again. In general, this is 1000 ms. For test persons who need more time (e.g. to verbalize the cards), the presentation time can be increased. However, it should be taken into consideration, that the remembering time and the time up to the retrieval is extended. Modifiers By activating the modifiers, the normal training tasks can be varied. Depending on modifier, the difficulty of the training gets influenced and/or a specific working memory component is trained more (for a better understanding of the described working memory functions see chapter Fundamentals and Training aim). Modifiers for the variation of the difficulty: Visual instructions. By default the spoken instructions during the processing of the tasks are additionally displayed in writing in a text window. The deactivation of the checkbox leads to a higher difficulty, because the task is only presented acoustically and can not be read later again. Repeat spoken instructions. Usually, instructions are just read two times at the beginning of a new module and not repeated afterwards. The instructions are read again each time the checkbox is activated. Easy tasks. Usually, cards with the same values are often presented on the side of the dealer. They only differ in color. This is to encourage the trainees to memorize all information on the card and not just individual values. By activating this parameter, no cards with the same value are presented anymore. The task is made easier. Modifiers for the specific training of individual working memory components: Distractors after acquisition. When activating the checkbox, an animated animal runs across the table, after the cards of the dealer were presented. This increases
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Training description
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the time, in which relevant information have to be kept in the working memory, but it also generates interferences, because the new information (the animal) compete with old information (the cards). By means of active inhibition processes the trainee must prevent that the deflector displaces relevant content in the working memory, and focus on the goal of the task with the selective attention. Acoustic acquisition only. When this modifier is set, the cards are no presented visually, but only named acoustically. The storing of relevant information occurs only in the phonological loop, which is specifically trained in this way. Selection non matching. This parameter changes the task of the module "Memorizing". Only exactly those cards must be selected from the cards of the players side which the dealer has not shown. For solving this task, the client has to memorize the cards of the dealer first. Afterwards, the trainee has to inhibit them in order to choose the correct cards. Instruction ex post. With this parameter, the tasks of the module "Memorize selectively" get more difficult. The color, which is to be selected, is named after the presentation of the dealer's cards and not before. Thus, the selection process does not take place at encoding, but when remembering relevant information from the working memory. Furthermore, the trainee has to memorize all cards first, because the client does not know, which information are needed later. When selecting the correct cards, the redundant information are finally inhibited again. Distractors on cards. When activating the parameter, symbols of other card colors appear on the originally white card background. Those symbols make the encoding of the cards, which have to be memorized, more difficult, stimulates the active interference defense processes and train the focusing on relevant information. If the client reaches a point, where a further increase of the cards, which have to be memorized, is not possible, the degree of difficulty can still be further increased. Training exercise We recommend the run of the entire training as standard. In some cases it can be helpful to omit individual modules of the training. By deactivating a checkbox, the corresponding module is skipped in the course of the training. Input mode The input mode controls the operation of the training. It can be chosen from the arrow keys on the keyboard, the mouse and the touchscreen. Currently, only the usage of the mouse is possible.
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Sheet (appearance of the cards) The appearance of the cards should be chosen for every participant individually, according to its discretion, habit, and performance level. The French and the German card decks are available, as well as a colored deck which categorizes the cards with simple colors (red, yellow, green and blue).
1.5
Data analysis The various possibilities of analyzing the data in order to find strategies how to continue the training are described in the Basic manual RehaCom. In the graph as well as in the tables you find - beside the setting of the training parameters - the following information:
Level
Level of difficulty
Effec. time
Effective duration of the training (without cover and breaks)
Breaks
Number of breaks caused by the client
No. tasks
Number of solved tasks in this level of difficulty (Repetitions of the same task are not counted)
No. repet.
Number of repetitions Shows how often a task had to be repeated (due to an error) It can be determined if the patient was able to memorize the cards from the beginning or if he needed several attempts.
No. errors
Total number of errors Shows how many errors were made in total. Several errors can be counted per solution:
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Training description
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forgot a card, putted down wrong card, cards placed in the wrong order (level sort), to many (more than 21) or to less points achieved (level card game) Is the number of mistakes much larger as the number of tasks, were often made multiple errors. No. correct
Number of correct answers Shows how many tasks were solved correctly.
Sol.-time Q1 [ms] Sol.-time Med [ms] Sol.-time Q3 [ms]
Solution time quartile 1, median and quartile 3 [ms] The time gets measured from the beginning of the reproduction (all of the player's cards are visible) up to actuating the "finish" counter. The reaction times just get used for the statistics, if the task was edited without an error. So the value gives information about the working speed of the patient with careful work.
Through a detailed analysis of the training, it is possible to indicate deficits to the patient and to draw conclusions for the further training. 1.5.1
Data export All data that are recorded during training, can be exported for statistical processing. The export is made by means of an Excel file. For export the program WOMEExport.exe is used. This program (for standard installation on Windows 7) is in the directory "C:\Program Files (x86)\RehaCom6 \WOME". When starting the program, the results of all clients are uploaded immediately from the database and indicated in a chart. This chart can be exported into an Excel file using the button "Save". The chart contains the following columns: forename
patient: forename
surname
patient: surename
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dateofbirth
patient: date of birth
sex
patient: sex (m/f)
par_session_dur
parameter: consultation time
par_pointsperlevel parameter: points per level par_repeatcount
parameter: number of repetitions
par_inputmode
parameter: input mode (0=Button, 1 =Mouse, 2=Touchscreen)
par_speakinstr
parameter: spoken instructions (0=without, 1=with)
par_repeatinstr
parameter: spoken instructions always (0=without, 1=with)
par_distractors
parameter: distractors on the cards (0=without, 1=weak, 2=strong)
par_taskdelay
parameter: distractors between aquisition and reproduction (0=without, 1=with)
par_akquiacoustico parameter: acquisition only acoustically (0=without, 1=with) nly par_hand
parameter: hand (0=french, 1=german)
par_showduration
parameter: card display in ms
par_nonmatching
parameter: Selektion non matching
par_expost
parameter: instruction ex post
par_easysort
parameter: easy sorting
par_taskmemorize
parameter: memorize tasks
par_taskmemorizes parameter: memorize tasks selectively el par_tasksort
parameter: sort tasks
train_at
training was performed the/at (consultation date and time)
trainlevel
performed level of difficulty
task_dur
task duration (up to level change)
numbreaks
number of breaks
break_dur
break duration
numtasks
number of performed tasks (without repetitions)
numrepeats
number of repetitions
numincorrect_forgo number of forgotten cards at 1. try (repetition 0) tten_R0 numincorrect_forgo number of forgotten cards at 1. repetition
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tten_R1 numincorrect_forgo 2. repetition tten_R2 numincorrect_forgo 3. repetition tten_R3 numincorrect_forgo 4. repetition tten_R4 numincorrect_wron number of incorrect cards at 1. try (repetition 0) gcard_R0 numincorrect_wron number of incorrect cards at 1. repetition gcard_R1 numincorrect_wron 2. repetition gcard_R2 numincorrect_wron 3. repetition gcard_R3 numincorrect_wron 4. repetition gcard_R4 numincorrect_wron number of cards in wrong order (only sort level 1) at 1. try (repetition 0) gorder_R0 numincorrect_wron number of cards in wrong order (only sort level 1) at 1. repetition gorder_R1 numincorrect_wron 2. repetition gorder_R2 numincorrect_wron 3. repetition gorder_R3 numincorrect_wron 4. repetition gorder_R4 numincorrect_tomu player put too much points (only level card game) at 1. try (repetition 0) ch_R0 numincorrect_tomu player put too much points (only level card game) at 1. repetition ch_R1 numincorrect_tomu 2. repetition ch_R2 numincorrect_tomu 3. repetition ch_R3 numincorrect_tomu 4. repetition ch_R4
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numincorrect_toles player put not enough points (only level card game) at 1. try (repetition 0) s_R0 numincorrect_toles player put not enough points (only level card game) at 1. repetition s_R1 numincorrect_toles 2. repetition s_R2 numincorrect_toles 3. repetition s_R3 numincorrect_toles 4. repetition s_R4 numcorrect_R0
number of correct cards at 1. try (repetition 0)
numcorrect_R1
number of correct cards at 1. repetition
numcorrect_R2
2. repetition
numcorrect_R3
3. repetition
numcorrect_R4
4. repetition
soltimeq1
solution time 1. quartil [ms]
soltimemed
solution time Median [ms]
soltimeq3
solution time 3. quartil [ms]
2
Theoretical concept
2.1
Foundations In this help file only the following sections are available in English: - Training task - Performance feedback - Levels of difficulty - Training parameters - Data analysis and - Data export.
Das Arbeitsgedächtnis dient zur Aufrechterhaltung und Manipulation von Informationen, die in der äußeren Umwelt nicht (mehr) vorhanden sind1. Laut Baddeleys Modell besteht das Arbeitsgedächtnis aus verschiedenen Speichersystemen (phonologische Schleife, visuell-räumlicher Notizblock und episodischer Puffer) und der zentralen Exekutive, welche diese Systeme überwacht
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Theoretical concept
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und zu verteilende Ressourcen koordiniert. Zusätzlich zu den von Baddeley beschriebenen Komponenten spielt die selektive Aufmerksamkeit eine wichtige Rolle, da sie notwendig ist, um relevante Informationen zu filtern und im Fokus zu halten. Gleichermaßen ist es notwendig, gespeicherte Informationen von anderen, konkurrierenden Reizen abzuschirmen und ein übergeordnetes Ziel zu verfolgen. Daher ist Interferenzabwehr ebenfalls ein zentrales Konzept bei Arbeitsgedächtnisprozessen2. Häufig sind Personen mit erworbenen Hirnschäden (z.B. durch Schlaganfall oder Schädel-Hirn-Traumata) oder psychischen Störungen (z.B. Kinder mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung) von Arbeitsgedächtnisdefiziten betroffen3. Die Funktionsfähigkeit des Arbeitsgedächtnisses stellt jedoch eine Grundlage für viele höhere Kognitionen wie Problemlösen, Sprachverständnis, Rechen- und Intelligenzleistungen dar4. Daher schränken Defizite in der Arbeitsgedächtnisleistung häufig die Funktionstüchtigkeit im Alltag und damit einhergehend das subjektive Wohlbefinden ein5. Die Fähigkeit des Gehirns, sich an neue Bedingungen anzupassen und je nach aktuellen Anforderungen verändern zu können (neuronale Plastizität6), ermöglicht es, durch ein intensives Training, die Leistung des Arbeitsgedächtnisses zu verbessern7. Das RehaCom Trainingsmodul „Arbeitsgedächtnis“ fördert sowohl die Speicher- als auch die Manipulationskomponenten des Arbeitsgedächtnisses und bindet dabei zunehmend selektive Aufmerksamkeits- und Inhibitionsprozesse ein.
2.2
Training aim In this help file only the following sections are available in English: - Training task - Performance feedback - Levels of difficulty - Training parameters - Data analysis and - Data export.
Das Trainingsverfahren „Arbeitsgedächtnis“ ist in verschiedene hierarchisch organisierte Module gegliedert, die auf den aktuellen theoretischen Erkenntnissen der Arbeitsgedächtnisstruktur basieren (siehe Abb. 4). Jedes Modul wird durch einen konkreten Aufgabentyp repräsentiert, mit dem die jeweilige Arbeitsgedächtnisfunktion trainiert wird. Im Folgenden werden die Arbeitsgedächtnisfunktionen beschrieben, die innerhalb eines Moduls trainiert werden. Für eine konkrete Erläuterung der entsprechenden Aufgabentypen siehe Kapitel Trainingsaufgaben.
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Ab b . 4 Hierarchische Struktur des Arbeitsgedächtnistrainings
In der Einführung wird die Oberfläche des Trainingsprogramms vorgestellt und die Bedienung geübt, Arbeitsgedächtnisprozesse werden dabei noch nicht beansprucht. Das Modul „merken“ trainiert die reine Speicherfunktion des Arbeitsgedächtnisses. Durch die parallele Darbietung von visuellen (Spielkarten) als auch akustischen (Vorlesen der Karten) Reizen werden sowohl der räumlich-visuelle Notizblock als auch die phonologische Schleife beansprucht. Durch das Aktivieren von Modifikatoren (s. Kapitel Trainingsparameter) kann auch ein Schwerpunkt auf einer Modalität bestimmt werden. Das Modul „selektiv merken“ trainiert ebenfalls die Speicherfunktion des Arbeitsgedächtnisses, jedoch wird nun der Aspekt der selektiven Aufmerksamkeit hinzugefügt (Fokussierung auf Karten einer bzw. zweier Farben). Hinzu kommen Inhibitionsprozesse, da sowohl bei der Enkodierung der Informationen (Präsentation der Karten des „Gebers“) als auch beim Abruf (Auswahl der gemerkten Karten auf Seite des „Spielers“) irrelevante Reize (Karten anderen Farben) unterdrückt werden müssen. Das Modul „sortieren“ erfordert neben der Speicherfunktion des Arbeitsgedächtnisses auch die mentale Manipulation der Informationen. Besonders bei der Aufgabenstellung „rückwärts sortieren“ wird dabei Prozesskomponente des Arbeitsgedächtnisses beansprucht. Neben dem regulärem Arbeitsgedächtnistraining wird das Spiel „17+4“ angeboten, welches vorrangig zu Motivationszwecken oder dem Überbrücken von Pausen genutzt werden kann. Es vereint die beiden basalen Arbeitsgedächtnisleistungen des Speicherns und Manipulierens von Informationen auf niedrigem bis mittlerem Schwierigkeitsniveau.
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Das reguläre Arbeitsgedächtnistraining ist so konstruiert, dass die Schwierigkeit im Verlauf kontinuierlich zunimmt. Zum einen wird die Schwierigkeit dabei durch die Anzahl der zu merkenden Karten bestimmt, zum anderen durch den Modultyp (siehe Abb. 4 für den hierarchischen Aufbau der Module). Wenn sichergestellt ist, dass der Proband sich eine bestimmte Anzahl von Karten merken kann, folgen die Module „selektiv merken“ und „sortieren“ mit derselben Anzahl von Karten. Sind alle Module mit einer Kartenanzahl erfolgreich bearbeitet worden, beginnt der Proband das Speichern mit einer zusätzlichen Karte zu üben, sowie sich anschließend diese erhöhte Kartenanzahl selektiv zu merken usw. Auf diese Weise wird gewährleistet, dass auf allen Schwierigkeitsebenen die wichtigsten Funktionen des Arbeitsgedächtnisses trainiert werden. Da Modulwechsel und Variation der Kartenzahl recht grobe Maße sind, um die Schwierigkeit zu verändern, erfolgt innerhalb der Module jeweils eine noch feinere Abstufung: die schrittweise Erhöhung der zusätzlich dargebotenen Karten auf der Seite des Spielers, die als Ablenker dienen. Der beschriebene Schwierigkeitsanstieg ist fest in die Levelstruktur des Trainings integriert (für den detaillierten Aufbau s. Kapitel Schwierigkeitsstruktur). Zusätzlich gibt es die Möglichkeit, mit Hilfe der Aktivierung von spezifischen Modifikatoren, Schwerpunkte auf bestimmte Arbeitsgedächtnisprozesse zu setzen und/oder die Schwierigkeit differenzierter zu beeinflussen. Die Beschreibung der verfügbaren Parameter finden Sie im Kapitel Trainingsparameter.
2.3
Target groups In this help file only the following sections are available in English: - Training task - Performance feedback - Levels of difficulty - Training parameters - Data analysis and - Data export. Zielgruppe des Arbeitsgedächtnistrainings sind vorrangig Patienten mit Störungen der Arbeitsgedächtnisfunktion. Das Training ist dabei so gestaltet, dass sowohl Patienten mit geringen Leistungseinbußen als auch schwerer betroffene Patienten profitieren. Ebenso ist die Anwendung bei Kindern möglich (z.B. Kinder mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung), sobald Zahlen im einstelligen Raum beherrscht werden. Durch das breite Schwierigkeitsspektrum ist zusätzlich die Verwendung des Trainings von gesunden älteren Erwachsenen oder anderen Personen, die ihre Arbeitsgedächtnisleistung steigern möchten, denkbar. Voraussetzung für das Training sind grundlegende Funktionen der Merkfähigkeit und selektiven Aufmerksamkeit sowie die Fähigkeit zum Erkennen einfacher Symbole
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Working M emory
und Zahlen. Zudem sollten einfache Anweisungen verstanden und wahrgenommene Informationen weitgehend verbalisiert werden können. Bei Patienten mit Aphasien muss daher geprüft werden, ob die sprachlichen Leistungen ausreichend sind, um die Grundanforderungen zu bewältigen. Patienten mit schweren Aufmerksamkeitsdefiziten sollten zunächst auf entsprechende Aufmerksamkeitstrainingsprogramme von RehaCom zurückgreifen.
2.4
Bibliography 1 Baddeley, 2003 2 D'Esposito, 1995; Awh & Jonides, 2001 3 Vallat et al., 2005; Klingberg et al., 2010 4 Kyllonen & Christal, 1990; Daneman & Merikle, 1996; Adams & Hitch, 1997 5 Johansson & Tornmalm, 2012 6 Stroemer, Kent, & Hulsebosch, 1998 7 Klingberg et al., 2005; Houben et al., 2011; Brehmer et al., 2012
© 2014 HASOMED GmbH
Index
Index
distractors 7 distractors on cards
-E-
-117+4
1
-Aacoustic acquisition only acquisition 7 adjustment 4 animated animal 7 appearance 7 auto adaptive 4 auto-adaptivity 7
-Bbibliography breaks 11
19
-Ccard game 1 cards 4 chart 4, 11, 12 client 12 color of cards 7 color of the card 1 consultation time 7
-Ddata 12 data analysis 11 database 12 dealer 1 deficits 11 deflector 7 degree of difficulty 2 difficulty structure 4 display time 7 distractor 4
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7
effec. time 11 error 2 errors 11 everyday-life 1 ex post 7 Excel file 12 export 12
-Ffeedback find 4
2
-Ggeneral settings 7 graph 11 graphic information 2
-Iinput mode
7
-Llevel 11 levels of difficulty
4
-Mmarkers 2 median 11 memorize 1 memorize selectively modifiers 7 module 4 modules 1
-Nno.
11
1
20
Working M emory
21
non matching 7 number 4 number of repetitions
visual instructions
7
7
-Pparameter 12 parameter menu 7 performance bar 2, 4 performance feedback 2 performance level 7 player 1 points 4 points per level 4, 7
-Qquartil
11
-Rrepetitions 4, 11 results 12
-Sselective attention 7 sheet 7 smiley 2 sorting 1 spoken instructions 7 statistical processing 12 structure 4
-Ttask type 1, 4 tasks 11 text information 2 training exercise 7 training material 1 training parameter 7
-Vvariation of the difficulty
7
Š 2014 HASOMED GmbH