COMPUTERS FOR MEMORY TRAINING: A new way to the early intervention in Dementia.
M.A., FRANCO MARTÍN T. ORIHUELA VILLAMERIEL Y. BUENO AGUADO P. GÓMEZ CONEJO D. GONZÁLEZ GATÓN INTRAS FOUNDATION Adress: Santa Lucía, núm. 19 - 1ª Planta (Edif. INTERCIMA) 47005-Valladolid Tfno.: +34 83 39.96.33 Fax number: +34 83 21.75.65 http://www.intras.es e-mail: firstname.lastname@example.org It looks obvious that one of the most important treatments for the cognitive impairment is the cerebral training. However we can find several dificulties to introduce the neuropsychological programs in clinical settings. It is just because some of the following reasons: 1) Therapist spend a long time for neuropsychological rehabilitation and due to this reason of the therapy turns very expensive. So the Director Manager of the clinical setting often considers that it is better for the economy of the center to decrease this kind of therapy. 2) It is necessary an specific trainer or a qualified person to apply the neuropsychological rehabilitation. Not all the psychologist or phisician know the neuropsychological techniques. 3) There are few qualified specialist in neuropsychological rehabilitation, so it is not easy to develop a Neuropsychological unit. Unless this is the context in Spain. 4) There are few cerebral training programs and sometimes the follow-up is difficult too. 5) When patiens live too far, for example in a small village, it´s very difficult to follow-up them. 6) At last, the progress cognitive impairment of the patient, for example in dementia, -Pág. 1-
wakes a lack of motivation among workers who develop cerebral training programs. Besides, cognitive impairment is more frecuent nowadays. So, we can observe that every time we have to treat more and more patients, we need time for the neuropsychological assessment and make the scores... and at last, itÂ´s easy that a Burnout Syndrome Appears. For preventieng this picture we have to do neuropsychological rehabilitation programs with the following characteristics: . Flexible: . Open: . Easy:
Useful for many different users with different grades of cognitive impairment. The program must be able to introduce all new advances about neuropsychological rehabilitation easily. It is neccesary that the rehabilitation program can be aplied by no qualified people in this area such as workers as nurses. So the neuropsychologist is not required every day and he just has to establish the therapy program and evaluate the follow-up.
. Available . Affordable:
Very importat for the manager director.
. Useful Computers and many software programs fulfil most of this characteristics. Besides when we aply computers for the memory training we can find the following advantages: . Many boring cognitive exercices can be aplied automatically. So, it is very useful to prevent the Burnout Syndrome. . Computers give a quick feedback just after the answer of the user. It is very important for his motivation. . It is posible to increase time for memory training because the user can continue the training in his own house. He only need the computer which could be manage on line. . So it could be very interesting for people who lives far away from the usual clinical settings, for example in small villages. However nowadays we can find general problems too: . We find high variability of software and hardware and no every software is compatible with all computers. It is a great problem when we want to charge the computer or the user has a different computer than me. . Usually the computer rehabilitation programs are rigid and they do not often give us the possibility modificate cognitive exercises. We only can do what the program know to do and no more. . Nowadays, computer programs for memory training are very expensive, and then cost of neuropsychological rehabilitation goes on very high. . Software is very rigid, so it is difficult to adapt the memory training to the specific cognitive impairment in every patient. . And at last it looks obvious that we have an strong dependence of computer -PĂĄg. 2-
specialists when it is necessary to change something of the computer program. So, in order to avoid all these problems and take adventage of the oportunities of computer for cerebral training we have designed the “GRADIOR” System. It´s a software program useful for cognitive assessment and neuropsychological rehabilitation and beside only need an standard multimedia computer and touch screen. The system incorporate all the requeriments of neuropsychological rehabilitation programs: flexible, open, easy to use, available, cheap and useful. The system separates contents and cognitive activity. It has a content storage which can be included in different exercises. Then every cognitive activity or function is related with an exercise model and the therapist is able to build his/her own specific exercises. He only has to join the specific content (for example the framework, objects, reinforments, intruction at start and so on) and the exercise model. The GRADIOR System has its own exercises generator. The GRADIOR System, include three modules (graph. 1):
1) First one is the exercise generator in which the therapist can build their own specific exercises for cerebral training. So he has to use the knowledge storage and the proper exercise generator in which we can find several model for cognitive activities. 2) Second is the Clinic Manager Program. The therapist can configurate the system, for example establish the directories, save contents files, etc... In the proper clinic manager, the therapist saves general clinical data of the patient: sociodemographic data, treatment and cognitive scores in scales as Minimental Test, ADAS... In the treatment desing, the therapist chooses the specific cognitive exercises -Pág. 3-
for the patient, number and kind of them and stablishs the level of dificculty of every exercise. In this way, the therapist can apply an individual memory training to every patient. In the reports, the therapist can print the scores of every patient for the followup of the rehabilitation program. 3) And Third, cerebral training application. The patient works with the computer and make different exercises. Besides itÂ´s possible to do a neuropsychological assessment. (Graph.2)
For example: In the first module, the therapist can generate 1.000 selective attention exercises. Then, in the second module, the same or another therapist choose the specific exercises for the patient depending on the cognitive level, specific features or an other clinic symtoms. In this way, only 90 exercises fulfil the specific conditions for the example patient. Finally, in the third module, this patient performs the specific rehabilitation session in which every time one of the ninety exercises is randomly ran.
In this way, in every session the patient performs several exercises, more o less, depending on the time spend in every exercise. Then, when the patient finishes to perform all selected exercices, the system begins again (graph. 3). In this case, every sesion spend 20 minutes.
So, the patient can performs randomly one of the ninety specific selective attention exercises in each circle of treatment (graph.3). And then, he can do differences among the diferent contents. And so the scores may be like the showed in the graph 4. But, what happens in these four times in the big dot? There is the same cognitive activity, but different contents, then it is possible that these contents are influencing in cognitive scores. So, we can elaborate different hypothesis about the influence of the contents on cognitive outputs. It is important to elaborate more specific memory training programs and to know more deeply the brain function.
Nowadays, this system is being adapting to British people in Bangor University by B. Woods. So, we hope to be realy an English-GRADIOR version during this year, and it can be a new tool for the early intervention in dementia. -Pรกg. 5-
BIBLIOGRAPHY BRIEF, R. (1994): Personal computers in Psychiatric Rehabilitation: A new Approach to Skills Training. Hospital and Community Psychiatry, March 1994, vol 45 (3). FRANCO, M.A.; ORIHUELA, T. (1998): Programa AIRE. Sistema Multimedia de Evaluación y Entrenamiento Cerebral. Edintras. FRANCO, M.A.(And cols.) (1999) Evaluación de un sistema informatizado de Orientación Temporal (AIRE) vs. Sistema clínico (MEC). Rev. Anales de Psiquiatría. Vol. 15, 4 (145-152) SERON, X; LORIES, G. (1996): El apoyo de la computadora en al valoración y rehabilitación neuropsocológica. En OSTROSKY-SOLIS; ARDILA, A.; CHAYO-DICHY,R.: Rehabilitación Neuropsicológica. Ed. Planeta. Méjico. WILSON, B.; PATTERSON K. (1990): Rehabilitation and cognitive neuropsychology does cognitive psychology apply?. Rev. Applied Cognitive Psychology, 4, 247-260.