Κλινική Τεκμηρίωση

To RehaCom έχει στηριχθεί, εξελιχθεί και τεκμηριωθεί βάσει πολυετών ερευνών από διάφορα Πανεπιστήμια της Ευρώπης. Κάθε δραστηριότητα αναπτύχθηκε σε συνεργασία με κλινικούς εταίρους και η αποτελεσματικότητα κάθε μίας είναι δημοσιευμένη σε διεθνή επιστημονικά περιοδικά. Παρακάτω μπορείτε να βρείτε μία λίστα με τις δημοσιεύσεις του RehaCom (όπου εμφανίζονται σε παρένθεση συντομογραφίες, αναφέρονται στις αντίστοιχες δραστηριότητες που μελετήθηκαν).

Objective

To evaluate the efficacy of a computer-based intensive training program of attention, information processing and executive functions in patients with clinically-stable relapsing–remitting (RR) multiple sclerosis (MS) and low levels of disability.

Design, patients and interventions

A total of 150 patients with RR MS and an Expanded Disability Status Scale (EDSS) score of ≤ 4 were examined. Information processing, working memory and attention were assessed by the Paced Auditory Serial Addition Test (PASAT) and executive functions by the Wisconsin Card Sorting Test (WCST). Twenty patients who scored below certain cut-off measures in both tests were included in this double-blind controlled study. Patients were casually assigned to a study group (SG) or a control group (CG) and underwent neuropsychological evaluation at baseline and after 3 months. Patients in the SG received intensive computer-assisted cognitive rehabilitation using the RehaCom system for attention, information processing and executive functions for 3 months; the CG did not receive any rehabilitation.

Setting

Ambulatory patients were sent by the MS referral center.

Outcome measures

Improvement in neuropsychological test and scale scores.

Results

After rehabilitation, only the study group significantly improved in tests of attention, information processing and executive functions (PASAT 3″ p = 0.023, PASAT 2″p = 0.004, WCST p = 0.037), as well as in depression scores (MADRS p = 0.01). Neuropsychological improvement was unrelated to depression improvement in regression analysis.

Conclusions

Intensive neuropsychological rehabilitation of attention, information processing and executive functions with RehaCom is effective in patients with RR MS and low levels of disability, and also leads to improvement in depression.

Μελέτη των δραστηριοτήτων "Προσοχή και Συγκέντρωση", Διάσπαση Προσοχής", "Εγρήγορση", "Συμπεριφορά Αντίδρασης", "Ακουστική Αντίδραση (μη διαθέσιμη στα ελληνικά)", "Χωροταξική Μνήμη" και "Οργάνωση Ημέρας (μη διαθέσιμη στα ελληνικά)" σε 35 παιδιά με ΔΕΠ/Υ με ευεργετικά αποτελέσματα. Η περίληψη και τα αποτελέσματα παρουσιάζονται παρακάτω στα Γαλλικά.

Résumé

La remédiation cognitive repose sur un modèle de stimulation de fonctions
cognitives qui présenteraient un retard de développement chez l’enfant souffrant de trouble de déficit de l’attention : attention, mémoire de travail et fonctions exécutives. Cette approche a été évaluée chez 35 enfants.

Résultats et discussion

L’analyse des résultats est en cours. Cliniquement nous observons une amélioration
notable chez les enfants participant à ce programme. Divers facteurs contribuent
probablement à cette amélioration: en dehors de la remédiation proprement dite:
Les séances à l’hôpital se font dans un open space, en groupe; cette particularité participe sans doute à la restauration de l’estime de soi chez les jeunes patients, en leur permettant de rencontrer d’autres enfants souffrant du même trouble qu’eux. Nous observons beaucoup d’entraide entre les enfants qui expliquent aux nouveaux inclus les tâches à effectuer et les encouragent. Le travail en groupe est écologique et semble
améliorer le transfert des habiletés acquises, en particuliers vers le domaine scolaire.
Cette approche nécessite un important soutien parental et rapproche parents et enfants tout en redonnant aux uns et aux autres un sentiment de maîtrise.

(το παρακάτω είναι περίληψη από την παρουσίαση την οποία μπορείτε να την διαβάσετε στον ακόλουθο σύνδεσμο.)

Σκοπός

Διερεύνηση της αποτελεσματικότητας του λογισμικού γνωσιακής αποκατάστασης RehaCom σε ασθενείς με γνωσιακά ελλείμματα από επίκτητη βλάβη στο ΚΝΣ που νοσηλεύονται σε Κέντρο Αποκατάστασης.

Μέθοδος

Η έρευνα πραγματοποιήθηκε στο Κέντρο Αποκατάστασης «Ευεξία» σε ασθενείς με 4 διαφορετικές νευρολογικές διαγνώσεις: α) Αγγειακό Εγκεφαλικό Επεισόδιο (ΑΕΕ) Αριστερή Ημιπληγία, β) ΑΕΕ Δεξιά Ημιπληγία, γ) Σκλήρυνση κατά Πλάκας (MS), και δ) Κρανιοεγκεφαλική Κάκωση (KEK).

Χρησιμοποιήθηκαν 2 ομάδες: ομάδα ελέγχου (Ν=41) και ομάδα παρέμβασης (Ν=56). Η ομάδα παρέμβασης συμμετείχε στο πρόγραμμα RehaCom, ενώ η ομάδα ελέγχου σε πρόγραμμα δημιουργικής απασχόλησης. Οι 2 ομάδες συμμετείχαν, με βάση τις ανάγκες τους, κανονικά στο πρόγραμμα αποκατάστασης του Κέντρου (φυσικοθεραπεία, εργοθεραπεία, ψυχολογική υποστήριξη), επιπρόσθετα της δημιουργικής απασχόλησης ή του RehaCom. Ο αριθμός ασθενών ανά διάγνωση σε κάθε ομάδα φαίνεται στο Σχήμα 1. Κατά την είσοδο στο Κέντρο, πραγματοποιήθηκε αξιολόγηση των γνωσιακών λειτουργιών των ασθενών των 2 ομάδων βάσει της ψυχομετρικής δοκιμασίας Montreal Cognitive Assessment (MOCA). Για τους ασθενείς που είχαν ΑΕΕ (ΔΕ) ημιπληγίας με αφασία εκπομπής χρησιμοποιήθηκε η δοκιμασία της Mini Mental State Examination (MMSE) σχετικά με την αξιολόγηση ικανότητας εκτέλεσης απλών και σύνθετων εντολών και κατονομασία.

Σχήμα 1 : Ασθενείς ανά διάγνωση σε κάθε ομάδα (ελέγχου και παρέμβασης)

Οι ασθενείς της ομάδας παρέμβασης παρακολουθούσαν συνεδρίες με το πρόγραμμα RehaCom για 30 λεπτά, 3 φορές/εβδομάδα για > 3 βδομάδες. Στο πρόγραμμα RehaCom υπάρχουν 20 διαφορετικές θεραπευτικές δραστηριότητες για την αντιμετώπιση διαταραχών στην προσοχή, αντίληψη, μνήμη, εκτελεστικές λειτουργίες, οπτικού πεδίου, κτλ. Ανάλογα με τα ελλείμματα κάθε ασθενή, επιλέχθηκαν συγκεκριμένες δραστηριότητες, όπως φαίνεται στον Πίνακα 1. Ο ασθενής κατά την πρώτη συνεδρία μίας δραστηριότητας άρχιζε με το χαμηλότερο επίπεδο δυσκολίας, ενώ το πρόγραμμα στη συνέχεια προσάρμοζε αυτόματα το επίπεδο ανάλογα με τις απαντήσεις του ασθενή στις ασκήσεις της δραστηριότητας. Σε κάθε επόμενη συνεδρία, συνέχιζε από το επίπεδο που είχε σταματήσει. 

ΠΙΝΑΚΑΣ 1: Δραστηριότητες του προγράμματος RehaCom που χρησιμοποιήθηκαν στους ασθενείς με διαφορετικές διαγνώσεις.

Στο τέλος ακολούθησε ψυχομετρική επανεκτίμηση με τη δοκιμασία MOCΑ. Ως επιπρόσθετο μέτρο προόδου αποκατάστασης μετρήθηκε η μεταβολή του επιπέδου δυσκολίας της τελευταίας συνεδρίας σε σχέση με αυτό της πρώτης για κάθε δραστηριότητα.

Αποτελέσματα

Ο μέσος όρος (μ.ο.) του χρόνου παρακολούθησης της παρέμβασης RehaCom ήταν οι 115±70 ημέρες. Για την ομάδα παρέμβασης βρέθηκε ότι η MOCA εξόδου ήταν στατιστικώς σημαντικά υψηλότερη από αυτήν της εισόδου με διαφορά 4,3 μονάδων (p<0,001), όπως φαίνεται το Σχήμα 2.

Σχήμα 2 : Η βαθμολογία στη δοκιμασία MOCA κατά την εισόδου και εξόδου από τη μελέτη και η αντίστοιχη βελτίωση τους για τους ασθενείς που παρακολούθησαν το πρόγραμμα RehaCom (ομάδα παρέμβασης) και οι αντίστοιχες βαθμολογίες της ομάδας ελέγχου.

Για τους ασθενείς της ομάδας ελέγχου, η αντίστοιχη αύξηση MOCA μετά το τέλος της νοσηλείας ήταν 1,2 μονάδες (μη στατιστικώς σημαντική). Για τους ασθενείς με αφασία εκπομπής της ομάδας παρέμβασης, πριν την είσοδο στο πρόγραμμα όλοι μπορούσαν να εκτελέσουν απλή εντολή ενώ μόνο 1 στους 8 είχε την ικανότητα εκτέλεσης σύνθετης εντολής. Μετά το τέλος της παρέμβασης, και οι 8 ήταν ικανοί για επιτυχή εκτέλεση σύνθετης εντολής. Σε αντίθεση, κανένας από τους 4 ασθενείς της ομάδας ελέγχου δεν μπορούσε να εκτελέσει σύνθετη εντολή κατά την είσοδο του (όλοι μπορούσαν να εκτελέσουν απλή εντολή), ενώ κατά την έξοδο μόνο 1 μπόρεσε να εκτελέσει επιτυχώς σύνθετη εντολή.

Τα επιμέρους αποτελέσματα για τους ασθενείς κάθε διάγνωσης απεικονίζονται στο Σχήμα 3. 

Σχήμα 3 : Βαθμολογία MOCA εισόδου, εξόδου και η αντίστοιχη βελτίωση για τους ασθενείς της ομάδας ελέγχου για κάθε πάθηση ξεχωριστά (σημ.: δεν υπήρχαν ασθενείς με MS στην ομάδα ελέγχου).

Συμπεράσματα

Συμπερασματικά, το RehaCom έχει στατιστικώς σημαντική θετική επίδραση στην νευροψυχολογική αποκατάσταση ασθενών με βλάβες στο ΚΝΣ. Στους ασθενείς της ομάδας παρέμβασης που αξιολογήθηκαν με MOCA (Ν=48), οι 45 είχαν βελτίωση κατά 1 τουλάχιστον μονάδα, ενώ μόνο 1 ήταν στάσιμος και 2 ασθενείς είχαν μείωση στη βαθμολογία MOCA (-1 και -2 μονάδες, αντίστοιχα). Για τους ασθενείς με αφασία εκπομπής (Ν=8), όλοι κατάφεραν να εκτελέσουν σύνθετη εντολή μετά το τέλος του προγράμματος RehaCom.

Ένα γενικό συμπέρασμα είναι ότι οι ασθενείς που ξεκίνησαν από χαμηλότερες βαθμολογίες MOCA επωφελήθηκαν περισσότερο από την εξάσκηση μέσω του προγράμματος RehaCom. Η υπο-ομάδα που φαίνεται να ωφελήθηκε περισσότερο είναι η ΑΕΕ (ΔΕ) ΗΜ (μ.ο. αύξησης MOCA = 6 μονάδες) και μετά ακολουθεί η ΚΕΚ (αύξηση 4,3 μονάδες).

Το επίπεδο δυσκολίας που έφθασαν οι ασθενείς στην τελευταία συνεδρία ήταν σημαντικά υψηλότερο από αυτό της αρχικής, με την αύξηση για κάθε δραστηριότητα, ωστόσο, να εξαρτάται από τον τύπο γνωσιακής διαταραχής του ασθενή. Ανάλογες τάσεις βελτίωσης παρατηρήθηκαν και για τις επιμέρους παραμέτρους επίδοσης (π.χ. χρόνος αντίφρασης, αριθμός λαθών, κτλ). Η αύξηση στο επίπεδο δυσκολίας εξόδου για κάθε δραστηριότητα είχε θετική συσχέτιση με την μεταβολή του MOCA εξόδου, δηλ. η βελτίωση της επίδοσης στο πρόγραμμα ενός ασθενή συνοδεύονταν και από αντίστοιχη γνωσιακή βελτίωση. Η υψηλότερη συσχέτιση προέκυψε για τη δραστηριότητα Προσοχή & Συγκέντρωση (ταύτιση εικόνων).

Επιπρόσθετα, το πρόγραμμα RehaCom έλαβε υψηλή αποδοχή από τους ασθενείς ως μέσο θεραπείας, ενώ οι δυνατότητες αυτόματης προσαρμογής του περιεχομένου και επιπέδου κάθε δραστηριότητας, καθώς και οι λειτουργίες ανάλυσης και αρχειοθέτησης του αξιολογήθηκαν από τους επαγγελματίες αποκατάστασης ως ιδιαίτερα χρήσιμες και αποδοτικές για τη ρουτίνα του Κέντρου.

Background and Purpose. Compensatory and restorative treatments have been developed to improve visual field defects after stroke. However, no controlled trials have compared these interventions with standard occupational therapy (OT).
Methods. A total of 45 stroke participants with visual field defect admitted for inpatient rehabilitation were randomized to restorative computerized training (RT) using computer-based stimulation of border areas of their visual field defects or
to a computer-based compensatory therapy (CT) using the RehaCom software to teach a visual search strategy. OT, in which different compensation strategies were used to train for activities of daily living, served as standard treatment for the active control group. Each
treatment group received 15 single sessions of 30 minutes distributed over 3 weeks. The primary outcome measures were visual field expansion for RT, visual search performance for CT, and reading performance for both treatments. Visual conjunction search, alertness, and the Barthel Index were secondary outcomes.

Results. Compared with OT, CT (RehaCom) resulted in a better visual search performance, and RT did not result in a larger expansion of the visual field. Intragroup pre–post comparisons demonstrated that CT improved all defined outcome parameters and RT several, whereas OT only improved one.

Conclusions. RehaCom, and more specifically the Procedure "Exploration" improved functional deficits after visual field loss compared with standard OT and may be the intervention of choice during inpatient rehabilitation. A larger trial that includes lesion location in the analysis is recommended.

Objective

Epilepsy surgery is a valuable treatment option for patients with pharmacoresistant epilepsy, but seizure freedom is often achieved at the cost of cognitive impairments caused by surgery. The aim of this study was to investigate the short-term effects of cognitive rehabilitation on memory outcome after temporal lobe epilepsy surgery.

Methods

Two groups of patients who underwent temporal lobe resection, one followed (n = 55) and one not followed (n = 57) by postoperative rehabilitation, were evaluated with respect to memory and attention before and 3 months after temporal lobe surgery. The groups came from different epilepsy centers, but were largely matched with respect to age, sex, type of surgery, and seizure outcome.

Results

After surgery, 78% of the patients were seizure-free. Repeated-measures MANOVA revealed a significant “side × surgery” effect on verbal recognition and a “rehabilitation × surgery” effect on verbal learning and recognition. There were no effects for loss in verbal delayed recall or figural memory. Detailed analyses indicated gains as a result of rehabilitation, particularly after right temporal lobe surgery. Attention generally improved. The risk of manifesting losses in verbal memory was about four times higher without than with rehabilitation.

Conclusions

Rehabilitation can counteract the verbal memory decline that is normally seen after temporal lobe resection. Its positive effects were evident particularly with respect to the more cortically associated aspects of verbal learning rather than to the mesial aspects of long-term consolidation/retrieval. Figural memory was not affected at all, and attention improved independent of rehabilitation. Interestingly, left temporal lobe-resected patients, who were most in need of an efficacious rehabilitation, profited less than right temporal lobe-resected patients, indicating that left-sided surgery may reduce the capacity needed for efficient training of verbal memory. Thus, rehabilitation has a positive effect on memory outcome, but its usefulness for risk groups and the question of whether training should be performed after or possibly before surgery are debatable. Further research should also address different interventions, longer-term outcome, and the carryover effects on everyday functioning.

Σκοπός

Η χρήση γνωσιακής αναδόμησης υποστηριζόμενης από υπολογιστή (λογισμικό RehaCom) σε μεγάλο αριθμό ασθενών με σχιζοφρένεια και η αξιολόγηση της αποτελεσματικότητας της αναφορικά με τη γνωσιακή επίδοση, κλινική εικόνα και λειτουργικό αποτέλεσμα των ασθενών. 

Μέθοδος

Σε μία πολυκεντρική μελέτη, 77 ασθενείς με σχιζοφρένεια χωρίσθηκαν τυχαία σε 2 ομάδες: η πρώτη, ομάδα παρέμβασης (Ν=39), έλαβε 14 2ωρες συνεδρίες για 7 εβδομάδες με το πρόγραμμα RehaCom (n=39), ενώ η δεύτερη ομάδα (Ν=38) χρησιμοποιήθηκε ως μάρτυρας και έλαβε κανονική θεραπεία. Η ομάδα παρέμβασης ακολούθησε 4 δραστηριότητες του RehaCom, συγκεκριμένα "Προσοχή & Συγκέντρωση", "Χωρική Μνήμη", "Λογική Σκέψη" και "Οργάνωση Αγορών".

Για την ψυχομετρική εκτίμηση η οποία έλαβε χώρα στην αρχή της μελέτης και μετά από 3 μήνες και για τις δύο ομάδες, χρησιμοποιήθηκαν διάφορα υπο-τεστ του Cogtest® battery test, συγκεκριμένα τα:

  • (Attention / vigilance): The Continuous Performance Test—Identical Pair version (CPT-IP)
  • (Non-verbal Working Memory): Spatial Working Memory test (SWM)
  • (Verbal Working memory): Auditory Number Sequencing (ANS)
  • (Verbal learning and memory): Word List Memory test (WLM)
  • (Visual learning and memory): Face Memory Test (FMT)
  • (Speed of processing): Finger Tapping Test (FTT)
  • (Reasoning and problem solving): Strategic Target Detection test (STDT).

Η κλινική αξιολόγηση έγινε από αξιολογητή τυφλό ως προς την ομάδα που ανήκει ο κάθε ασθενής με χρήση της κλίμακας βαθμονόμησης Positive and Negative Syndrome Scale (PANSS) και της Clinical Global Impression (CGI). Τέλος, η ποιότητα ζωής εκτιμήθηκε τόσο με αναφορά που συμπληρώθηκε από τον ίδιο τον ασθενή όσο και με τη γαλλική κλίμακα με την ονομασία Social Autonomy Scale (EAS).

Αποτελέσματα

Η γνωσιακή ικανότητα αναφορικά με την προσοχή/εγρήγορση, λεκτική εργαζόμενη μνήμη, λογική σκέψη και επίλυση προβλημάτων βελτιώθηκε στατιστικώς σημαντικά στην ομάδα παρέμβασης, ενώ καμία βελτίωση δεν παρατηρήθηκε στην ομάδα ελέγχου. Ωστόσο, δεν παρουσιάστηκε σημαντική βελτίωση αναφορικά με τα μέτρα που χρησιμοποιήθηκαν για την αξιολόγηση της μη λεκτικής εργαζόμενης μνήμης, οπτικής μάθησης και μνήμης, και ταχύτητα επεξεργασίας, καθώς και στο κλινικό και λειτουργικό αποτέλεσμα.

Συμπεράσματα

Η γνωσιακή αναδόμηση σε άτομα με σχιζοφρένεια ήταν αποτελεσματική μέσω της χρήσης του RehaCom, ωστόσο τα οφέλη δεν γενικεύτηκαν σε λειτουργικά αποτελέσματα. Η έλλειψη βελτίωσης στη μη λεκτική μνήμη ενδεχομένως να οφείλεται στις ίδιες τις δραστηριότητες που χρησιμοποιήθηκαν οι οποίες είναι σχεδιασμένες να βοηθούν στην αντιμετώπιση διαταραχών της λεκτικής μνήμης. 

Επίσης, η έλλειψη θετικής επίδρασης σε κλινικό και κοινωνικό επίπεδο, καθώς και στην ποιότητα ζωής, θα μπορούσε να αποδοθεί στο σχετικά σύντομο διάστημα παρακολούθησης (3 μήνες). Για το λόγο αυτό προτείνεται η διεξαγωγή μελετών με πρωτόκολλο παρακολούθησης (follow-up) για μεγαλύτερο διάστημα, ώστε να παρατηρηθούν πιθανές ευεργετικές αλλαγές και σε αυτά τα επίπεδα.

In this study the possibility of late rehabilitation after a CRANIOCEREBRAL TRAUMA was examined using seven patients. The CRANIOCEREBRAL occurred two to ten years before. The main focus lay on the areas attention and memory. The diagnostics of the attention performance was done on the one hand using subtests from TAP (divided attention, reaction change, intermodal comparison, visual scanning) and on the other with subtests of the FWIT (Color-Word reading, Color-Stroke-Naming and Interference condition). The memory functions were checked with Selective Reminding, Pair-Association Learning Test, Logical Memory, Visual Reproduction and Digit Span (the last three are subtests of the WMS-R). All patients had light to massive attention and memory deficits.

Each patient trained for five to six sessions with the training programs ATTENTION, VIGILANCE, REACTION CAPACITY, SHAPE MEMORY, TOPOLOGICAL MEMORY and WORD MEMORY. In the pre-post comparison there were significant improvements for Divided Attention, Reaction Change and Selective Reminding. After a stability check 24-29 weeks later, the effects of the training were still noticeable.

This study aimed to examine the connections between the improvement of attention or memory performances and the use of relevant computer programs. For this purpose 120 cerebrally damaged patients (stroke, craniocerebral trauma) were used. The initial and final diagnosis was done using TAT and the program to determine cerebral disorders. Between these two measuring points lay about 8 weeks, during which every patient trained with one or more of the following REHACOM programs: ATTENTION & CONCENTRATION, DIVIDED ATTENTION, VIGILANCE, REACTIVE CAPACITY, WORD MEMORY, TOPOLOGICAL MEMORY, VERBAL MEMORY and SHAPE MEMORY. The patient clientele was divided into three partial samples: In Group 1 (patients under 60 years of age, with neither speech impairment nor hemiparesis) there was a clear performance improvement (significant for 5%) in the pre-post comparison for 83% of all relevant variables. In Group 2 (under 60 years of age with additional speech and movement impairments) there were significant performance improvements for 57% of the parameters. Even in Group 3 (patients over 60 years and impairments or deficits in all areas), 50% of the values improved. The influence of spontaneous remission on the results can excluded for the majority of the patients, because of the great time span between traumatic occurrence and start of the therapy.
Regel et al. distinguishes three transfer effects:
Transfer effect of the first order (training effect): Pre-post comparison with tests, that were the subject of the training (attention training, check with a corresponding attention test, e.g. d2 or Cognitrone).
Transfer effect of the second order (Generalization effect): Pre-post comparison with tests, which were not the subject of the training (attention training, check of the memory function).
Transfer effect of the third order (Reality effect): The training of the attention and/or memory function leads to improvements in every-day or work requirements (difficult to assess psychometrically).
Significant positive changes in the pre-post comparison were easier to prove, when a training was administered in the function, that was also assessed by a test (transfer of the first orderEven if it was not possible until now to present a quantitative proof of a transfer of the third order, there were strong hints in that directions, from the patient interviews, talks and the observation of the patients' behavior.

Cognitive remediation therapy (CRT) is a non biological treatment that aims to correct cognitive deficits through repeated exercises. Its efficacy in patients with schizophrenia is well recognized, but little is known about its effect on cerebral activity. Our aim was to explore the impact of CRT on cerebral activation using functional magnetic resonance imaging (fMRI) in patients with schizophrenia. Seventeen patients and 15 healthy volunteers were recruited. Patients were divided into two groups: one group received CRT with Rehacom® software (n=8), while a control group of patients (non-CRT group) received no additional treatment (n=9). The three groups underwent two fMRI sessions with an interval of 3 months: they had to perform a verbal and a spatial n-back task at the same performance level. Patients were additionally clinically and cognitively assessed before and after the study. After CRT, the CRT group exhibited brain over-activations
in the left inferior/middle frontal gyrus, cingulate gyrus and inferior parietal lobule for the spatial task. Similar but nonsignificant over-activations were observed in the same brain regions for the verbal task. Moreover, CRT patients significantly improved their behavioural performance in attention and reasoning capacities. We conclude that CRT leads to measurable physiological adaptation associated with improved cognitive ability.
Trial name: Cognitive Remediation Theraphy and Schizophrenia.
clinicaltrials.gov/ct2/show/NCT01078129.
Registration number: NCT01078129.

This study deals with the question, of whether cognitive deficits, which were found in ALCOHOLIC PATIENTS at the start of a withdrawal therapy, can be alleviated through cognitive training measures.For 20 alcoholic men, who took part at a three-week detoxification study at the Psychiatrische Universitätsklinik Tübingen four cognitive training sessions on the computer were administered within two weeks. Each time there were sessions of 40 minutes of the tests ATTENTION & CONCENTRATION and TOPOLOGICAL MEMORY. At the start and at then end of the treatment the following tests were administered to check the memory and training performance: LPS (short form), Alcoholism questionnaire, Trailmaking Test B, Benton Test and Revision Test.
To summarize the findings, one can say that the patients made clear improvements within the three weeks of detoxification in the neuropsychological tests as well as in training. What became clear is that the behavior in training is generally very complex and depends on a multitude of factors, especially on the respondents' age and on their degree of alcoholism.

This study was carried out at the Psychiatric University Hospital Tübingen, within a three week controlled in-patient alcohol withdrawal program. The examination sample consisted of 18 male, CHRONICALLY ALCOHOLIC PATIENTS. The respondents were assigned to their groups at random.The study follows a before and after design, and the patients were always presented with one neuropsychological test battery. This consisted of the LPS, the Alcoholism questionnaire, Trailmaking Test, the Benton Test, the Revision Test, complaint list and Becks Depression Inventory. Between the two measurement points lay a 45-minute special training for two groups. For the play group the training consisted of four different party games, each of which was played once. The computer-training group spent its training with the REHACOM programs ATTENTION & CONCENTRATION and TOPOLOGICAL MEMORY. The control group just went through the normal ward routine.
The study came to the following conclusion:
An influence of the training can only be proved for one cognitive performance area, for the visual short-term memory (Benton-Test). For this area an improvement of the cognitive performance becomes effective a few days after the withdrawal starts.


 



This study was carried out with six CRANIOCEREBRRAL TRAUMA patients. WAIS-R, WMS-R, RBMT, d2 and the Vienna Determination Unit were used to check the cognitive performance capacity. All six patients showed clear attention and memory deficits. The patients trained in sessions of 20 minutes each with the tests ATTENTION, VIGILANCE and TOPOLOGICAL MEMORY.
In a before and after comparison, significant improvements in the subtests of the WMS-R and the Vienna Determination Unit. An individual case evaluation led to the following results. The effects of a specific computerized cognitive training are most obvious for tests that assess the same function as the process. Each training only improves the intended dimension and does not show any global effect on other functions. It improves the performance capacity of craniocerebral trauma patients in the trained cognitive functions.

Using 30 patients with acute hemispheric CEREBRAL INFARCT and impairment of the functions attention and memory, the effectiveness of the REHACOM tests ATTENTION & CONCENTRATION, VERBAL MEMORY and SHAPE MEMORY. In the trained group there were short-term improvements for 60% of the patients and for 70% there were long-term improvements.
In the control group only 22% showed a short-term improvement and 17% a long-term improvement.

Preetz studied the effectiveness of REHACOM in comparison with Mnemotechniques. 30 patients with VASCULAR CEREBRAL LESIONS took part. The training group consisted of 15 patients with cognitive performance impairments. The control group consisted of cerebrally damaged patients without severe cognitive impairments.
With instruments and conventional processes the cerebral organic performance capacity (performance test for the assessment of the areas memory, concentration, intellectual performance capacity, cognitive adaptation capacity and reaction capacity; questionnaire for the assessment of the mental state, limitations due to cerebral damages and control convictions). The training group received a total of 16 hours of training with the tests ATTENTION & CONCENTRATION, VIGILANCE, TOPOLOGICAL MEMORY and WORD MEMORY. Before and after each training session the patients filled in a rating scale to assess their current mental state.
The important results of the performance tests were:
An improved performance in the trained functions, partially into the norm value area of the tests

  • A transfer of the training effects on untrained performance areas
  • No significant change in the control group

The following results could be gathered from the questionnaire:

  • After the training the patients felt less handicapped
  • Their mental state was much less negative
  • No significant change in the control group

Using a sample of 12 patients with not very strongly formed dementia, the remaining functions were assessed, with the aid of a neuropsychological test battery. These functions should correspond to the age norm or be situated in the lower deviation area of the age norm. The test battery consisted of the following subtests: Selective Reminding and Recognition (Dementia Test according to Kessler), Mosaic-Test (HAWIE), Age Concentration Test (Gatterer), as well as the subtests Labyrinth, Repeating Numbers, Connecting Number and Word List I and II from the Nuremberg Age Inventory. Two of the following training programs were chosen, depending on the remaining functions: ATTENTION & CONCENTRATION, TOPOLOGICAL MEMORY, SHAPE MEMORY, VERBAL MEMORY and SURFACE OPERATIONS. The cognitive training consisted of 15 sessions of 40 minutes per patient. The neuropsychological test battery was presented before and after the training.
For the dimensions visual short-term memory, consistent attention and general cognitive performance speed there was a significant performance improvement.

In a second study 36 patients with high degree craniocerebral trauma and ORGANIC PSYCHO-SYNDROME were divided into two study groups (one REHACOM and one Vienna Determination Unit) and one control group. 12 patients of study group 1 (REHACOM) received over 20 sessions of the tests TOPOLOGICAL MEMORY AND SURFACE OPERATION) in addition to the standard therapy.
12 patients in study group 2 (WDG) received 20 sessions with the Vienna Determination Unit, in addition to standard therapy. The control group received only standard therapy.
Training with the Determination Unit, which was developed for testing purposes, brought no improvements in the attention performance, whereas, whereas the two REHACOM processes brought an improvement of short-term memory (Benton Test) and of visual spatial perception (Honeycomb-Test).

The effectiveness of the training programs ATTENTION & CONCENTRATION, DIVIDED ATTENTION, LOGICAL THINKING, TOPOLOGICAL THINKING and WORD MEMORY was studied using 97 STROKE patients. Cognitive performance deficits were diagnosed with the following test battery, consisting of tests from the Vienna Test System (Dr. G. Schuhfried Ges.m.b.H.): Colored Progressive Matrices (deductive thinking), Cognitrone (attention), Verbal Learning Test (memory for verbal material), Non-Verbal Learning Test (memory for non-verbal material) and Corsi (visuo-spatial memory span). Depending on the noticed deficit, two of the training programs above were used for 10 sessions to 15 minutes each. In a pre-post comparison, scored using LLTM (Linear Logistic Test Model according to Rausch), clear transfer effects of the first (training effect) and of the third order (ADL effect) were found. A transfer effect of the second order (generalization effect could not be found). There were no more visible deficits in the cognitive profile. The impairments found in the pre-test could be alleviated through training with REHACOM. The patients reached their individual cognitive standard again.

The effectiveness of the computerized training program was tested on 28 patients with the diagnosis "CHRONIFIED SCHIZOPHRENIA". Using the following tests the cognitive performance capacity: Multiple choice Vocabulary Test (MWT), Syndrome Short Test (SKT) from the Performance Control System. Additionally some self and external rating scales were presented (Frankfurt Complaint Questionnaire, Brief Psychiatric Rating Scale, NOSIE and SANS). 14 patients of the training group (seven men and seven women) completed in a four to 7 week program a 20-minute computer training of 20 minutes (ATTENTION & CONCENTRATION and TOPOLOGICAL MEMORY). In a concluding examination the training group showed an improvement for all performance variables. The values for the SKT total score, SKT- Attention and MWT were significant. A generalization effect was not found. The control group improved only slightly, stayed the same or worsened in its performance. The training apparently had no effect on the self-assessment. In the external assessment there was a significant improvement for the trained patients, a strongly positive effect, in a change of social adaptability, social interest and irritability.

It was the aim of the study, to try out the REHACOM training programs ATTENTION & CONCENTRATION for the treatment of CHILDREN. For this the computer program was evaluated using healthy children of different age groups. There was a significant difference between age groups in the recorded performance parameters of the training (performance level reached). School children profited to a higher degree from the training than younger children. Questionnaires of the motivation before and during the training revealed, that the motivation can be kept up by adapting the training to the performance. The overall acceptance of the computerized cognitive training was positive.

This study controls the effectiveness of a computerized cognitive training in an individual setting. Of special interest was the question of whether relatively short computer training can improve the intellectual capacities and the emotional state of the participants (assessed using pre-post tests). A total of 28 VERY OLD PATIENTS (median age 81 years, median MMSE 26 points) of a geriatric hospital took part in the study. Using the scores in the Syndrome Short Test (SKT), pairs with just about the same cognitive starting level were formed, and the patients were assigned to different training groups. Trained were ATTNETION & CONCENTRATION, VIGILANCE, WORD MEMORY and TOPOLOGICAL MEMORY. Each training patient received a total of 9 hours of computer training with the four training programs mentioned above. The results showed that patients were able to improve in all areas where the training data were concerned, so that they were able to solve progressively more difficult tasks. However this was not true to the same extent for all patients and all training programs. On the level of test data effect strengths were evaluated. The training patients showed themselves to be vastly superior to the control group in psychomotor speed (Number Connection Test). Considering the fact that psychomotor speed is a basic variable of human behavior, and that aging is characterized by a general diminishment of psychomotor speed, this result is very positive. For the variable memory it was shown, that the training group was more capable than the control group to store the items, if not always very precisely, which led to an increased number of false positive answers. In the other variables like attention, concentration and emotional values, no clear differences between training and control groups could be established.

Effectiveness of the RehaCom programmes ‘Attention and Concentration’, ‘Divided Attention’, ‘Topological Memory’, ‘Memory for Words’ and ‘Logical Reasoning’ in neuropsychological rehabilitation. Günthner/Jung studied 60 alcoholics during detoxification using a three group experimental design. The first group was trained with RehaCom (AUFM and MEMO) in four sessions of 40 minutes each (20 minutes per dimension). The second group was given memory training with (non-computer) memory games in the same timeframe. The third group was used as a control, and received no training. All three groups were tested before and after with a battery of paper/pencil tests (LPS [short form], revision test, trail-making test B and Benton Test). One important result was the significant intervention effect found in the RehaCom and memory-game groups in the Benton Test. In a second study, Günthner examined 20 schizophrenic patients using the same battery of tests. In this case, however, he omitted the ‘games’ comparison group. In this study too, memory training was found to have had an effect, because there were again significant improvements in the Benton Test. No effects on other test performances (LPS) could be proven in either study.

Another Swedish study looked at computer-assisted cognitive rehabilitation in outpatient psychiatric treatment. In this study, eight psychiatric patients with problems linked to depression and cognitive deficits were trained with selected RehaCom programs. Each patient received 40 training sessions (no more than 60 minutes per session) split between the AUFM, GEAU, VIGI, MEMO and BILD programs.

The following tests were used to study the effects of the training: WAIS-R, Benton Visual Retention Test, Wisconsin Card Sorting Test, TMT-A, TMT-B and the Beck Depression Inventory. The final test analysis was an analysis of individual cases, whereby every patient in the WAIS-R, TMT-A, TMT-B and Beck Depression Inventory showed significant improvements.

Dissertation on RehaCom VERB for the psychology course in the Faculty of Pedagogy, Philosophy and Psychology at Otto Friedrich University in Bamberg (2007). The study was conducted at the “Fachklinik für Physikalische Medizin und Medizinische Rehabilitation” [Specialist Hospital for Physical Medicine and Medical Rehabilitation] in Herzogenaurach and showed that RehaCom “Verbal Memory” training can be used to treat specific memory disorders very successfully. “Manual group therapy” and “computer therapy” were compared and the results showed that “computer therapy” is in no way inferior to “manual group therapy”.
Thirty memory patients with acquired brain damage took part in the study. The parallelised sample was randomly assigned either individual computer-assisted cognitive therapy (RehaCom Verbal Memory) or metacognitive memory training in a group setting (based on the Finauer & Keller Manual, 2002). Two memory tests (VLT and NVLT, Sturm & Willmes, 1999) and two attention tests (Alertness and Divided Attention, TAP, Zimmermann & Fimm, 2002) were conducted before and after intervention. Both memory tests revealed highly significant intervention effects.
There was a slight improvement in divided attention, but performance in the attention tests improved much less than performance in the memory tests. Verbal memory benefited significantly more from the treatment. The results of this study make it clear that the success of neuropsychological treatment is attributable to a specific improvement in the trained function. This is also suggested by the fact that verbal memory improved more, as this area is particularly accessible for specific strategy training. No difference was seen between the types of intervention used.

Eleven alcohol-dependent men from the “Alte Ölmühle” specialist rehabilitation hospital in Magdeburg took part in the study. It consisted of three 30-minute sessions a week for 8 weeks, 15 minutes on attention/concentration tasks and 15 minutes on memory tasks. The Frankfurt Attention Inventory (FAIR) and Multiple Choice Verbal Intelligence Test (MWT-B) were conducted with all patients at the beginning and end of the treatment in order to measure their attention, concentration and general intelligence level. The patients clearly improved their performance. In particular, the training variables were seen to depend on the duration of alcohol dependence. The fact that almost all patients had only slight attention and concentration deficits (see pre-training FAIR results) led to the first successes being recorded after only four weeks of training. In conclusion, it can be said that the use or provision of computer-assisted cognitive training during medical rehabilitation is very sensible. In order to achieve even greater success, the training should be given throughout the treatment period. The RehaCom computer program, in particular, enables the training to continue even after treatment has ended. With appropriate assistance and monitoring, it can be undertaken online at home, in special facilities or with a GP.

30 patients who were diagnosed with schizophrenia (DSM IV) attended an explorative study. It was a precondition for those patients to have been taking antipsychotica since at least three months. In seven sessions happening once a week the following RehaCom® procedures for cognitive remediation were applied: Reha-AUFM, that trains the attention/concentration, Reha-MEMO, which trains the topological memory, Reha-LODE with training of the executive functions using a procedure of logical reasoning, as well as Reha-EINK, which also trains the executive functions via a virtual shopping exercise. So far there was no control group since this happened to be a preliminary study. Alternatively results of similar studies were consulted. Those patients showed a clear improvement of all trained skills as well as their functional skills. Furthermore clinical symptoms of schizophrenia were reduced which was e.g. reflected in a low termination rate.

85% of schizophrenic patients exhibit severe cognitive deficits (Palmer 1997; Kremen 2000) that are related to functional outcome (Green, 1996) and do not respond well to medication. 25 schizophrenic patients, treated with atypical antipsychotics for more than 6 months, underwent during one year, twice a week, a computerized neuropsychological remediation program using the software Rehacom (Hasomed). Patients performances are measured before and after treatment (WAIS III, WCST, Stroop, fluencies) and compared to standardized mean scores (matched for age and socio cultural level). Treatment significantly improved global cognitive and executive functioning. WAIS scores at the different subtests are more homogeneous; this latter result may help schizophrenic patients to adjust themselves to real life conditions.