Intendu Functional Brain Trainer UTILIZING INTENDU TO TRANSFORM COGNITIVE REHABILITATION FOR INDIVIDUALS WITH MILD TRAUMATIC BRAIN INJURY

Transcription

1 Intendu Functional Brain Trainer UTILIZING INTENDU TO TRANSFORM COGNITIVE REHABILITATION FOR INDIVIDUALS WITH MILD TRAUMATIC BRAIN INJURY ADELIN DYON MSC.OT., OT REG. (ONT.) & SARAH BERRY MSC.OT., OT REG. (ONT.) Introduction What It Is o Software program combining cognitive training with physical movements o Target users: clients with acquired brain injury o Current focus: Executive Functions o Functional environments in the program (e.g. food truck, bus stop, grocery store) Introduction Underlying Principles o Transfer to daily life is improved through training in realistic environments (Alexander et al., 2005; Greitzer et al., 2007) o Personalized and adaptable training to enhance ease of use for target population (Ahissar & Hochstein, 2004; Green & Bavelier, 2008) o Physical and cognitive challenge together enhance neuroplasticity (Holzschneider et al., 2012; Kempermann, 2008) o Motivation is increased through engaging software (Alexander et al., 2005) o Training cognitive functions in multiple contexts improves generalization (Green & Bavelier, 2008; Toglia et al., 2010; Seidler, 2004) 1

2 Introduction How It Works o Purchase software, camera, computer able to run software, cords o Need strong internet, large screen, room to train o Set up account for client, set level of challenge o Therapist demonstrates each game, reviews instructions with client o Client practices each game o Computer software tracks client s progress o Used in the clinic and developing a version for the home 2

3 10/23/16 Video Staff Demonstration Comparable Programs o Lum osity o Cogm ed o Captain s Log from BrainTrain o NeuroPsychOnline (NPO) Cognitive Rehabilitation Therapy System 3

4 Evidence Peer Reviewed o Computer-based cognitive rehabilitation programs demonstrate an improvement in objective measurements of cognitive performance (Prokopenki, et. al., 2013; Hardy, et al., 2011; De Luca, et al., 2014; Larson, et al., 2014) o Limited evidence regarding the generalization of cognitive improvements to functional performance, participation, and life satisfaction. (Cicerone, et.al., 2003; Prokopenki, et. al., 2013; Finn, et. al. 2011; Li, K., et al., 2013; Larson, et al., 2014) Evidence: Recommendations for Therapy o Remediation of memory should be tailored to the severity of memory impairment, with different interventions for mild versus severe impairment. o Interventions should address the cognitive, emotional, and interpersonal difficulties of people with acquired brain injury o Applying the intervention to functional, every day activities o Providing treatment in a comprehensive, holistic way o Avoiding the use of repetitive computer-based tasks without some involvement and intervention by a therapist Cicerone, et. al. (2011) Evidence Intendu Team 1. Pilot study of feasibility and usability o Participants reported: low fatigue, high enjoyment and success (Eliav R., Blumenfel, B., Swartz, Y., Preminger, S., Rand, D., & Sacher, Y., 2014) 2. Study of usability and effectiveness of the program o Preliminary results from an ongoing RCT o Reported enjoying the program and feeling success following the training o Participants gradually able to perform games with higher cognitive demands o Preliminary results show improvement in functional task (Eliav, R., Blumefel, B., Swartz, Y., Preminger, S., Rand, D., & Sacher, Y., 2014) 4

5 Our Process o Set up: Purchasing computer, liaising with Intendu team, training BCMA staff (2 orientations) o Developed pre and post self-report measures for clients and staff o Recruited clients with the following inclusion criteria: ABI, funding for therapy, able/willing to travel oacquired written informed consent to participate in program o 3 clients participated and provided feedback o 5 staff members participated and provided feedback o Literature review Findings Client What they liked o Movement enjoyable o Fun to do o Interesting and novel experience o Enjoyed seeing success o Positive activity, productive use of time Findings Client What they didn t like o Pictures of items should be more clear o Instant replay of their performance o Clearer information on benefit of using software o Concern over cost of program o Repetitive UE movement leading to pain 5

6 Findings Client Would they keep using it otwo of the three participants interested in continuing with the program oongoing participation was preferable in the home setting othird participant was not interested in continuing due to perceived lack of challenge Findings - Therapists What we liked oexciting new potential direction for therapy oautomatically increases difficulty otracks client progress oincorporate of cognitive and physical elements Findings - Therapists Recommendations oall tasks should be functional o In-game baseline assessment to rapidly determine level of difficulty ofully developed version for in-home use (simpler, less cords etc.) opause game to review instructions 6

7 Take Away Points o Not replacing therapy, to be used in addition to occupation-based therapy o New direction for therapy that has potential oclient-centred and intrinsically motivating o Potentially more beneficial in an inpatient or outpatient setting o Need to be aware of potential conflict of interest o Peer reviewed, third party research to be completed References Ahissar, M. & Hochstein, S. (2004). The reverse hierarchy theory of visual perceptual learning. Trends in cognitive sciences, 8, Alexander, A. L., Brunye, T., Sidmna, J., Weil, S. A. (2005). From gaming to training: A review of studies on fidelity, immersion, presence, and buy-in and their effects on transfer in pc-based simulations and games. DARWARS Training Impact Group, 5, Cicerone, K.D., Langenbahn, D.M., Braden, C., Malec, J.F., Kalmer, K., Fraas, M., Felicetti, T., Laatsch, L., Harely, J.P., Bergquist, T., Azulay, J., Cantor, J. & Ashman, T. (2011). Evidence-based cognitive rehabilitation: Updated review of the literature from 2003 through Arch Phys Med Rehabil, 92, De Luca R., Calabro, RS., Gervasi, G., DeSalvo S., Bonanno, L., Corallo, F., De Cola, MC., Bramanti, P. (2014) Is computer-assisted training effective in improving rehabilitative outcomes after brain injury? A case-control hospital-based study. Disability and Heath Journal, 7(3), Eliav, R., Blumenfeld, B., Swartz, Y., Preminger, S., Rand, D., & Sacher, Y. (2014). Training executive functions with natural and adaptive virtual games in traumatic brain injury Pilot study. Rehabilitation 2014 Abstract Book (pp.92). Finn, M. & McDonald, S. (2011). Computerised cognitive training for older persons with mild cognitive impairment: A pilot study using a randomised controlled trial design. Brain Impairment, 12(3), Green, C. S., & Bavelier, D. (2008). Exercising your brain: A review of human brain plasticity and training-induced learning. Psychology and Aging, 23, Greitzer, F. L., Kuchar, O. A., & Huston, K. (2007). Cognitive science implications for enhancing training effectiveness in a serious gaming context. Journal on Educational Resources in Computing, 7, References Hardy, J.L., Drescher, D., Sarkar, K., Kellet, G. & Scanlon, M., (2011). Enhancing visual attention and working memory with a web-based cognitive training program. Mensa Research Journal, 42(2), Holzschneider, K., Wolbers, T., Roder, B., & Hottling, K. (2012). Cardiovascular fitness modulates brain activation associated with spatial learning. Neuroimage, 59, Kempermann, G. (2008). The neurogenic reverse hypothesis: What is adult hippocampal neurogenisis good for? Trends in Neuroscience, 31, Larson, E., Feigon, M., F., Gagliardo, P., & Dvorkin, A.Y. (2014). Virtual reality and cognitive rehabilitation: A review of current outcome research. NeuroRehabilitation. 394): Li, K., Robertson, J., Ramos, J., & Gella, S. (2013). Computer-based cognitive retraining for adults with chronic acquired brain injury: A pilot study. Occupational Therapy in Health Care. 27(4): Prokopenko, S.V., Mozheyko, E.Y., Petrova, M.M., Koryagina, T.D., Kaskaeva, D.S, Vhernykh, T.V., Shvetzova, I.N. & Bezdenezhnih, A.F. (2013). Correction of post-stroke cognitive impairments using computer programs. Journal of Neurological Sciences, 325, Seidler, R. D. (2004). Multiple motor learning experiences enhance motor adaptability. Journal of cognitive neuroscience, 16, Toglia, J., Johnston, M. V., Goverover, Y., & Dain, B. (2010). A multicontext approach to promoting transfer of strategy use and self regulation after brain injury: An exploratory study. Brain Injury, 24,