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COMPUTERS FOR MEMORY TRAINING: A new way to the early intervention in Dementia.

M.A., FRANCO MARTÍNT. ORIHUELA VILLAMERIELY. BUENO AGUADOP. GÓMEZ CONEJOD. GONZÁLEZ GATÓN

INTRAS FOUNDATIONAdress: Santa Lucía, núm. 19 - 1ª Planta (Edif. INTERCIMA)

47005-ValladolidTfno.: +34 83 39.96.33Fax number: +34 83 21.75.65http://www.intras.ese-mail: intras@intras.es

It looks obvious that one of the most important treatments for the cognitive impairment is thecerebral training. However we can find several dificulties to introduce the neuropsychological programsin clinical settings. It is just because some of the following reasons:

1) Therapist spend a long time for neuropsychological rehabilitation and due to thisreason of the therapy turns very expensive. So the Director Manager of the clinicalsetting often considers that it is better for the economy of the center to decrease thiskind of therapy.

2) It is necessary an specific trainer or a qualified person to apply theneuropsychological rehabilitation. Not all the psychologist or phisician know theneuropsychological techniques.

3) There are few qualified specialist in neuropsychological rehabilitation, so it is noteasy 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 difficulttoo.

5) When patiens live too far, for example in a small village, it´s very difficult to follow-upthem.

6) At last, the progress cognitive impairment of the patient, for example in dementia,

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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 andmake the scores... and at last, it´s easy that a Burnout Syndrome Appears.

For preventieng this picture we have to do neuropsychological rehabilitation programs with thefollowing characteristics:

. Flexible: Useful for many different users with different grades of cognitiveimpairment.

. Open: The program must be able to introduce all new advances aboutneuropsychological rehabilitation easily.

. Easy: It is neccesary that the rehabilitation program can be aplied by noqualified people in this area such as workers as nurses. So theneuropsychologist is not required every day and he just has toestablish 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 weaply computers for the memory training we can find the following advantages:

. Many boring cognitive exercices can be aplied automatically. So, it is very useful toprevent the Burnout Syndrome.. Computers give a quick feedback just after the answer of the user. It is very importantfor his motivation.. It is posible to increase time for memory training because the user can continue thetraining 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 clinicalsettings, 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 compatiblewith all computers. It is a great problem when we want to charge the computer or theuser has a different computer than me.. Usually the computer rehabilitation programs are rigid and they do not often give usthe possibility modificate cognitive exercises. We only can do what the program knowto do and no more.. Nowadays, computer programs for memory training are very expensive, and thencost of neuropsychological rehabilitation goes on very high.. Software is very rigid, so it is difficult to adapt the memory training to the specificcognitive impairment in every patient.. And at last it looks obvious that we have an strong dependence of computer

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Graph 1

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 forcerebral training we have designed the “GRADIOR” System. It´s a software program useful forcognitive assessment and neuropsychological rehabilitation and beside only need an standardmultimedia 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 beincluded in different exercises. Then every cognitive activity or function is related with an exercise modeland 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 exercisemodel. 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 specificexercises for cerebral training. So he has to use the knowledge storage and the properexercise 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 thepatient: sociodemographic data, treatment and cognitive scores in scales asMinimental Test, ADAS...

In the treatment desing, the therapist chooses the specific cognitive exercises

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Graph 2

for the patient, number and kind of them and stablishs the level of dificculty of everyexercise. In this way, the therapist can apply an individual memory training to everypatient.

In the reports, the therapist can print the scores of every patient for the follow-up of the rehabilitation program.

3) And Third, cerebral training application. The patient works with the computer andmake different exercises. Besides it´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 patientdepending on the cognitive level, specific features or an other clinic symtoms. In this way, only 90exercises fulfil the specific conditions for the example patient. Finally, in the third module, this patientperforms the specific rehabilitation session in which every time one of the ninety exercises is randomlyran.

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Graph 3

Graph 4

In this way, in every session the patient performs several exercises, more o less, depending onthe time spend in every exercise. Then, when the patient finishes to perform all selected exercices, thesystem 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 exercisesin each circle of treatment (graph.3). And then, he can do differences among the diferent contents. Andso the scores may be like the showed in the graph 4. But, what happens in these four times in the bigdot?

There is the same cognitive activity, but different contents, then it is possible that thesecontents are influencing in cognitive scores. So, we can elaborate different hypothesis about theinfluence of the contents on cognitive outputs. It is important to elaborate more specific memorytraining 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 theearly intervention in dementia.

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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 yEntrenamiento 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 rehabilitaciónneuropsocológica. En OSTROSKY-SOLIS; ARDILA, A.; CHAYO-DICHY,R.: RehabilitaciónNeuropsicológica. Ed. Planeta. Méjico.

WILSON, B.; PATTERSON K. (1990): Rehabilitation and cognitive neuropsychology does cognitivepsychology apply?. Rev. Applied Cognitive Psychology, 4, 247-260.