Cognitive therapy and brain training
Screening: 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
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Inhaltsverzeichnis Teil I Applications
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Teil II Target group
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Teil III Structure
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Teil IV Implementation and Duration
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Teil V Data analysis
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Teil VI Bibliography
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Index
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Applications Basic information on the screening you will find in the RehaCom manual, Chapter "Screening and Diagnostics". The visual-spatial memory span and the visual-spatial memory functions are determined. The task is also used to test the implicit visual-spatial learning and the working memory.
The screening is similar to the classic Corsi-Block-Tapping.
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Target group Attention disorders may occur in almost all neurological diseases, which affect the central nervous system. Depending on whether these diseases lead to rather circumscribed and localized brain damages (such as a stroke) or to rather diffused impairments (such as traumatic brain injury or degenerative diseases), the malfunction in the attention area can be rather specific or global. Cerebrovascular Diseases After lesions in the brain stem portion of the formatio reticularis (Mesulam 1985) and after strokes, especially in the area of the median brain artery (A. cerebri media) of
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Target group
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the right brain hemisphere, disorders of attention activation as well as the vigilance and the long-term maintenance of attention can occur (Posner et al. 1987). While the reticular system of the brain stem portion is the "noradrenergic source" of attention activation(Stuss u. Benson 1984), the frontothalamic "Gating-System" controls the selective and directed allocation of this attention activation. Lesions of this system lead to a limited selectivity for external stimuli and to increased distractibility, i.e. to disorders of the attention focus. Lesions especially of frontal parts of the left hemisphere, also cause impairments of attention selectivity, especially in situations, in which fast decisions between relevant and irrelevant aspects of a task have to be made (Dee u. van Allen 1973, Sturm u. Bussing 1986). Disorders of spatial attention can be selectively affected by localized brain damages. Damages of the posterior parietal lobe seem to lead especially to disorders of disengaging the attention off a stimulus, when the attention must be moved towards a target stimulus in the room half on the opposite side of the lesion (Posner et al. 1984). Here, a cause for a unilateral neglect after a parietal lesion is seen (see guidline "Rehabilitation of disorders of spatial cognition"). Disorders of divided attention seem to occur particularly often after bilateral frontal vascular damages (Rousseaux et al. 1996). Traumatic Brain Injury (TBI) Along with memory disorders, attention impairments are the most common neuropsychological deficits after a TBI. The most consistent result after TBI is a general, non-specific slowdown of the information processing. The cause of this malfunction after TBI remains largely unclear. As a pathological correlate of the damage due to the mainly rotational acceleration of the brain, "diffuse axonal damages" are discussed or a hypometabolism in prefrontal and cingulate brain areas (Fontaine et al. 1999). Multiple Scleroses Cognitive slowing and increased variability with an often preserved performance quality at the beginning of the disease is a widespread deficit in patients with multiple sclerosis, so that tests with reaction time measurement are of special significance in this disease. It is obvious, that this retardation relatively independent of the individual sub-functions of the attentional performance. As neuronal basis, a diffusely localized axonal damage and demyelination is assumed, whose counterpart a generally increased degree of brain atrophy could be proved (e. g. Lazeron et al. 2006). Neurodegenerative Diseases Already at the early stage of Alzheimer- dementia (AD), attention deficits are often seen. They often seem to occur after memory disorders, but before impairments of language and spatial performances (Perry et al. 2000). Other results indicate a
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relative maintenance of the cognitive control of attention activation and visuo-spatial attention, but also early disorders of the selective attention. In the course of the disease, also disorders of the inhibitory control increase. In Lewy body dementia, fluctuating attention performances and deficits in the visuospatial attention are a central diagnostic criterion. Recent studies (Calderon et al. 2005) reported that clients showed significant worse results in almost all attention functions (sustained attention, selective attention, divided attention) compared to AD-patients. Patients with Parkinson's disease or Huntington's chorea generally show no deficits in phasic alertness and vigilance tasks, whereas patients with progressive supranuclear paralysis (Steele-Richardson-Olszewski-Syndrome) suffer from such disorders. Disorders of the divided attention seem to be a general problem in dementia diseases in later stages of diseases. Depression and Attention Disorders Even in case of depression, memory and attention disorders are to the fore of the cognitive functional impairments. Primarily, conscious cognitive controlled functions are affected. Especially the performance during tasks for the attention distribution has been identified as a prognostic parameter (Majer et al. 2004). Only in very severe depressions, disorders of automatic processing can be present (Hartlage et al. 1993). In comparison to e.g. patients after traumatic brain injury (TBI) depressed patients often estimate their performances worse than they actually are in the psychometric examination. Farrin et al. (2003) could show that this negative selfassessment, e.g during task for sustained attention, can lead to "disaster reactions" after mistakes with an enlarged reaction times immediately afterwards. TBI -patients did not show such reactions. Source: Leitlinien fĂźr Diagnostik und Therapie in der Neurologie; 4. revised edition, ISBN 978-3-13-132414-6; Georg Thieme Verlag Stuttgart
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Structure Ten dots are presented in a circle.
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Structure
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Figure 1: dotted circle during screening, flashing dots represent the sequences to be memorized
Individual dots light up in color and fade again. Beginning with two colored dots, the position of those dots should be marked in the appropriate order, after they lit up. The task is to register and memorize the presentation order and the skips. The subject should try to memorize the position order of the red dots and to reproduce them. The program allows a adaptive adjustment according to the performance of the client. In case of a failure, the degree of difficulty is reduced automatically. The screening ends after two consecutive failures or after 7 minutes.
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Implementation and Duration The test starts with an exercise, in which a sequence from two dots has to be reproduced correctly.
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Figure 1: Practice screen
Subsequently to the exercise, the test starts.
Figure 2: During the Screening
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Implementation and Duration
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The subject has to memorize and reproduce the position order of the colored flashing dots. Based on two consecutive flashing dots, the number of the flashing dots and of the dots to be memorized increases, until errors occurs. The sequence is extended, whenever sequences of the same length were reproduced two times without an error. When an error occurs, less flashing dots are presented in an order, the sequence length decreases. When two consecutive sequences are reproduced incorrectly, the screening is completed. If the subject works on the task continually correct, the screening ends after 7 minutes.
Duration 2 - 7min
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Data analysis Basic information on the data analysis of the screening results you will find in the RehaCom manual, chapter "Results screening". In the screening Working Memory, two Z-values are calculated. Z-value 1: Attention Number of correct dots in the highest level Z-value 2: Memory capacity Highest fully completed level. A level is considered as completed, when two consecutive sequences of the same length were reproduced correctly. Details Detailed information on the course of the screening can be displayed via the button "Details". On the right side is a list of all conducted screenings of the working memory and their end times. Results marked with an asterisk (*) indicate that the particular screening was canceled. In this case, the evaluation is incomplete. The detailed analysis allows the presentation of a maximum of three results at the
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same time. The first and the last fully completed screening is preselected. One can change the selection by clicking the particular checkbox. The display in the performance diagram and the table changes accordingly. The background color of each result row corresponds to the line color in the diagram. The performance graphic shows the number of correctly reproduced sequences per level. Characteristic is a distinct performance peak in a closed level area (in figure 1: level 3 and 4). For the detailed display of the number of correct sequences, one can click on the square marker. The most and least correct answers of a screening are displayed automatically.
In the chart of the tab "Summary", a row is assigned for every result selected on the right side (figure.2). The columns have the following meaning: Date: Duration: Max. Level: Correct in a row: Errors position: Errors order: order Rule 1: Z-value 1:
End time of the screening Duration of the screening without practice time Highest completed level (corresponds Z-value 2) Number in a row, reproduced sequences without errors Sum of all wrong selected dots Sum of all correct dots, which were marked in a wrong Used rules for calculating the Z-value Calculated Z-value for attention
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Data analysis
Rule 2: Z-value 2:
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Used rules for calculating the Z-value Calculated Z-value for memory capacity
Bibliography Baddeley, A. D. (2012). Working Memory: Theories, models, and controversies. Annual Review of Psychology, 63(1), 1–29. Thöne-Otto, A., George, S., Hildebrandt, H., Reuther, P., Schoof-Tams. K., Sturm, W., & Wallesch, C.-W. (2010). Leitlinie zur Diagnostik und Therapie von Gedächtnisstörungen. Zeitschrift für Neuropsychologie, 21, 271-281. Berti, S. (2010). Arbeitsgedächtnis: Vergangenheit, Gegenwart und Zukunft eines theoretischen Konstruktes. Psychologische Rundschau, 61(1), 3–9. Baddeley, A. D. (2009). Working memory. In: A. D. Baddeley, M. W. Eysenck & M. C. Anderson. Memory (pp. 41–68). Hove, New York: Psychology Press. ISBN 978-184872-001-5. Baddeley, A.D. (2003). Working memory. Looking back and looking forward. Nature Reviews Neuroscience, 4, 829-839. Sturm, W. (2002). Diagnostik von Aufmerksamkeitsstörungen in der Neurologie. Aktuelle Neurologie, 29, 25-29. de Fockert, J.W., Rees, G., Frith, C.D. & Lavie, N. (2001) The role of working memory in visual selective attention. Science, 291, 1803-1806. Miyake, A., & Shah, P. (Eds.) (1999). Models of working memory: Mechanisms of
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active maintenance and excutive control. Cambridge: Cambridge University Press. Coull, J.T. & Frith, C.D., Frackowiak, R.S.J. & Grasby, P.M. (1996) A fronto-parietal network for rapid visual information processing: A PET study of sustained attention and working memory. Neuropyschologia, 34, 1085-1095. Baddeley, A.D. (1993). Working Memory or Working Attention. In A.D. Baddeley & L. Weiskrantz (Hrsg.), Attention: Selection, Awareness and Contro/. Oxford: University Press. Baddeley, A.D. (1986). Working Memory. Oxford: Oxford Univ. Press. Baddeley, A.D. & Hitch, G. (1974). Working memory. In G.H. Bower (Hrsg.), The Psychology of Learning and Motivation (Bd. 8, S. 47-89). New York: Academic Press. Leitlinien fur Diagnostik und Therapie in der Neurologie; 4. Ăźberarbeitete Auflage, ISBN 978-3-13-132414-6; Georg Thieme Verlag Stuttgart
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Index
Index
-Llesions
-A-
-M-
adaptive 3 alzheimer- dementia applications 1 attention 1, 6
memorize 3 memory capacity memory span 1 multiple scleroses
1
-B8
1
neurodegenerative diseases
-C-
-O-
cerebrovascular diseases 1 circle 3 Corsi-Block-Tapping 1 course of the screening 6
order
3
-P-
-D-
position order 3, 4 presentation 6
data analysis 6 degree of difficulty 3 depression and attention disorders details 6 diagram 6 dots 3, 4 duration 4, 6
-Eerrors 4 evaluation 6 exercise 4
-F-
-R1
results
6
-Ssequence 4, 6 skips 3 spatial 1 structure 3 subject 3, 4 summary 6
-Ttarget group 1 traumatic brain injury
3
-Ggraphic
6
-N-
bibliography
failure
1
-V6
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vigilance
1
1
1
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1
-Wworking memory
1
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