Reducing everyday memory and planning problems by means of a paging system: a randomised control crossover study

From conception to evaluation of mobile services for people with head injury: A participatory design perspective

Adults with cognitive impairments lack the means to organise their daily life, plan their appointments, cope with fatigue, and manage their budget. They manifest interest in using new technologies to be part of society. Unfortunately, the applications offered on smart phones are often beyond their cognitive abilities. The goal of this study was to design a mobile cognitive assistant to enhance autonomy of people living with acquired traumatic brain injury. Participatory design methodologies guided this research by involving adults with cognitive impairments (CI) and their caregivers in the early stages of the design process. The population of the study is composed of four male adults who present cognitive impairments (three with head injury and one with stroke) and three caregivers. The first phase of this research was to design the Services Assistance Mobile and Intelligent (SAMI) application based on the needs expressed by the participants. During three focus groups, needs emerged concerning planning, health monitoring and money management and led to the implementation of assistive solutions on an Android mobile phone. During the second phase, the participants evaluated the mobile assistant SAMI at home for eight weeks. The results demonstrate that the participants were able to participate actively in the conception of SAMI and to use it successfully. People with CI showed a slight improvement in their life satisfaction. Due to the small number of participants, these promising results need to be confirmed by a larger-scale study.

An RCT to Treat Learning Impairment in Traumatic Brain Injury

Objective. To examine the efficacy of the modified Story Memory Technique (mSMT) to improve learning (ie, acquisition) and memory in participants with TBI. The mSMT is a behavioral intervention that teaches context and imagery to facilitate learning within 10 sessions over 5 weeks. Methods. A total of 69 participants with moderate-severe Traumatic Brain Injury (TBI), 35 in the treatment group and 34 in the placebo control group, completed this double-blind, placebo-controlled randomized clinical trial. A baseline neuropsychological assessment was administered, including questionnaires assessing everyday memory. Repeat assessments were conducted immediately posttreatment and 6 months following treatment. Participants in the treatment group were randomly assigned to a booster session or a non–booster session group after completion of treatment with the mSMT to examine the efficacy of monthly booster sessions in facilitating the treatment effect over time. Results. The treatment group demonstrated significant improvement on a prose memory task relative to the placebo group posttreatment (η2 = 0.064 medium effect). Similar results were noted on objective measures of everyday memory, specifically prospective memory (Cohen’s w = 0.43, medium effect), and family report of disinhibition in daily life (η2 = 0.046, medium effect). Conclusion. The mSMT is effective for improving learning and memory in TBI. Classification of evidence. Based on widely accepted classification systems for treatment study design, this study provides class I evidence that the mSMT behavioral intervention improves both objective memory and everyday memory in persons with TBI over 5 weeks. Thus, this study extends the evidence for efficacy of the treatment protocol to a sample of persons with TBI.

Enhancing prospective memory in mild cognitive impairment: The role of enactment

INTRODUCTION

Prospective memory (PM) is a fundamental requirement for independent living which might be prematurely compromised in the neurodegenerative process, namely in mild cognitive impairment (MCI), a typical prodromal Alzheimer's disease (AD) phase. Most encoding manipulations that typically enhance learning in healthy adults are of minimal benefit to AD patients. However, there is some indication that these can display a recall advantage when encoding is accompanied by the physical enactment of the material. The aim of this study was to explore the potential benefits of enactment at encoding and cue-action relatedness on memory for intentions in MCI patients and healthy controls using a behavioral PM experimental paradigm.

METHOD

We report findings examining the influence of enactment at encoding for PM performance in MCI patients and age- and education-matched controls using a laboratory-based PM task with a factorial independent design.

RESULTS

PM performance was consistently superior when physical enactment was used at encoding and when target-action pairs were strongly associated. Importantly, these beneficial effects were cumulative and observable across both a healthy and a cognitively impaired lifespan as well as evident in the perceived subjective difficulty in performing the task.

CONCLUSIONS

The identified beneficial effects of enacted encoding and semantic relatedness have unveiled the potential contribution of this encoding technique to optimize attentional demands through an adaptive allocation of strategic resources. We discuss our findings with respect to their potential impact on developing strategies to improve PM in AD sufferers.

Identifying participation needs of people with acquired brain injury in the development of a collective community smart home

PURPOSE

This study explored the personalized and collective participation needs of people with acquired brain injury (ABI) living in a future shared community smart home.

METHODS

An action research study was conducted with 16 persons, seven with ABI, four caregivers and five rehabilitation or smart home healthcare providers. Twelve interviews and two focus groups were conducted, audiotaped, transcribed and analyzed for content.

RESULTS

Seventy personalized and 18 collective participation needs were reported related to daily and social activities. Personalized needs concerned interpersonal relationships, general organization of activities, leisure, housing, fitness and nutrition. Collective needs related mainly to housing, general organization of activities and nutrition.

CONCLUSIONS

Personalized and collective participation needs of people with ABI planning to live in a community smart home are diverse and concern daily as well as social activities. Implications for Rehabilitation To meet participation needs of people with ABI, the design of smart homes must consider all categories of daily and social activities. Considering personalized and collective needs allowed identifying exclusive examples of each. As some persons with ABI had difficulty identifying their needs as well as accepting their limitations and the assistance required, rehabilitation professionals must be involved in needs identification.

Strategic use of reminders: Influence of both domain-general and task-specific metacognitive confidence, independent of objective memory ability

How do we decide whether to use external artifacts and reminders to remember delayed intentions, versus relying on unaided memory? Experiment 1 (N=400) showed that participants' choice to forgo reminders in an experimental task was independently predicted by subjective confidence and objective ability, even when the two measures were themselves uncorrelated. Use of reminders improved performance, explaining significant variance in intention fulfilment even after controlling for unaided ability. Experiment 2 (N=303) additionally investigated a pair of unrelated perceptual discrimination tasks, where the confidence and sensitivity of metacognitive judgments was decorrelated from objective performance using a staircase procedure. Participants with lower confidence in their perceptual judgments set more reminders in the delayed-intention task, even though confidence was unrelated to objective accuracy. However, memory confidence was a better predictor of reminder setting. Thus, propensity to set reminders was independently influenced by (a) domain-general metacognitive confidence; (b) task-specific confidence; and (c) objective ability.

Smartphone technology: Gentle reminders of everyday tasks for those with prospective memory difficulties post-brain injury

BACKGROUND

Prospective memory is a common deficit following brain injury that can reduce an individuals' ability to complete everyday tasks. The smartphone is a device that may compensate for these difficulties using the calendar's prompting function. Reminders can be programmed remotely using email to phone synchronization.

OBJECTIVE

To explore whether smartphone reminders help people complete pre-identified tasks as compared to when reminders are not provided.

METHODS

An ABAB case series design compared reminder present vs. reminder absent phases with regards completion of pre-set tasks. Six participants aged 24-55 with Acquired Brain Injury (ABI) and five caregivers participated in the study. Both completed a series of questionnaires looking at the impact of the smartphone reminders on everyday memory functioning at pre, post and follow-up. A 3-month follow-up questionnaire assessed continued use of the system.

RESULTS

There was a significant improvement in task completion rates when smartphone reminders were provided. A thematic analysis identified that smartphone reminders improved independence, confidence in coping with memory difficulties and general mood. All participants were still using the system at 3-month follow-up.

CONCLUSIONS

Smartphone reminders may provide a cost-effective, accessible and non-stigmatizing tool for participants to compensate for prospective memory difficulties.

Strategic offloading of delayed intentions into the external environment

In everyday life, we often use external artefacts such as diaries to help us remember intended behaviours. In addition, we commonly manipulate our environment, for example by placing reminders in noticeable places. Yet strategic offloading of intentions to the external environment is not typically permitted in laboratory tasks examining memory for delayed intentions. What factors influence our use of such strategies, and what behavioural consequences do they have? This article describes four online experiments (N = 1196) examining a novel web-based task in which participants hold intentions for brief periods, with the option to strategically externalize these intentions by creating a reminder. This task significantly predicted participants' fulfilment of a naturalistic intention embedded within their everyday activities up to one week later (with greater predictive ability than more traditional prospective memory tasks, albeit with weak effect size). Setting external reminders improved performance, and it was more prevalent in older adults. Furthermore, participants set reminders adaptively, based on (a) memory load, and (b) the likelihood of distraction. These results suggest the importance of metacognitive processes in triggering intention offloading, which can increase the probability that intentions are eventually fulfilled.

Differential focal and nonfocal prospective memory accuracy in a demographically diverse group of nondemented community-dwelling older adults

Although prospective memory (PM) is compromised in mild cognitive impairment (MCI), it is unclear which specific cognitive processes underlie these PM difficulties. We investigated older adults' performance on a computerized event-based focal versus nonfocal PM task that made varying demands on the amount of attentional control required to support intention retrieval. Participants were nondemented individuals (mean age=81.8 years; female=66.1%) enrolled in a community-based longitudinal study, including those with amnestic MCI (aMCI), nonamnestic MCI (naMCI), subjective cognitive decline (SCD), and healthy controls (HC). Participants included in the primary analysis (n=189) completed the PM task and recalled and/or recognized both focal and nonfocal PM cues presented in the task. Participants and their informants also completed a questionnaire assessing everyday PM failures. Relative to HC, those with aMCI and naMCI were significantly impaired in focal PM accuracy (p<.05). In a follow-up analysis that included 13 additional participants who successfully recalled and/or recognized at least one of the two PM cues, the naMCI group showed deficits in nonfocal PM accuracy (p<.05). There was a significant negative correlation between informant reports of PM difficulties and nonfocal PM accuracy (p<.01). PM failures in aMCI may be primarily related to impairment of spontaneous retrieval processes associated with the medial temporal lobe system, while PM failures in naMCI potentially indicate additional deficits in executive control functions and prefrontal systems. The observed focal versus nonfocal PM performance profiles in aMCI and naMCI may constitute specific behavioral markers of PM decline that result from compromise of separate neurocognitive systems.

The effect of group reminiscence on the cognitive status of elderly people supported by ilam welfare organization in 2013; a randomized controlled clinical trial

BACKGROUND

Cognitive impairments, which are common problems among the elderly people, account for a wide range of aging disorders. Group reminiscence can be used as a profitable therapeutic method for preventing cognitive-behavioral disorders in older adults. Therefore, we aimed to investigate the effect of group reminiscence on the cognitive status of elderly people.

METHODS

This study was a non-blinded randomized controlled trial. We enrolled 100 elderly people who were under the support of Ilam Welfare Organization, western Iran in 2013. Balanced block randomization method was used to randomize the participants into intervention and control groups.Elderly people in the intervention group participated in a group reminiscence program consisted of two one-hour sessions per week for 8 consecutive weeks. Data were collected using Mini Mental State Examination (MMSE). The questionnaire was completed four times by the participants; before, immediately after, two and three months after the intervention.

RESULTS

The mean±SD of cognitive status scores in the intervention group was 24.66±3.8 which increased to 25.02±3.67, 25.04±3.72 and 24.72±3.66 immediately after, two and three months after the intervention respectively. The results showed that the changes in the mean scores were statistically significant in the intervention group immediately after the intervention (P=0.001) and at second month (P=0.003) follow-ups. However, we found no statistically significant difference in the intervention group at the mentioned time intervals in this regards (P=1.000). 

CONCLUSION

We concluded that continuous programs of group reminiscence could improve cognitive status of elderly population.

TRIAL REGISTRATION NUMBER

IRCT201405147531N7.

Google Calendar: A single case experimental design study of a man with severe memory problems

A single case experimental design across behaviours was utilised to explore the effectiveness of Google Calendar text alerts delivered to a mobile phone as a memory aid. The participant was a 43-year-old man (JA) with severe memory problems and executive difficulties caused by a traumatic brain injury (TBI). JA was initially very unwilling to use any memory aid and so a detailed assessment of his beliefs about memory aids, his cognitive difficulties and his social context was performed and a set of specifications for an aid was produced collaboratively. Six weeks of baseline data and six weeks of intervention data were collected for three target memory behaviours and three control memory behaviours. Results were analysed using nonoverlap of all pairs (NAP) analysis which showed a reduction in forgetting in the three target behaviours and no change in two of the three control behaviours. A subjective measure (the revised Everyday Memory Questionnaire) also suggested improvement. This study illustrates that Google Calendar is a highly effective memory aid and emphasises the importance of choosing a memory aid to suit the person's lifestyle and beliefs.

Efficacy of electronic portable assistive devices for people with acquired brain injury: a systematic review

A systematic review was conducted to evaluate the efficacy of electronic portable assistive devices (EPADs) for people with acquired brain injury. A systematic database search (OVID, CINAHL) found 541 citations published between 1989 and the end of 2012. A total of 23 reports met the inclusion/exclusion criteria, namely intervention studies (group, n-of-1) testing the efficacy of EPADs as compensatory devices for cognitive impairment for people with acquired brain injury aged 16-65 years. Study quality was rated by the PEDro (Physiotherapy Evidence Database) scale, (randomised controlled trials), the Downes and Black tool (other group intervention studies), and the Single Case Experimental Design tool (single participant studies). Levels of evidence were determined using five levels of classification based on the Spinal Cord Injury Rehabilitation Evidence table. Results found no Level 1 studies (RCTs with PEDro score ≥ 6), four Level 2 studies and 10 Level 3 studies. There was insufficient evidence to recommend any practice standards, but sufficient evidence to recommend the use of electronic reminder systems in supporting the everyday functioning of people with acquired brain injury as a practice guideline. Higher quality studies are required to support a broader range of compensatory roles that EPADs have the potential to play in neurorehabilitation and the long-term support of people with acquired brain injury.

Prospective memory training in older adults and its relevance for successful aging

In research on cognitive plasticity, two training approaches have been established: (1) training of strategies to improve performance in a given task (e.g., encoding strategies to improve episodic memory performance) and (2) training of basic cognitive processes (e.g., working memory, inhibition) that underlie a range of more complex cognitive tasks (e.g., planning) to improve both the training target and the complex transfer tasks. Strategy training aims to compensate or circumvent limitations in underlying processes, while process training attempts to augment or to restore these processes. Although research on both approaches has produced some promising findings, results are still heterogeneous and the impact of most training regimes for everyday life is unknown. We, therefore, discuss recent proposals of training regimes aiming to improve prospective memory (i.e., forming and realizing delayed intentions) as this type of complex cognition is highly relevant for independent living. Furthermore, prospective memory is associated with working memory and executive functions and age-related decline is widely reported. We review initial evidence suggesting that both training regimes (i.e., strategy and/or process training) can successfully be applied to improve prospective memory. Conceptual and methodological implications of the findings for research on age-related prospective memory and for training research in general are discussed.

Outcomes of neuropsychological interventions of stroke

The reported prevalence of cognitive deficits within the first month of stroke ranges widely from 10% to 82%, depending primarily on the criteria used to define cognitive impairment and on the selected patient population. These cognitive defects progress toward impairment over a course of time if left untreated. Among the most common cognitive deficits are the attentional, the visuoperceptual, the memory and executive function deficits. As these impairments are being increasingly recognized in the scientific communities, more and more studies are being devoted to the outcomes of various therapies for these disorders. In this review, we focus on the outcomes of various therapies for these cognitive disorders over time. We reviewed all the possible medical databases using key words for individual cognitive deficit treatment outcomes. All the possible studies including randomized controlled trials, pre-post design studies, case series and single case reports were included in this study. On the basis of present literature review, we conclude that the evidence is definitively positive only for outcomes of attentional and visuoperceptive skill deficits. On the other hand, there have been very few studies to conclude for effectiveness of various therapies for memory and executive function outcomes.

Comparison of remedial and compensatory approaches in memory dysfunction: a comprehensive literature review

ABSTRACT Memory is a cognitive process of information storage and retrieval that is essential to performing daily functional activities efficiently. Occupational therapists regularly help individuals with memory impairment to manage their memory deficits. The purpose of this paper was to review the main memory strategies and instructional methods used to improve or manage memory. Studies were identified by searching for the relevant literature published between 1980 and 2007 through the use of several databases with the inclusion criteria that the study must identify at least one specific memory rehabilitation method with an outcome measure representative of the specific method. The reviewed studies included three reviews, 10 randomized control trials, 17 quasi-experimental studies, and five single subjects' designs. The results suggest that there is empirical evidence to support the effectiveness of certain remedial and compensatory memory rehabilitation methods with healthy populations, but weaker evidence can be identified for the memory-impaired populations. In general, remedial methods are effective in lab settings with primarily healthy populations, yet effectiveness in daily activities is less clear. Compensatory methods are generally more efficient than remedial ones and more easily generalized to daily activities, even with memory-impaired populations.

Stroke, cognitive deficits, and rehabilitation: still an incomplete picture

Cognitive impairment after stroke is common and can cause disability with major impacts on quality of life and independence. There are also indirect effects of cognitive impairment on functional recovery after stroke through reduced participation in rehabilitation and poor adherence to treatment guidelines. In this article, we attempt to establish the following: ● whether there is a distinct profile of cognitive impairment after stroke; ● whether the type of cognitive deficit can be associated with the features of stroke-related damage; and ● whether interventions can improve poststroke cognitive performance. There is not a consistent profile of cognitive deficits in stroke, though slowed information processing and executive dysfunction tend to predominate. Our understanding of structure-function relationships has been advanced using imaging techniques such as lesion mapping and will be further enhanced through better characterization of damage to functional networks and identification of subtle white matter abnormalities. Effective cognitive rehabilitation approaches have been reported for focal cortical deficits such as neglect and aphasia, but treatments for more diffusely represented cognitive impairment remain elusive. In the future, the hope is that different techniques that have been shown to promote neural plasticity (e.g., exercise, brain stimulation, and pharmacological agents) can be applied to improve the cognitive function of stroke survivors.

Cognitive rehabilitation for executive dysfunction in adults with stroke or other adult non-progressive acquired brain damage

BACKGROUND

Executive functions are the controlling mechanisms of the brain and include the processes of planning, initiation, organisation, inhibition, problem solving, self monitoring and error correction. They are essential for goal-oriented behaviour and responding to new and novel situations. A high number of people with acquired brain injury, including around 75% of stroke survivors, will experience executive dysfunction. Executive dysfunction reduces capacity to regain independence in activities of daily living (ADL), particularly when alternative movement strategies are necessary to compensate for limb weakness. Improving executive function may lead to increased independence with ADL. There are various cognitive rehabilitation strategies for training executive function used within clinical practice and it is necessary to determine the effectiveness of these interventions.

OBJECTIVES

To determine the effects of cognitive rehabilitation on executive dysfunction for adults with stroke or other non-progressive acquired brain injuries.

SEARCH METHODS

We searched the Cochrane Stroke Group Trials Register (August 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library, August 2012), MEDLINE (1950 to August 2012), EMBASE (1980 to August 2012), CINAHL (1982 to August 2012), PsycINFO (1806 to August 2012), AMED (1985 to August 2012) and 11 additional databases. We also searched reference lists and trials registers, handsearched journals and conference proceedings, and contacted experts.

SELECTION CRITERIA

We included randomised trials in adults after non-progressive acquired brain injury, where the intervention was specifically targeted at improving cognition including separable executive function data (restorative interventions), where the intervention was aimed at training participants in methods to compensate for lost executive function (compensative interventions) or where the intervention involved the training in the use of an adaptive technique for improving independence with ADL (adaptive interventions). The primary outcome was global executive function and the secondary outcomes were specific components of executive function, working memory, ADL, extended ADL, quality of life and participation in vocational activities. We included studies in which the comparison intervention was no treatment, a placebo intervention (i.e. a rehabilitation intervention that should not impact on executive function), standard care or another cognitive rehabilitation intervention.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened abstracts, extracted data and appraised trials. We undertook an assessment of methodological quality for allocation concealment, blinding of outcome assessors, method of dealing with missing data and other potential sources of bias.

MAIN RESULTS

Nineteen studies (907 participants) met the inclusion criteria for this review. We included 13 studies (770 participants) in meta-analyses (417 traumatic brain injury, 304 stroke, 49 other acquired brain injury) reducing to 660 participants once non-included intervention groups were removed from three and four group studies. We were unable to obtain data from the remaining six studies. Three studies (134 participants) compared cognitive rehabilitation with sensorimotor therapy. None reported our primary outcome; data from one study was available relating to secondary outcomes including concept formation and ADL. Six studies (333 participants) compared cognitive rehabilitation with no treatment or placebo. None reported our primary outcome; data from four studies demonstrated no statistically significant effect of cognitive rehabilitation on secondary outcomes. Ten studies (448 participants) compared two different cognitive rehabilitation approaches. Two studies (82 participants) reported the primary outcome; no statistically significant effect was found. Data from eight studies demonstrated no statistically significant effect on the secondary outcomes. We explored the effect of restorative interventions (10 studies, 468 participants) and compensative interventions (four studies, 128 participants) and found no statistically significant effect compared with other interventions.

AUTHORS' CONCLUSIONS

We identified insufficient high-quality evidence to reach any generalised conclusions about the effect of cognitive rehabilitation on executive function, or other secondary outcome measures. Further high-quality research comparing cognitive rehabilitation with no intervention, placebo or sensorimotor interventions is recommended.

Electronic reminding technology for cognitive impairment

Demographic changes highlight the need to address disabilities associated with the costly morbidities of old age, such as dementia. Memory impairment associated with dementia represents a significant challenge for many older people. Difficulties occur in carrying out activities in their entirety or in commencing them at all. Technology has the potential to help individuals overcome the barriers created by cognitive disability in terms of performing activities of daily living and therefore help to maintain independence and enhance quality of life (Czaja, 2005). This literature review examines the current reported research, which employs electronic reminding technology to support individuals with cognitive impairment. These devices range from everyday technologies, such as phones, to sophisticated interactive devices with specifically designed software. A summary of the current evidence base is presented and recommendations for future practice are made.

Long-term benefits of the Memory-Link programme in a case of amnesia

Objective:

To systematically evaluate the maintenance of clinical gains from a structured memory intervention programme. Efficacy of the programme was initially demonstrated in RR, a woman with moderate-to-severe memory impairment following colloid cyst removal. In the current study (Svoboda and Richards, 2009), we examined RR’s day-to-day memory functioning 18 months after completion of the intervention programme.

Design:

Within-subject A1B1A2B2B3 single-case experimental design.

Setting:

Outpatient memory rehabilitation clinic.

Intervention:

A theory-driven training programme in the use of commercially available smartphones for individuals with moderate-to-severe memory impairment.

Main measures:

A phone call task was used as an objective measure of prospective memory function. Self-report, ecologically valid questionnaires were also completed to further assess generalization of smartphone use to day-to-day memory function.

Results:

Eighteen months after intervention, RR completed 80% of scheduled calls using the smartphone, a rate significantly higher than at baseline (40%) and comparable to her success rate immediately following intervention (90%) and at the four-month follow-up (90%). Responses to questionnaires indicated that RR felt more confident in her ability to handle memory-demanding situations and was making fewer memory mistakes. This favourable outcome was not found with the use of another smartphone brand for which training was not received.

Conclusions:

Results from ecologically valid measures of memory functioning demonstrated robust maintenance of independent commercial smartphone use over an 18-month period, with increases observed in independence, confidence and real-life memory functioning. The findings further suggest poor cross-device generalizability.

Design and implementation of clinical trials in rehabilitation research

The growth of evidence-based medicine means that both researchers and clinicians must grasp the complex issues involved in implementing clinical trials, which are especially challenging for the behavioral (experience-based) treatments that predominate in rehabilitation. In this article we discuss selected issues germane to the design, implementation, and analysis of group-level clinical trials in rehabilitation. We review strengths, weaknesses, and best applications of 1-sample, between-subjects, and within-subjects study designs, including newer models such as practical clinical trials and point-of-care trials. We also discuss the selection of appropriate control conditions against which to test rehabilitation treatments, as well as issues related to trial blinding. In a section on treatment definition, we discuss the challenges of specifying the active ingredients in the complex interventions that are widely used in rehabilitation, and present an illustration of 1 approach to defining treatments via the learning mechanisms that underlie them. Issues related to treatment implementation are also discussed, including therapist allocation and training, and assessment of treatment fidelity. Finally we consider 2 statistical topics of particular importance to many rehabilitation trials: the use of multiple or composite outcomes, and factors that must be weighed in estimating sample size for clinical trials.

Usability of a new electronic assistive device for community-dwelling persons with mild dementia

OBJECTIVE

To evaluate a newly developed integrated digital prosthetic, the COGKNOW Day Navigator (CDN), to support persons with mild dementia in their daily lives, with memory, social contacts, daily activities and safety.

METHODS

A user participatory method was applied in the development process, which consisted of three iterative 1-year cycles with field tests in Amsterdam, Belfast and Luleå. In the successive cycles 16, 14 and 12 persons with dementia and their carers participated. Data on usability were collected by means of interviews, observations, questionnaires, logging and diaries. The CDN prototype consists of a touch screen, a mobile device, sensors and actuators.

RESULTS

The evaluation showed that persons with dementia and carers valued the CDN overall as user-friendly and useful. Conclusions regarding the effectiveness of the system in daily life were limited due to insufficient duration of the testing period caused by delays in development and some instability of the final prototype.

CONCLUSION

With the suggested adaptations, the CDN is expected to be a useful tool for supporting community-dwelling persons with mild dementia and their carers.

Discovery and diagnosis of behavioral transitions in patient event streams

Users with cognitive impairments use assistive technology (AT) as part of a clinical treatment plan. As the AT interface is manipulated, data stream mining techniques are used to monitor user goals. In this context, real-time data mining aids clinicians in tracking user behaviors as they attempt to achieve their goals. Quality metrics over stream-mined models identify potential changes in user goal attainment, as the user learns his or her personalized emailing system. When the quality of some data-mined models varies significantly from nearby models—as defined by quality metrics—the user's behavior is then flagged as a significant behavioral change. The specific changes in user behavior are then characterized by differencing the data-mined decision tree models. This article describes how model quality monitoring and decision tree differencing can aid in recognition and diagnoses of behavioral changes in a case study of cognitive rehabilitation via emailing. The technique may be more widely applicable to other real-time data-intensive analysis problems.

Memory Rehabilitation for people with multiple sclerosis

BACKGROUND

Impairments in cognitive function, particularly memory, are common in patients with Multiple Sclerosis (MS) and these can potentially affect their ability to complete functional activities. There is evidence from single-case or small group studies that memory rehabilitation can be beneficial for patients with MS but findings from randomised controlled trials (RCTs) and systematic reviews have been inconclusive.

OBJECTIVES

To determine the effectiveness of memory rehabilitation for patients with MS who have memory problems, and the effect of such interventions on functional abilities.

SEARCH METHODS

We searched the Cochrane Multiple Sclerosis Group's Specialised Trials Register (last searched February 2011), and the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, latest issue), NIHR Clinical Research Network database, MEDLINE (1966 to February 2011), EMBASE (1980 to February 2011), CINAHL (1982 to April 2010), PsycINFO (1980 to February 2011), AMED (1985 to April 2010), British Nursing Index (1985 to April 2010) and CAB Abstracts (1973 to April 2010). We handsearched relevant journals and reference lists.

SELECTION CRITERIA

We selected RCTs of memory rehabilitation or cognitive rehabilitation for patients with MS in which a memory rehabilitation treatment group was compared to a control group. Selection was conducted independently first and confirmed through group discussion. Studies that included participants whose memory deficits were the result of conditions other than MS were excluded unless a subgroup of participants with MS with separate results could be identified.

DATA COLLECTION AND ANALYSIS

Four reviewers were involved in study selection, quality assessment and data extraction. Investigators of primary studies were contacted for further information where required. Data analysis and synthesis were conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. A 'best evidence' synthesis was performed based on the methodological quality of the primary studies included.

MAIN RESULTS

Eight studies, involving 521 participants, were included. The interventions involved various memory retraining techniques, such as computerised programmes and training on internal and external memory aids. Control groups varied in format from assessment-only groups, discussion and games, non-specific cognitive retraining and attention or visuospatial training. The risk of bias of the included studies was generally low; three of the studies were evaluated to have high risk of bias related to certain aspects of their methodology. Meta-analysis showed no significant effects of memory rehabilitation on memory function or functional abilities immediately or long-term. No significant effect of intervention was found, either immediately or long-term, on subjective reports of memory problems [Standard mean difference (SMD)  0.06 (95% confidence interval [CI] -0.21 to 0.34) and SMD 0.04 (95% CI -0.24 to 0.31)] respectively; on objective memory [SMD 0.24 (95% CI -0.02 to 0.49) and SMD 0.19 (95% CI -0.09 to 0.47)]; on mood [SMD -0.04 (95% CI -0.26 to 0.17) and SMD 0.13 (95% CI -0.10 to 0.36)]; and on Quality of Life [SMD -0.13 (95% CI -0.12 to 0.39) and SMD -0.11 (95% CI -0.39 to 0.17)]. On Activities of Daily Living, no immediate treatment effect was observed [SMD -0.13 (95% CI -0.60 to 0.33)], but on long-term follow up the intervention group performed significantly worse than the control group [SMD -0.33 (95% CI -0.63 to -0.03)].

AUTHORS' CONCLUSIONS

There is no evidence to support the effectiveness of memory rehabilitation on memory function or functional abilities in patients with MS. However, this conclusion has been arrived because of the limited quality of some of the primary studies reviewed in this area. Further robust, RCTs of higher methodological quality and better quality of reporting are needed.

Prospective Memory Intervention: A Review and Evaluation of a Pilot Restorative Intervention

Prospective memory impairments continue to be among the greatest impediments to return to work for individuals following neurological illness or injury. Current approaches to prospective memory intervention are reviewed in this article. These include behavioral interventions, metacognitive strategies and restorative approaches. In addition, the summary of a study using the restorative approach is presented and discussed. Eight subjects were given a course of prospective memory training designed to increase the length of time that they are able to maintain to-be-performed tasks in mind. These subjects demonstrated improvement on neurospsychological measures, a standardised measure of prospective memory and a generalisation measure of prospective memory in daily life. These data lend support to the notion that prospective memory may be one area of cognition that is responsive to restorative intervention approaches.

Realising the Potential of Cognitive Rehabilitation for the Brain-Injured: Next Steps

Contemporary psychological literature as well as the preceding papers (Mateer & Sohlberg, 2003; Wilson, 2003; Ylvisaker, 2003) emphasise the individual patient's personal ecological context as a crucial factor in the delivery of cognitive rehabilitation services. Testing and assessment procedures in neuropsychology have been enjoined to take increasing notice of the patient's historical, cultural and social background in providing services (American Psychological Association, 2003). Similarly, the design and delivery of treatment services must take into account how and where patients are living their lives post-injury. This has the benefit of moving cognitive rehabilitation from an emphasis on the more obvious or face-valid concerns about sterile “cognitive” models to individual ways of facilitating learning and information transfer improvement in the real world. In this way of approaching the problem, the patient's cultural and demographic context as well as their emotional adaptations are not confounding variables but critical design variables. The challenge now in delivering these paradigms of care is to show that they are appropriate and effective in some place in healthcare delivery systems, whether traditional or alternative. Questions of effectiveness of cognitive rehabilitation treatments and cost should be balanced in an equation relating to the probability of objective and demonstrable patient enhancement in living. Goals set and achieved must have consensual value that cannot be captured by traditional cost-benefit analysis in preventive or curative healthcare economic methodology. Cognitive rehabilitation as a family of interventions has little to no chance of being evaluated as efficacious using traditional treatment designs, using traditional neuropsychological measures as dependent variables, and involving research designs with crossover, sham or placebo conditions.

Goal Planning Rather than Neuropsychological Tests Should Be Used to Structure and Evaluate Cognitive Rehabilitation

Many studies of cognitive rehabilitation use neuropsychological tests to plan and evaluate treatment. This paper suggests that this is not a good rehabilitation procedure. The main purposes of rehabilitation are to achieve the maximum physical, psychological, social and vocational wellbeing of each individual and to enable people to return to their own, most appropriate environment. We do not engage in rehabilitation in order to help people achieve better scores on tests. This might be acceptable if there were a direct relationship between test scores and real life problems but there is not such a relationship. Although tests are useful in providing a picture of strengths and weaknesses, they are extremely limited in identifying everyday disabilities and handicaps. People can lead improved lives by compensating for or by-passing some of their cognitive problems yet remain unchanged on test scores. Conversely, they can improve on test scores yet remain severely handicapped in everyday life. One approach that is gaining ground in rehabilitation is goal planning. This allows patients/clients, their relatives and rehabilitation staff to negotiate appropriate and meaningful goals, determine how these should be achieved and measure success, or failure in real life situations. Goal planning both reduces the artificial distinction between rehabilitation practice and outcome measures, and allows the integration of theory and practice. The processes and procedures involved in goal planning are described and followed by an evaluative discussion.

The role of prospective memory in medication adherence: a review of an emerging literature

Although neurocognitive impairment is an established risk factor for medication nonadherence, standard neurocognitive tests developed for clinical purposes may not fully capture the complexities of non-adherence behavior or effectively inform theory-driven interventions. Prospective memory, an innovative cognitive construct describing one's ability to remember to do something at a later time, is an understudied factor in the detection and remediation of medication non-adherence. This review orients researchers to the construct of prospective memory, summarizes empirical evidence for prospective memory as a risk factor for non-adherence, discusses the relative merits of current measurement techniques, and highlights potential prospective memory-focused intervention strategies. A comprehensive literature review was conducted of published empirical studies investigating prospective memory and medication adherence. Overall, reviewed studies suggest that prospective memory is an important component of medication adherence, providing incremental ecological validity over established predictors. Findings indicate that prospective memory-based interventions might be an effective means of improving adherence.

Cognitive function and assistive technology for cognition: a systematic review

The relationship between assistive technology for cognition (ATC) and cognitive function was examined using a systematic review. A literature search identified 89 publications reporting 91 studies of an ATC intervention in a clinical population. The WHO International Classification of Functioning, Disability and Health (ICF) was used to categorize the cognitive domains being assisted and the tasks being performed. Results show that ATC have been used to effectively support cognitive functions relating to attention, calculation, emotion, experience of self, higher level cognitive functions (planning and time management) and memory. The review makes three contributions: (1) It reviews existing ATC in terms of cognitive function, thus providing a framework for ATC prescription on the basis of a profile of cognitive deficits, (2) it introduces a new classification of ATC based on cognitive function, and (3) it identifies areas for future ATC research and development.

Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008

OBJECTIVE

To update our clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) and stroke, based on a systematic review of the literature from 2003 through 2008.

DATA SOURCES

PubMed and Infotrieve literature searches were conducted using the terms attention, awareness, cognitive, communication, executive, language, memory, perception, problem solving, and/or reasoning combined with each of the following terms: rehabilitation, remediation, and training for articles published between 2003 and 2008. The task force initially identified citations for 198 published articles.

STUDY SELECTION

One hundred forty-one articles were selected for inclusion after our initial screening. Twenty-nine studies were excluded after further detailed review. Excluded articles included 4 descriptive studies without data, 6 nontreatment studies, 7 experimental manipulations, 6 reviews, 1 single case study not related to TBI or stroke, 2 articles where the intervention was provided to caretakers, 1 article redacted by the journal, and 2 reanalyses of prior publications. We fully reviewed and evaluated 112 studies.

DATA EXTRACTION

Articles were assigned to 1 of 6 categories reflecting the primary area of intervention: attention; vision and visuospatial functioning; language and communication skills; memory; executive functioning, problem solving and awareness; and comprehensive-holistic cognitive rehabilitation. Articles were abstracted and levels of evidence determined using specific criteria.

DATA SYNTHESIS

Of the 112 studies, 14 were rated as class I, 5 as class Ia, 11 as class II, and 82 as class III. Evidence within each area of intervention was synthesized and recommendations for Practice Standards, Practice Guidelines, and Practice Options were made.

CONCLUSIONS

There is substantial evidence to support interventions for attention, memory, social communication skills, executive function, and for comprehensive-holistic neuropsychologic rehabilitation after TBI. Evidence supports visuospatial rehabilitation after right hemisphere stroke, and interventions for aphasia and apraxia after left hemisphere stroke. Together with our prior reviews, we have evaluated a total of 370 interventions, including 65 class I or Ia studies. There is now sufficient information to support evidence-based protocols and implement empirically-supported treatments for cognitive disability after TBI and stroke.