Implementing strategy training in Taiwan: perspectives of individuals with Acquired brain injury

PURPOSE

Strategy training is a rehabilitation intervention that aims to enhance problem-solving skills with respect to daily activity-related challenges and has achieved favorable results in Western countries. This study explored the perspectives of individuals with acquired brain injury (ABI) in Taiwan who received strategy training.

MATERIALS AND METHODS

Semi-structured interviews with community-dwelling adults with ABI were conducted, and reflective memos made by research team members were recorded. Interviews and memos were analyzed through thematic analysis.

RESULTS

This study included 55 participants. The analysis of the participants' interview responses and memos yielded nine themes under three categories: 1) expectations regarding strategy training, 2) perceived benefits of strategy training, and 3) barriers affecting the process and outcomes of strategy training.

CONCLUSIONS

All the participants endorsed strategy training through different gains. Most participants' expectations before the intervention were uncertain. Including family members into the strategy training is of key importance for a successfulness of their goals. The participants' experiences about strategy training were affected by various barriers (i.e., health and medical problems, the physical environment, and natural events). Clinicians and researchers should consider these expectations, benefits, and barriers when studying and implementing strategy training in non-Western contexts.IMPLICATIONS FOR REHABILITATIONStrategy training provides clients the opportunity to actively engage in their own goal setting and decision making.Strategy training increases the client's confidence in their ability to participate in the community, communicate, and perform daily living and physical activities.Therapists should consider the health conditions and physical environment of clients when helping them set goals and before facilitating their engagement in the community.Taiwanese family members play a crucial role in supporting acquired brain injury survivors in strategy training.

Fostering cognitive performance in older adults with a process- and a strategy-based cognitive training

       The present study investigates the impact of process-based and strategy-based cognitive training to boost performance in healthy older adults. Three groups trained with either a dichotic listening training (process-based training, n = 25), an implementation intention strategy training (strategy-based training, n = 23), or served as a non-contact control group (n = 30). Our results demonstrated that training participants improved their performance in the trained tasks (process-based training: d = 3.01, strategy-based training: d = 2.6). For untrained tasks, the process-based training group showed significant working memory (d = .58) as well as episodic memory task improvement (d = 1.19) compared to the strategy-based training and to the non-contact control group (all d < .03). In contrast, in the strategy-based training group there was a tendency towards some performance gain in a fluid intelligence test (d = .92). These results indicate that cognitive training can be tailored to improve specific cognitive abilities.

Lesion location may attenuate response to strategy training in acute stroke

BACKGROUND

Strategy training, a rehabilitation intervention, reduces disability and improves functional skills associated with goal-directed behavior. Stroke lesions impacting selected ventromedial regions of interest associated with initiation of goal-directed behavior may attenuate intervention response. If so, strategy training may not be optimal for people with stroke lesions in these regions.

OBJECTIVE

To examine whether ventromedial regions of interest attenuate changes in disability status attributed to strategy training.

DESIGN

Secondary analysis of data from two randomized controlled clinical trials.

SETTING

Inpatient stroke rehabilitation.

PARTICIPANTS

People with acute stroke diagnosis and available diagnostic studies enrolled in inpatient rehabilitation randomized controlled studies between 2009 and 2017.

INTERVENTION

Participants were randomized to strategy training or a control condition in addition to the usual care during inpatient rehabilitation.

MAIN OUTCOME MEASURES

Diagnostic magnetic resonance imaging studies were retrieved from electronic medical records, and stroke lesion location was characterized by a neuroradiologist. Intervention response was defined by Functional Independence Measure change scores of 22 points or greater.

RESULTS

Only 186 of 275 participants had diagnostic studies available; 13 patients showed no apparent lesion on their diagnostic study. Among 173 cases, 156 had complete data at discharge (strategy training n = 71, control n = 85). Twenty-five cases had a lesion within a region of interest (strategy training n = 14, control n = 11). Intervention response was attenuated in the strategy training group for those with lesions in regions of interest [χ² (1, n = 71) = 4.60, P = .03], but not for those in the control group [Fisher exact test, n = 85, P = .19).

CONCLUSIONS

Lesions in the ventromedial regions of interest may attenuate response to strategy training.

The intention was good: How promoting strategy use does not improve multimedia learning for secondary students

BACKGROUND

It is well established that successful learning with multimedia is challenging, especially for younger learners.

AIMS

It was investigated whether students would profit from instructional support regarding the use of multimedia learning strategies.

SAMPLE

Participants were high school students in 8^th , 9^th , and 10^th grade (N = 168).

METHODS

Participants were assigned to a no-support control group or one of four experimental groups. In the experimental groups, students received either only a multimedia strategy training before learning (training group) or the training was enriched by prompts (prompts before or during learning) or if-then plans (implementation intentions). In the training, multimedia learning strategies were introduced (e.g., linking information from text and picture). The prompts and implementation intentions were aimed at enhancing the application of the multimedia strategies conveyed through the training. Students learned about the process of mitosis by studying multimedia instructions and were tested regarding the acquired knowledge. It was expected that solely training students to use adequate multimedia learning strategies would not promote learning compared with the control group, rather, that additional support like prompts or implementation intentions would be necessary to enhance learning.

RESULTS

Although in the experimental groups, multimedia learning strategies were used more frequently especially in the beginning of the instructional unit, there were no effects on learning outcome.

CONCLUSIONS

Promoting multimedia strategy use did not improve learning. The quality of the different instructional support measures and their suitability for the target groups are discussed as possible explanations for these findings.

The Effectiveness of Home-Based Training Software Designed to Influence Strategic Navigation Preferences in Healthy Subjects

One approach to the rehabilitation of navigation impairments is to train the use of compensatory egocentric or allocentric navigation strategies. Yet, it is unknown whether and to what degree training programs can influence strategic navigation preferences. In validating this approach, the key assumption that strategic preference can be changed by using a navigation training was assessed in a group of healthy participants (n = 82). The training program consisted of a psychoeducation session and a software package that included either allocentric or egocentric navigation exercises in virtual environments. Strategic navigation preference, objective and self-reported spatial abilities were assessed in pre- and post-training sessions. Based on their pre-training strategic preference, participants received either the egocentric training (n = 19) or the allocentric training (n = 21) version of the training. These participants engaged in four training sessions over a period of 2-3 weeks. The second group of participants did not use the training software (n = 43) and served as a control group. The results show that 50% of participants that received the egocentric training shifted from an allocentric to and an egocentric strategic preference. The proportion of participants that switched their strategic preference as a result of the allocentric training was identical to this proportion in the control group (19%). The training did not affect objective and self-reported navigation abilities as measured in the pre- and post-training sessions. We conclude that strategic navigation preferences can be influenced by using home-based training in healthy participants. However, using the current approach, only a preference shift from an allocentric to an egocentric navigation strategy could be achieved. The effectiveness of this navigation strategy training should next be assessed in relevant patient populations.

Far-Transfer Effects of Strategy-Based Working Memory Training

We assessed the transfer effects of training working memory strategies to a novel problem-solving task. Previous WM training studies have produced little evidence for transfer across contexts. In the current study, 64 6- to 9-year-olds were randomly assigned to one of four training conditions: semantic and rehearsal training, semantic training only, rehearsal training only, and treated control group. All training groups performed significantly better on the transfer task than the control group, but training groups did not differ significantly from each other. Implications of the findings for cognitive interventions and future WM training studies are discussed.

Feasibility of an iterative rehabilitation intervention for stroke delivered remotely using mobile health technology

Background: Telehealth affords rehabilitation professionals opportunities to expand access to intervention for people in rural areas. Complex interventions have not been adapted for remote delivery using mobile health technologies. Strategy training is a complex intervention that teaches clients skills for identifying barriers and solutions to engagement in meaningful activities. Our goal was to adapt the delivery of strategy training for remote delivery using mobile health technology.Methods: We conducted a sequential descriptive case series study (n = 5) in which community-dwelling participants with chronic stroke and prior exposure to strategy training used the iADAPTS mobile health application for 5 weeks. Expert practitioners advised revisions to the intervention process. Safety was assessed via monitoring occurrence of adverse events and risk for adverse events. Acceptability was assessed via the Client Satisfaction Questionnaire-8 (CSQ-8) and the Patient-Provider Connection Short Form of the Healing Encounters and Attitudes Lists (HEAL PPC).Results: Revisions to the intervention process supported the delivery of strategy training using mobile health technology after stroke. No adverse events occurred and risk for adverse events was managed through the intervention process. Acceptability was high (CSQ-8, 25 to 32; HEAL PPC, 59.9 to 72.5).Conclusions: Strategy training can be adapted for delivery using mobile health technology, with careful consideration to methods for training participants on new technology and the intervention delivery. Future research should establish the efficacy and effectiveness of integrating mobile health in delivery of interventions that promote engagement in client-selected activities and community participation.Implications for rehabilitationTranslating the strategy training intervention from face-to-face to remote delivery required thoughtful adaptation of the intervention protocol.Strategies for training clients to use mobile health technology during intervention may be important when designing remotely delivered mHealth intervention protocols.Client safety should be considered within the design of the intervention protocol for a complex intervention designed to be delivered remotely.Future studies should examine the efficacy of complex rehabilitation interventions such as strategy training on clinical outcomes (e.g., community participation).

Temporal Chunking Makes Life's Events More Memorable

Declines in episodic memory accompany both healthy aging and age-related diseases, such as dementia. Given that memory complaints are common in the aging population, a wealth of research has evaluated the underlying mechanisms of these declines and explored strategy interventions that could offset them. In the current paper, we describe a newer approach to improving memory: event segmentation training. Event segmentation is an encoding strategy in which individuals parse continuous activity into meaningful chunks. The ability to segment activity is associated with later memory for the events, but unfortunately, this segmentation ability declines with age. Importantly, interventions designed to improve event segmentation have resulted in memory improvements for both young and older adults. We will review these past experiments as well as some new event segmentation training work that uses older adults' semantic knowledge to improve their segmentation and episodic memory. We believe that future research on event segmentation is a promising avenue for improving older adults' ability to remember everyday activities.

Therapists' experience of the cognitive orientation to daily occupational performance (CO-OP) approach: Shifting from conventional practice

Background: The CO-OP Approach^TM has been increasingly used in research and practice, yet its critical elements and implementation challenges are largely undescribed. Obtaining therapists' perspectives on CO-OP may reveal insights into potential critical and mediating factors.Aim/Objective: To explore the experiences of CO-OP therapists by understanding their perceptions on the approach compared with conventional practice, and by identifying mediating factors in its implementation.Material and Method: This exploratory study utilized a qualitative descriptive design. A purposive sample of occupational therapists (n = 3) was interviewed. Data were analyzed using thematic analysis and themes were validated within a focus group.Results/Findings: Three themes were identified: 'CO-OP works,' 'CO-OP delivery is mediated by contextual factors,' and 'CO-OP shifts the therapeutic approach.' Therapists perceived CO-OP to be efficacious for client-centred goal attainment. Guided discovery and the problem-solving strategy were identified as unique and challenging CO-OP elements. Mediating factors such as level of cognitive impairment and quality of family member involvement may affect CO-OP efficacy.Conclusions: Therapists found CO-OP to be efficacious and adopted unique elements into their professional approaches.Significance: This is the first study to investigate CO-OP therapists' experiences. Future research is recommended to enhance training of therapists in key CO-OP features.

Developing a Non-Pharmacological Intervention for Individuals With Mild Cognitive Impairment

The purpose of this study is to describe one potential intervention model that is designed to slow decline to disability for individuals at-risk for dementia due to Mild Cognitive Impairment. Strategy training is a treatment model that focuses on behavioral activation through addressing barriers to daily activities. Strategy training encourages development of goals and plans to address self-identified impaired processes, and it maintains or improves individuals' ability to perform desired activities. Progression to dementia may be slowed due to the link between engagement in daily activities and production of biological factors associated with neurocognitive health. We demonstrated that an older adult with mild cognitive impairment is able to develop goals, establish effective plans, and engage in daily activities through the strategy training intervention model.

Feasibility of a cognitive strategy training intervention for people with Parkinson's disease

PURPOSE

To investigate the feasibility of a novel client-centered cognitive strategy training intervention for people with Parkinson's disease (PD).

MATERIALS AND METHODS

This was a case series of seven people with PD without dementia but with subjective cognitive decline. The intervention involved ≥5 treatment sessions at the participant's home. Participant acceptance and engagement were assessed by the Credibility/Expectancy Questionnaire (CEQ), Client Satisfaction Questionnaire (CSQ), enjoyment and effort ratings, and homework completion. Logistical information was tracked, and the Canadian Occupational Performance Measure (COPM) was an exploratory outcome measure. Data analysis was descriptive.

RESULTS

CEQ scores were positive and increased over time. CSQ scores were high (M = 30.8, SD = 0.75), with all participants rating all items positively. Almost all (95%) effort and enjoyment ratings were ≥3 (Much), and homework completion rates averaged 84% (SD = 18). Intervention duration was 6-15 weeks (M = 9.2, SD = 2.8), with treatment sessions averaging 1.7 h (SD = 0.5). Group and most individual COPM ratings improved ≥2 points.

CONCLUSIONS

These findings support the feasibility of the intervention for people with PD. It was acceptable, engaging, and promising in terms of its effect on self-identified functional cognitive problems. Implications for Rehabilitation People with Parkinson's disease (PD) without dementia can experience cognitive decline that negatively impacts function and quality of life. Strategy-based interventions that explicitly train for transfer may mitigate the negative functional consequences of cognitive decline in this population. We developed a client-centered cognitive strategy training intervention for people with PD. This small case series supports its feasibility, indicating that it is acceptable and engaging for people with PD and promising in terms of its effect on self-identified functional cognitive problems.

Neural change following different memory training approaches in very preterm born children - A pilot study

OBJECTIVE

There is mixed evidence regarding neural change following cognitive training. Brain activation increase, decrease, or a combination of both may occur. We investigated training-induced neural change using two different memory training approaches.

METHODS

Very preterm born children (aged 7-12 years) were randomly allocated to a memory strategy training, an intensive working memory practice or a waiting control group. Before and immediately after the trainings and the waiting period, brain activation during a visual working memory task was measured using fMRI and cognitive performance was assessed.

RESULTS

Following both memory trainings, there was a significant decrease of fronto-parietal brain activation and a significant increase of memory performance. In the control group, no neural or performance change occurred after the waiting period.

CONCLUSION

These pilot data point towards a training-related decrease of brain activation, independent of the training approach. Our data highlight the high training-induced plasticity of the child's brain during development.

Inducing Proactive Control Shifts in the AX-CPT

The Dual Mechanisms of Control (DMC) account (Braver, 2012) proposes two distinct mechanisms of cognitive control, proactive and reactive. This account has been supported by a large number of studies using the AX-CPT paradigm that have demonstrated not only between-group differences, but also within-subjects variability in the use of the two control mechanisms. Yet there has been little investigation of task manipulations that can experimentally modulate the use of proactive control in healthy young adults; such manipulations could be useful to better understand the workings of cognitive control mechanisms. In the current study, a series of three experiments demonstrate how individuals can be systematically biased toward and away from the utilization of proactive control, via strategy training and no-go manipulations, respectively. These results provide increased support for the DMC framework, and provide a new basis from which to examine group-based differences and neural mechanisms underlying the two control modes.

Comparison of two cognitive interventions for adults experiencing executive dysfunction post-stroke: a pilot study

Purpose This pilot partially randomised controlled trial compared the feasibility and preliminary efficacy of two promising interventions for persons with executive dysfunction post-stroke: (1) occupation-based strategy training using an adapted version of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach; and (2) Computer-based EF training (COMPUTER training). Method Participants received 16 h of either CO-OP or COMPUTER training. We assessed feasibility and acceptability of each intervention, and change in intervention outcomes at baseline, post-intervention and one-month follow-up. Performance and satisfaction with performance in self-selected everyday life goals were measured by the participant and the significant other-rated Canadian Occupational Performance Measure (COPM). Other intervention outcomes included changes in EF impairment, participation in daily life and self-efficacy. Results Six participants received CO-OP and five received COMPUTER training: one in each group discontinued the intervention for medical reasons unrelated to the intervention. The remaining nine participants completed all 16 sessions. Participants expressed high levels of satisfaction with both interventions. Both treatment groups showed large improvements in self and significant other-rated performance and satisfaction with performance on their goals immediately post-intervention and at follow-up (CO-OP: effect sizes (ES) = 1.6-3.5; COMPUTER: ES = 0.9-4.0), with statistically significant within-group differences in CO-OP (p < 0.05). The COMPUTER group also showed large improvements in some areas of EF impairment targeted by the computerised tasks (ES = 0.9-1.6); the CO-OP group demonstrated large improvements in self-efficacy for performing everyday activities (ES = 1.5). Conclusions Our findings provide preliminary evidence supporting the feasibility of using both CO-OP and COMPUTER training with patients with executive dysfunction post-stroke. Implications for Rehabilitation Computerised executive function training and occupation-based strategy training are feasible to deliver and acceptable to persons with executive dysfunction post-stroke. Preliminary evidence suggests that both interventions have a positive impact on real-world outcomes; and, that CO-OP might have a greater impact on improving self-efficacy for performing everyday activities.

The effectiveness of working memory training with individuals with intellectual disabilities - a meta-analytic review

Working memory (WM) training has been increasingly popular in the last years. Previous studies have shown that individuals with intellectual disabilities (ID) have low WM capacity and therefore would benefit by this type of intervention. The aim of this study was to investigate the effect of WM and cognitive training for individuals with ID. The effects reported in previous studies have varied and therefore a meta-analysis of articles in the major databases was conducted. Inclusion criteria included to have a pretest-posttest design with a training group and a control group and to have measures of WM or short-term memory. Ten studies with 28 comparisons were included. The results reveal a significant, but small, overall pretest-posttest effect size (ES) for WM training for individuals with ID compared to controls. A mixed WM approach, including both verbal and visuo-spatial components working mainly on strategies, was the only significant training type with a medium ES. The most commonly reported training type, visuo-spatial WM training, was performed in 60 percent of the included comparisons and had a non-significant ES close to zero. We conclude that even if there is an overall effect of WM training, a mixed WM approach appears to cause this effect. Given the few studies included and the different characteristics of the included studies, interpretations should be done with caution. However, different types of interventions appear to have different effects. Even if the results were promising, more studies are needed to better understand how to design an effective WM intervention for this group and to understand if, and how, these short-term effects remain over time and transfer to everyday activities.

Cognitive strategy interventions improve word problem solving and working memory in children with math disabilities

This study investigated the role of strategy instruction and working memory capacity (WMC) on problem solving solution accuracy in children with and without math disabilities (MD). Children in grade 3 (N = 204) with and without MD subdivided into high and low WMC were randomly assigned to 1 of 4 conditions: verbal strategies (e.g., underlining question sentence), visual strategies (e.g., correctly placing numbers in diagrams), verbal + visual strategies, and an untreated control. The dependent measures for training were problem solving accuracy and two working memory transfer measures (operation span and visual-spatial span). Three major findings emerged: (1) strategy instruction facilitated solution accuracy but the effects of strategy instruction were moderated by WMC, (2) some strategies yielded higher post-test scores than others, but these findings were qualified as to whether children were at risk for MD, and (3) strategy training on problem solving measures facilitated transfer to working memory measures. The main findings were that children with MD, but high WM spans, were more likely to benefit from strategy conditions on target and transfer measures than children with lower WMC. The results suggest that WMC moderates the influence of cognitive strategies on both the targeted and non-targeted measures.

Strategy Training Shows Promise for Addressing Disability in the First 6 Months After Stroke

BACKGROUND

Cognitive impairments occur frequently after stroke and contribute to significant disability. Strategy training shows promise but has not been examined in the acute phase of recovery.

OBJECTIVE

We conducted a single-blind randomized pilot study estimating the effect of strategy training, relative to reflective listening (attention control), for reducing disability and executive cognitive impairments.

METHODS

Thirty participants with acute stroke who were enrolled in inpatient rehabilitation and had cognitive impairments were randomized to receive strategy training (n = 15, 10 sessions as adjunct to usual inpatient rehabilitation) or reflective listening (n = 15, same dose). The Functional Independence Measure assessed disability at baseline, rehabilitation discharge, 3, and 6 months. The Color Word Interference Test of the Delis-Kaplan Executive Function System assessed selected executive cognitive impairments (inhibition, flexibility) at baseline, 3, and 6 months.

RESULTS

Changes in Functional Independence Measure scores for the 2 groups over 6 months showed significant effects of group (F1,27 = 9.25, P = .005), time (F3,74 = 96.00, P < .001), and group * time interactions (F3,74 = 4.37, P < .007) after controlling for baseline differences in stroke severity (F1,27 = 6.74, P = .015). Color Word Interference Inhibition scores showed significant effects of group (F1,26 = 6.50, P = .017) and time (F2,34 = 4.74, P = .015), but the group * time interaction was not significant (F2,34 = 2.55, P = .093). Color Word Interference Cognitive Flexibility scores showed significant effects of group (F1,26 = 23.41, P < .001), time (F2,34 = 12.77, P < .001), and group * time interactions (F2,34 = 7.83, P < .002). Interaction effects suggested greater improvements were associated with strategy training.

CONCLUSIONS

Strategy training shows promise for addressing disability in the first 6 months after stroke. Lessons from this pilot study may inform future clinical trials.

Cognitive Strategies, Working Memory, and Growth in Word Problem Solving in Children With Math Difficulties

This study investigated the role of strategy instruction and working memory capacity (WMC) on word problem solving accuracy in children with (n = 100) and without (n = 92) math difficulties (MD). Within classrooms, children in Grades 2 and 3 were randomly assigned to one of four treatment conditions: verbal-only strategies (e.g., underlining question sentence), verbal + visual strategies, visual-only strategies (e.g., correctly placing numbers in diagrams), or untreated control. Strategy interventions included 20 sessions in both Year 1 and Year 2. The intent-to-treat as well as the "as-treated" analyses showed that treatment effects were significantly moderated by WMC. In general, treatment outcomes were higher when WMC was set to a high rather than low level. When set to a relatively high WMC level, children with MD performed significantly better under visual-only strategy conditions and children without MD performed better under verbal + visual conditions when compared to control conditions.

Cognitive stimulation of executive functions in mild cognitive impairment: specific efficacy and impact in memory

Executive functions play an important role in the maintenance of autonomy in day-to-day activities. Nevertheless, there is little research into specific cognitive training for Mild Cognitive Impairment (MCI). We present the results of a program which aims to teach specific strategies and metacognitive abilities in order for patients to be able to carry out attentional and executive tasks. Two groups (A and B) were compared in a cross-over design. After the first evaluation, Group A (but not B) participated in a six month cognitive stimulation program. After a second assessment, only Group B received treatment and then a final evaluation was carried out on both groups. The results show that: i) both groups improved their performance as an effect of training; ii) improvements generalized to memory and general cognitive tasks; iii) in the interval without training, Group B's performance worsened and iv) Group A partially maintained their results over time.

Developing complex interventions: lessons learned from a pilot study examining strategy training in acute stroke rehabilitation

OBJECTIVE

To examine the feasibility of a strategy training clinical trial in a small group of adults with stroke-related cognitive impairments in inpatient rehabilitation, and to explore the impact of strategy training on disability.

DESIGN

Non-randomized two-group intervention pilot study.

SETTING

Two inpatient rehabilitation units within an academic health centre.

PARTICIPANTS

Individuals with a primary diagnosis of acute stroke, who were admitted to inpatient rehabilitation and demonstrated cognitive impairments were included. Individuals with severe aphasia; dementia; major depressive disorder, bipolar, or psychotic disorder; recent drug or alcohol abuse; and anticipated length of stay less than five days were excluded.

INTERVENTION

Participants received strategy training or an attention control session in addition to usual rehabilitation care. Sessions in both groups were 30-40 minutes daily, five days per week, for the duration of inpatient rehabilitation.

MAIN OUTCOME MEASURES

We assessed feasibility through participants' recruitment and retention; research intervention session number and duration; participants' comprehension and engagement; intervention fidelity; and participants' satisfaction. We assessed disability at study admission, inpatient rehabilitation discharge, 3 and 6 months using the Functional Independence Measure.

RESULTS

Participants in both groups (5 per group) received the assigned intervention (>92% planned sessions; >94% fidelity) and completed follow-up testing. Strategy training participants in this small sample demonstrated significantly less disability at six months (M (SE) = 117 (3)) than attention control participants (M(SE) = 96 (14); t 8 = 7.87, P = 0.02).

CONCLUSIONS

It is feasible and acceptable to administer both intervention protocols as an adjunct to acute inpatient rehabilitation, and strategy training shows promise for reducing disability.

Oscillatory EEG correlates of arithmetic strategies: a training study

There has been a long tradition of research on mathematics education showing that children and adults use different strategies to solve arithmetic problems. Neurophysiological studies have recently begun to investigate the brain correlates of these strategies. The existing body of data, however, reflect static end points of the learning process and do not provide information on how brain activity changes in response to training or intervention. In this study, we explicitly address this issue by training participants in using fact retrieval strategies. We also investigate whether brain activity related to arithmetic fact learning is domain-specific or whether this generalizes to other learning materials, such as the solution of figural-spatial problems. Twenty adult students were trained on sets of two-digit multiplication problems and figural-spatial problems. After the training, they were presented with the trained and untrained problems while their brain activity was recorded by means of electroencephalography (EEG). In both problem types, the training resulted in accuracies over 90% and significant decreases in solution times. Analyses of the oscillatory EEG data also revealed training effects across both problem types. Specifically, we observed training-related activity increases in the theta band (3-6 Hz) and decreases in the lower alpha band (8-10 Hz), especially over parietooccipital and parietal brain regions. These results provide the first evidence that a short-term fact retrieval training results in significant changes in oscillatory EEG activity. These findings further corroborate the role of the theta band in the retrieval of semantic information from memory and suggest that theta activity is sensitive to fact retrieval not only in mental arithmetic but also in other domains.

Strategic insight and age-related goal-neglect influence risky decision-making

Maximizing long-run gains often requires taking on some degree of risk, yet decision-makers often exhibit risk aversion (RA), rejecting risky prospects even when these have higher expected value (EV) than safer alternatives. We investigated whether explicit strategy instruction and practice can decrease prepotent RA, and whether aging impacts the efficacy of such an intervention. Participants performed a paired lottery task with options varying in risk and magnitude, both before and after practice with a similar task that encouraged maximization of EV and instruction to use this strategy in risky decisions. In both younger and older adults (OAs), strategy training reduced RA. Although RA was age-equivalent at baseline, larger training effects were observed in younger adults (YAs). These effects were not explained by risk-related (i.e., affective) interference effects or computation ability, but were consistent with a progressive, age-related neglect of the strategy across trials. Our findings suggest that strategy training can diminish RA, but that training efficacy is reduced among OAs, potentially due to goal neglect. We discuss implications for neural mechanisms that may distinguish older and YAs' risky decision-making.

Cognitive stimulation in a-MCI: an experimental study

Nowadays, preventing the effects of mental decline is an international priority, but there is little research into cognitive training in mild cognitive impairment (MCI). We present the results of a program aimed at teaching memory strategies and improving metacognitive abilities. This was associated with training to ameliorate caregivers' assistance. Two groups (A and B) were compared in a crossover design. After the first evaluation, group A (but not B) participated in a 6-month cognitive stimulation program. After a second assessment, only B received treatment and then a final evaluation was carried out on both the groups. The results show that (1) both the groups improved their performance as an effect of training; (2) improvements are specific to the functions trained; (3) in the interval without intervention, performance of group B worsened; and (4) group A has maintained their results over time. In conclusion, our results show that specific training may reduce memory impairment in MCI.

Verbal to visual code switching improves working memory in older adults: an fMRI study

The effect of verbal to visual code switching training on working memory performance was investigated in individuals aged 63 and older. During verbal working memory task performance, the training group (n = 25) was introduced to a verbal to visual code switching strategy while the control group (n = 25) was not exposed to such a strategy. Working memory recognition accuracy was enhanced only in the training group. To explore the neural substrates underlying these strategy effects, fMRI was used to measure brain activity in both groups during working memory task performance before and after an attention training period. In a comparison between pre- and post-training sessions, results showed increased activation in the anterior cingulate cortex (ACC). Relative to the control group, the post-training group exhibited increased activation in the left and right inferior parietal lobules (IPLs) and right superior parietal lobule (SPL). These findings suggest that use of a verbal to visual code switching strategy may assist older individuals in the maintenance of information in working memory.