Αγγλικό Εγχειρίδιο RehaCom

Cognitive Rehabilitation

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Further information on www.hasomed.com:

Functional Electrical Stimulation Gait AnalysisCognitive Rehabilitation

3HASOMED – Hard- and Software for Medicine

Close to Reality Motivatingfor Patients

21 Languages

Adaptive and Deficit -Specific32 Training Modules for

all Rehab Phases

Varied Therapy Material

Easy Handling


RehaCom

Training of Attention

Training of Memory

Introduction into the system RehaCom.................................................

Alertness...............................................................................................................................

Acoustic Responsiveness (AKRE)

Reaction Behaviour (REVE)

Ability to Responsiveness (REA1)

Vigilance (VIGI)..............................................................................................................

Visuel-Spatial Attention.............................................................

Spatial Operations (RAUM)

Two-Dimensional Operations (VRO1)

Three-Dimensional Operations (RO3D)

Visuo-Constructive Abilities (KONS)

Attention and concentration (AUFM).. ...................................................

Divided Attention........................................................................................................

Divided Attention (GEAU)

Divided Attention 2 (GEA2)

Topological Memory (MEM0)...........................................................................

Physiognomic Memory (GESI)........................................................................

Memory for Words (WORT).................................................................................

Figural Memory (BILD)..........................................................................................

Verbal Memory (VERB)..........................................................................................

06

12

15

16

20

21

2324252627

Table of Contens


Executive Functions

Training of Visual Field

Visuo-Motoric Coordination

Important Information

Shopping (EINK)...........................................................................................................

Plan a Day (PLAN)......................................................................................................

Logical Reasoning (LODE) .................................................................................Calculationsg (CALC)...............................................................................................

Compensating...........................................................................................................

Saccadic Training (SAKA)

Exploration (EXPL)

Overview and Reading (ZIHL)

Restoring...............................................................................................................................

Visual Restitution Training (VIST)

Visuo-Motoric Coordination (WISO).....................................................

Effectiveness Studies.............................................................................................

Team of Development..............................................................................................

Patient Keyboard and Chin Rest...................................................................

Overview of Training Modules..........................................................................

28293031

32

35

36

38400910

Table of Contens


RehaCom 2012 – Developed by Therapists for Therapists

For a long time the main emphasis in rehabilitation

had been put on teaching people with diseases or

those who had had an accident to relearn certain

physical functions. From today’s perspective, howe-

ver,trainingcognitivefunctionsisconsideredequally

important, particularly in the sectors of neuropsy-

chology and occupational therapy. Some basic prin-

ciplesshouldbetakenintoaccount,suchas:helping

thepatienttobuildself-confidence,offeringavariety

oftrainingmaterial,communicatingproblemsolving

strategies,givingclearlystructuredtasksandprovi-

ding for an appropriate length of training sessions.

Functions that are not damaged should be trained

first, inorder toevokeasenseofachievement lea-

dingtoabetterself-esteem.Then,therapistscantre-

atthe impairedfunctionsbygivingclear tasks, lea-

ving no room for misunderstandings. Furthermore,

it is important to use diverse training methods and

exercises,preferably involvingvisual, linguistic,tactile

and auditory elements. By observing the patient’s

actions, thetherapistcanfigureoutwaysto ideally

apply strategies to achieve best training results for

the individual situation. The length of a session de-

pendsonthepatient’sabilitytoworkunderpressure.

According to clinic guidelines patients should train

10 to 15 minutes per day in the acute phase of reha-

bilitation.Afterthisphase,trainingsessionsof45to

6o minutes should be held every day or at least three

timesaweek for a timeperiodof6 to8weeks. In

the late phase of rehabilitation patients should train

twoorthreetimesperweekforaboutthreetofive

months.

Cognitive Therapy in Rehabilitation

Therapy programmes used to be based on psycholo-

gicaltests.Therequirementprofileofatherapypro-

cedurehoweverdeviatesfromtheoneofatest.A

psychological test is not aimed to have an impact on

cognitiveperformance,whereastrainingismeantto

improve cognitive capacities. RehaCom is an ideal

tool,itmeetsthenecessaryconditions:1. adaptivity

andindividualisation,2.consistencyandmonitoring,

3.efficiencyandeconomy,4. patient-friendly input

device,5.multilingualstructureandmodularity.

Morethan25yearsagoscientificstudiesfirstproved

RehaCom’s effective functioning. Since then, more

and more studies have shown similar results. Those

studies were based on more than theoretical con-

cepts of a diagnostic test and its transfer to a similar

training tool. Find current studies on our website at

www.rehacom.com.

A good training system guarantees individual

training sessions in several dimensions. RehaCom

adapts automatically and offers the possibility to adjust

parameter settings. Every training unit is built up

in different levels of difficultywith varying training

tasks. The difficulty of a task given always corre-

sponds with the patient’s current performance level.

RehaComgivesconstantpositivefeedbackoriented

to the individual performance. Thus, it fosters to

developlearningpatternsandcontributestofiguring

out strategies.

After havingfinishedone training level in a session,

thenextonewillstartfromtheachievedlevel.Alltrai-

ningresultsaresaved.Hence,therapistscancheckon

how the patient’s overall performance develops as,

viewresultsofsingletasksandobjectivesandadjust

parameter settings promptly.

WithRehaCommanypatientscantrainindependently.

Atthebeginningandattheendofatrainingsession

the patient and the therapist can agree on particular

training aims to focus on and discuss results. There

is less patient-related work to do for the therapist

whocannowusefreecapacities,forexampletoputa

bigger emphasis on communicating strategies.

The Role of Computers in Cognitive Therapy

Effectiveness

Adaptivity and Individualisation

Consistency and Monitoring

Efficiency and Economy



A high number of our procedures are available in

different languages,freeofextra-charge.Hence,pa-

tientscantrainintheirmothertongue.Thankstothe

variety of procedures thousands of RehaCom systems

have beenused in several fields such as neurology,

psychiatrics, geriatrics, paediatrics as wells as in

vocational rehabilitation since 1992. In recent ye-

ars, therapydedicatedtohelp improvebrainperfor-

mancedeficitshasgained international recognition.

RehaComhasbecomemarketleaderinEurope.

RehaCom is a theory-based system which comprises

diverse procedures. It helps to train different areas

of cognitive functions. Starting at a low level of dif-

ficulty, patients are confronted with more complex

tasksathigherlevels.DuringtrainingRehaComgives

positive feedback on the patient’s performance.

Itsmodularstructureallowsforbasictraininginseveral

areas,suchas:

•differentiatedcomponentsofattention,

•differentareaofmemory,

•executivefunctions

•treatmentofvisualfield,and

•visuo-motorfunctions.

Moreover,patientscandomorecomplexexercises in

areassuchas:

•actionplanninganddevelopingstrategies,

•situationsfromeverydaylife,e.g.shopping,

•commercialenvironmentofvocationaltraining.

Apart from achieving particular aims of training,

RehaComhasfurtherwelcomesideeffects.Experien-

ce with RehaCom has shown that patients are much

more motivated in terms of training independently at

acomputer.Duetoits individualfunctioning,require-

ments are neither too high nor too low for the patient.

Thecomputerfunctionsasanobservermakingneutral

commentsandgivingfeedbackspecificallydirectedto

patient’serrors.Evenpatientswithsevereimpairments

benefit from improvements in performance which

leads to a stronger self-confidence. In addition,

RehaCom contributes to minimise signs of secondary

consequencesafterbraindamage,suchasdepressions

andlackofself-confidence.

Multilingual Structure and Distribution

Modularity Specific Cognitive Training for all Phases of Rehabilitation and Home TrainingRehaComfulfilsallconditionsnecessary foraspecific

and complex training during all phases of cognitive

rehabilitation. Treating cognitive impairments usually

takesquitelong.Thetherapybeguninahospitalcan

thus be continued at home under supervision of a neu-

ropsychologist in a private practice or an occupational

therapist. The therapist sets up a training schedule

withtaskswhichthepatienthastofulfilathome.After

thetraining,thetherapistcanevaluateresultspromptly

and intervene if necessary. During therapy sessions,

the focus is on communicating strategies while eva-

luating results and discussing further therapy plans.

Frequently, patients can thus receive ambulant

treatment.

Thankstoalongexperiencewithstandardiseddia-

gnostic tests, we can give recommendations for

therapy methods based on results gathered from

neuropsychological diagnostics. That is why we are

constantlyworkingonrelatingscientificallyproven

standardised tests to our RehaCom procedures.

Results then undergo a clinical trial. These recom-

mendationshoweverarenotsufficienttomakean

if-then setting. They exclusively serve as a guideline.

Diagnostics and Intervening



RehaComcanbe licensedviaan in-housecomputer server (computernetwork inyourhouse).Theserver

versionenablestheinstallationofRehaComlicencesonanetwork(server)computer.Severalworkingstations

(clientcomputers)willhaveaccesstotheRehaComserverlicencesatthesametime.

Licencing via Network

9HASOMED–Hard-andSoftwareforMedicine

Patient KeyboardAspecialkeyboard(RehaCompanel)helpsthepatienttocommunicatewiththecomputer.

Aconventionalkeyboardismostlyunsuitablefortherapiessinceitistooconfusingandrequires

high dexterity. The RehaCom panel is reduced to the minimum necessity.

Chin Rest Inordertotrainthevisualfield, it isrecommendedtouseachinrest.Thus,thepatient

can maintain a comfortable and straight posture that is easy to reproduce. This is important

because the position in front of the screen has to stay the same during the whole training

session.

The chin rest can be adjusted individually and its height can be changed. Concerning the

material,itismadeoflightandstablealuminiumandwood.Withascrewclampyoucanfix

the chin rest at a table. The rest made of varnished wood allows for easy cleaning.

Patient Keyboard and Chin Rest


Overview of Training Modules

GROUP

Attention

Memory

Alertness

Visual-Spatial Attention (spatial-perceptive)

Acoustic Responsiveness 20

Responsiveness 20

Spatial Operations 42

Spatial Operations 3D 24

Visual-Constructional Ability 18

Attention and Concentration 24

Divided Attention 14

Divided Attention 2 22

Topological Memory 20

Physiognomic Memory 21

Memory for Words 20

Figural Memory 09

Verbal Memory 10

Shopping 18

Plan a Day 55

Logical Reasoning 23

Calculations 42

Saccadic Training 28

Overview and Reading 69

Visual Restoration Training 00

Visuo-Motoric Coordination 96

Exploration 30

Two-Dimensional Operations 24

Vigilance 15

Reaction Behaviour 16

Visual-Spatial Attention (spatial-cognitive)

Visual-Spatial Attention (spatial-constructive)

Selective Attention

Divided Attention

Vigilance

Executive Functions

Visual Field

Visuo-Motoric Abilities

SUP-GROUP REHACOM TRAINING MODULES LEVEL


Overview of Training Modules

Severe to intermediate leveled disturbances

Intermediate to mild leveleddisturbances

Mild leveled disturbances

60 sounds

over 200 stimuli, editor

80 objects in photo quality

432 3-D bodies in 67 categories

3D, visual and acoustic

47 persons in 4 different views each

task generator

80 symbols in 2 sizes

200 photos of concrete objects

visual stimuli

43 traffic signs

88 objects in 4 variations

46 pools with each 16 photos

over 100 photos and drawings

77 pools with each 16 photos

3D, visual and acoustic

4 pools with up to 60 pictures

photos of 100 different goods

20 objects in variations

3 groups with 200 words each

geometric symbols

words, letters, numbers, forms

more than 80 short stories, editor

17 types of tasks with 76 pictures

25 pictured objects

TRAINING MATERIAL NeurologicalRehab

Multiple Sclerosis

Geriatrics Psychiatry Pediatrics


Theprocedureisrecommendedinadultswithadiagnoseddeficitofreactionspeedandreactionprecision

butalsoinimpairmentsofacousticdifferentiationability.Furthermorethetrainingmakesastrongrequest

tomentalflexibilityandfocusedattention.Inclientsliabletointerferencesthetherapistshouldmakesure

theyarenotover-strained.Fortrainingwithchildrenfrom8yearsonchild-orientedinstructionsareprovided.

The ability to perceive sounds and to differentiate between them are precondition. For an independent training

the client needs to be able to handle the RehaCom panel.

Indications

Basic requirements of the patient

Acoustic Responsiveness (AKRE)

The aim of the procedure “Acoustic reactivity”

is to improve precision and speed of acous-

tic reactions. The sounds are familiar to the

patient from his everyday environment.

Training material

Levels of difficulty

Effectiveness

TaskDuring the preparation phase the client learns to associate the sounds with the buttons of the RehaCom panel.

Ifdesired,apractisingphasefollows.Finallytheactualtrainingstarts.Nowarangeofsounds(abarkingdog,

aringingtelephoneetc.)areheardandthecorrespondingbuttonsontheRehaCompanelhavetobepushed

asquicklyaspossible.

Atthemomentabout60differentsoundswiththeirtypicalbackgroundsounds(e.g.wavesonthebeach)are

provided.Picturesonthescreenandcertainacousticstimulicreateaparticularenvironmentorsituation(e.g.at

home,onafarmetc.).TheRehaCompanelisrequiredtousethisprogramme.Thecomputermustbeequipped

withaDirectX-compatibleSoundcardandsuitableloudspeakersorheadphones!

Thedifficultyismodifiedthroughthenumberofsoundstobedifferentiated,theuseofirrelevantstimuliandthe

useofbackgroundsounds(e.g.quietmusic).

Atthemomenttheprocedureistestedscientifically.Becauseofthehighclosenesstoreallifeagoodtransferof

theskillstrainedtoeverydaysituationscanbeexpected.


The training is indicated for all patients with reduced response speed induced by the central nervous system.

Such a reduction of response speed almost always occurs in diffuse brain dam-ages as well as in frontal and

prefrontallesions(e.g.dementia,braintrauma,insult,formationofatumour,ischemia,etc.).

The client needs to be able to understand and comply independently with easy instruction texts.

Indications


Training material


TaskVeryrealisticstimuli(trafficsigns)werechosenforthistraining.Thetaskistopressthecorresponding

reactionkeyasquicklyaspossiblewheneveratargetstimulus(i.e.atrafficsign)appearsonthemonitor.

Thetrainingmaterialconsistofrealistictrafficsigns.Inthelearningphasethepicturesofthetargetstimuli(traf-

ficsigns)andthecorrespond-ingreactionkeysarepresented.BypressingtheOK-buttonthelearningphaseis

terminated.Thenthetargettrafficsigns(towardswhichtheclientmustreactwithinacertaintimeinterval),and

inhigherlevelsofdifficultyalsoirrelevanttrafficsigns(whichrequirenoreaction),aredisplayed.TheRehaCom

panelisrequiredtousethisprogramme.

Threetypesoftaskswith4or6levelsofdifficultyeachhavebeenconstructed:

•Thenexttrafficsignappearsonlyaftertheresponseoftheprevious(6levelsofdifficulty).

•Fixedintervalbetweentheitems(4levels).

•Theintervalchangesadaptively.Afteracorrectresponseashorterintervalischosen,andviceversa(6levels).

Reaction Behaviour (REVE)

Respondent behaviour of single and

multiple choice reactions (speed and

accuracy) towards optical signals is trained.

On the edge of the screen traffic signs can

be seen. Next to each a key of the RehaCom

panel is displayed which has to be pressed

when the traffic sign appears in the middle

of the monitor. Thus, attention and memory

are jointly trained.

EffectivenessInvestigationresultsforthistrainingprogrammarenotyetavailable.However,goodrehabilitationresultsare

expectedfortheabovementionedindicationsbecauseaspecificdisorderistrained.


The objective of reactivity training is to improve the speed of reactions and the speed and accuracy of reactions

followingcerebrallesions.Itisrecommendedinthecaseofdisordersofselectiveattentionperformance,andin

thecaseofdisordersofvisualoracousticdiscrimination,cognitionand/orbehaviouralperformance.

Thetrainingprogrammeislesssuitableforpatientswithseriousametropiaorpoorhearing(acousticstimulation).

The patient must be capable of pressing the large reaction buttons of the RehaCom panel accurately. Serious

memoryimpairment(forgettingstrategies)anddisordersaffectingattentionandconcentrationmayimpairthe

success of training.

Indications


The objective of reactivity training is to im-

prove the speed and accuracy of reactions

to visual and acoustic stimuli. Simple, simp-

le choice and multiple choice reaction tasks

are designed to train the patient to react

as quickly and differentially as possible to

signals.

Training material


TaskReactivity is trainedusingsimple,simplechoiceandmultiplechoicereactions,and involvesvisualand/oracoustic

stimuli.Afterapredefinedvisualstimulusappearsand/orafteranacousticstimulusisplayed,thepatientmustpress

aparticularbuttonontheRehaCompanelasquicklyaspossible.Duringanacquisitionphase,thepatientfamiliarises

himselfwiththepracticalitiesofthetask.Helearnstoassociatethestimuliwiththerelevantbuttonsonthepanel.

The assignment of stimulus to reaction which is learned can be consolidated during a practice session. Training then

proceeds with a selectable number of stimuli. The speed and accuracy of the patient’s reactions are measured and

evaluated.

Trainingincorporatesmorethan200visualstimuliand6acousticstimuliin3variationseach.Thetherapistcan

addhisownvisualandacousticstimuli(anypicturesandsoundshechooses).Thereisanintegratededitorto

create individualised training programmes.

Theprogrammeoffers20levelsofdifficultywith5tasksperlevel.Eachtaskcomprisesseveralcombinationsof

stimuli.Thevariouscombinationsarerandomlyselectedbycomputer,ensuringthateachpatientexperiencesan

extremelyvariedtrainingprogramme.Theprogrammeworksadaptivelythroughthe20levelsofdifficulty.The

higherthelevelofdifficulty,thegreaterthenumberofstimulitobedeterminedandthemorevariedthetemporal

sequenceofstimuli.

Responsiveness (REA1)


Thetrainingisindicatedforalldisordersorimpairmentsofthelong-term(continuous)attentionofdifferentetiology

and genesis. The ‘Vigilance’ training programme is particularly suitable where there are disorders affecting tonic

attention.Inthecaseofpatientswithvascularbraindamage,craniocerebralinjuriesanddementia,improvements

canbeexpectedincognitiveperformanceaswellas,tosomeextent,age-relatedtransfereffects.

Thetaskofthistrainingisverysimple.Thepatienthassimplevisualdifferentiationstosolve.Childrencanbe

trained also to appropriate instructions.

Indications


Training material


TaskThetaskofthistrainingisdesignedtobeveryeasy.Basicvisualdifferentiationtasksarerequiredintheclient.

Objectsmovepastonaconveyorandmustbecomparedcontinuouslywithoneormorepermanentlyvisible

specimenobjects.Thepatientmustidentifywhichobjectsarenotidenticaltothespecimens,andremove

these from the conveyor at the point indicated.

Objectsaredisplayedonaconveyorbeltandhavetobecomparedtooneorseveralfault-free„sampleobjects“.

Theclientshouldfindthoseobjectsthatarenotidenticaltothesampleobjects(=faultyobjects).

Accordingtotheparametersettingsconcreteobjects(e.g.awashingmachine,arefrigerator,etc.)orabstractfigures

aredisplayed.Childfriendlyinstructionsareprovidedtoassistinitsusebychildren.15levelsofdifficultyareavailable.

Withincreasingdegreeofdifficultythefollowingparametersgrow:

•thenumberofdiffering(„faulty“)objects,

•thenumberofdifferingelements,

•thenumberofobjectsdisplayedaswellas

•thecomplexityofthepictures.

The ability to maintain one‘s attention

over a longer period of time is trained in a

design with limited response time towards

the items. The task of the patient is to

monitor a conveyor belt and to select those

objects that differ from a sample object in

one or several details.

Vigilance (VIGI)

EffectivenessFordetailedinformationpleaserefertothesection„EffectivenessStudies“,especiallytothestudiesofBECKERS,

HÖSCHEL,PREETZandFRIEDL-FRANCESCONI,PHUR,PFLEGER,GÜNTHER.


The procedure is recommended especially for training basic cognitive functions of spatial perception. Through

using non-verbal material it is also suitable for patients with impaired ability to understand words or language.

Visualbasicskillsbelong to thecomplexcognitiveskills.For that,on theonehand,performances inattention

areprecondition,ontheotherhand,thereprovedtobesignificantcorrelationstotheabilityofabstractthinking.

Inhighlyimpairedintellectualskillsordisturbancesofattentionthisprocedureislesssuitable.

Indications


The ability to imagine something spatially is

focus of the procedure “Spatial operations”.

It is trained in 5 categories: estimating

positions, estimating angles, estimating

relations (filling of vessels) and estimating

sizes one- and two-dimensionally.


Task and Training materialBWhenestimatingpositions,twofieldswithstructuredbackgroundsaredisplayedonthescreen.Oneofthemshows

anobject(e.g.acar)atafixedposition.Inthesecondfieldthesameobjectisdisplayedatadifferentposition.Thetask

istomovethesecondpicturetothesamepositioninitsfieldasthefirstpicturebymeansofthecursorbuttonsonthe

RehaCompanel.Photographsanddrawingsareused.Whenestimatingangles,2angleshavetobemadeequiangular.

Whenestimatingrelations,vesselshavetobefilledwith“liquid”(halffull,1/3etc.)Whenestimatingsizes,thefieldsdisplay

objects–drawingsorphotographs-ofdifferentsizeswhichhavetobebroughttoequalsizebymeansofthecursor

buttons.Thistaskisavailableinaone-andinatwo-dimensionalversion.Theshort-termmemoryforspatialperception

istrainedinhigherlevelswhentheoriginalobjectvanisheswiththefirstadjustmentofthe“copy”.Reconstructingthe

original position then has to be carried out from memory.

Theprocedureworksadaptively,foreachcategoryaseparateserialoflevelsfrom1to9hasbeenvalidated,in

total42levels.Thetasksofeachcategoryareexplainedinaninstructionphasevia“learningbydoing”.

Spatial Operations (RAUM)

EffectivenessStudies for thisprocedurearenotyetavailable.However,goodrehabilitationsuccesscanbeexpected inthe

indicationsdescribedabovesincetheclienttrainsdisturbancespecifically.


Adecline in theperformance invisual-constructive tasks, itemsof theposition-in-space-explorationaswellas

in spatial orientation are observed for right hemispheric temporal and parietal and damages of the frontal lobe.

Thetrainingisindicatedforpatientswithlesionsinthislocation,diffusebraindamageormentaldefectives.

Two-dimensionalandspatialoperations,inwhichtheposition-in-space-relationmustbeperceivedandtheobject

turned or tilted in order to find out the corresponding picture, belong to themore complex cognitive abilities.

Thereforebasalattentioncapabilitiesareaprecondition.Ontheotherhandconsiderablecorrelationwiththeability

tosolveabstract„brain-teasers“andintelligenceingeneralhavebeenfoundinvariousinvestigations.Forclients

with extreme intellectual impairments or a pronounced attention disturbance the training is less suitable.

Indications


Training material


TaskOnthescreenvariouspictures(objects)aredisplayedthatshouldbecomparedtoanobjectattheedgeof

thescreen.Thecorrespondingpicture,whichhastobefoundout,istwistedtowardsthecomparisonpicture.

Geometricfigures,e.g.squares,arrows,hexagons,areusedasobjects.Athigherlevelsofdifficulty,thetraining

material increases in complexity – up to concrete objects and street-maps.

With increasing difficulty the number of pictures in the matrix grows. Additionally more and more similar

objectsaredisplayed.Sothedifferentiationcapacityneededtofindthecorrespondingpictureincreases.Whilstat

lowerlevelsofdifficultythetaskscanbesolvedbyestimatingsizesandlengths,athigherlevelsthepatientmust

visualise the rotation of objects.

The procedure “Two-dimensional operations”

trains the positioned relationship with two-

dimensional presentation. The task is to

find the picture of a matrix which exactly

corresponds to a „comparison picture“. The

corresponding picture is twisted towards

the „comparison picture“.

Two-Dimensional Operations (VRO1)

EffectivenessFor detailed information please refer to the section „Effectiveness Studies“, especially to the study of

FRIEDL-FRANCESCONI.


Theprogramme issuitablefortreatingcognitivedisorders,particularlyofspatialperceptionfunctions.The

programmecanalsobeusedasahigh-levelcontinuationofattentiontraining.Byusingnon-verbalmaterials,

itispossibletoworkwiththeprogrammeeveniflanguageisrestrictedorthereareproblemsunderstanding

words.

Aspatialsenseisoneofthemorecomplexcognitiveactivities. Itrequiresabasic levelofattention,andmany

studies have found not inconsiderable correlations with the capacity for abstract reasoning. The training is less

suited in the case of profound intellectual im-pairment or for those suffering from serious attention disorders.

Intact vision is required, particularly at higher levels of difficulty where details have to be recognised. Initial

findingsindicatethatthetrainingcanbeusedfromtheageof10years.Thepatientneedstobeabletomovethe

mouse of the computer.

Indications


Spatial sense and attention performance

are trained. This is achieved by showing

several three-dimensional bodies on the

screen which must be compared with a

reference body. All of the bodies on the

screen can be rotated freely, making a

three-dimensional view possible. Stereo

glasses for a genuine 3D representation are

an additional option.


Task and Training materialAthree-dimensionalobjectisshownontheupperhalfofthescreen.Beloware3to6objects,whosedegreeof

similarityvarieswiththelevelofdifficulty.Thepatientmustidentifytheobjectwhichmatchestheobjectatthe

topofthescreenexactly.Alloftheobjectsonthescreencanberotatedinthreedimensions,andcanthereforebe

viewedfromeveryside.Atotalof4323Dbodiesin67groupsareavailableastrainingmaterial.

Theprogrammeworksadaptively.Twenty-fourlevelshavebeenvalidatedaltogether.Trainingcommenceswith

simplebodiesandshapes,laterprogressingtocompoundobjectswithandwithoutanindicationofdirection.

Atthehighestlevelsofdifficulty,thecomplexityofthebodiesincreasesconsiderably;differentiationbecomes

increasinglychallenging.Thelevelofdifficultyisalsovariedbyusing3,4,5or6objectsofcomparison.

Three-Dimensional Operations (RO3D)

EffectivenessStudiesonthistrainingprogrammeareatapreparatorystage.Withtheindicationsdescribedabove,however,

goodrehabilitationresultscanbeanticipated,becausethetrainingthepatientreceivesisspecifictohisdisorder.

Theexperiencesandresultsobtainedusingthe‘Two-dimensionalOperations’RehaComprogrammeappeartobe

transferable.


Specialists literature claims that parietal lesions cause constructional apraxia. Formanaging tasks as in this

procedure,however,notonlyabilitiestosolvevisualreconstructiontasksareneededbutalsomemoryandattention.

The training is indicated for patients with a light or medium decline in the capacity of the visuo-constructive

fieldaswellasinothergeneralizedfunctionaldisorders.Oftensuchageneraldeclineintheperformancecanbe

observedinorganicbraindamages(e.g.throughintoxication,alcoholabuseetc.).Sinceonlypictorialmaterialis

used,thetrainingisalsosuitableforchildrenfromabout8yearson.

Forclientswithseriousapraxia,amnesia,andconcentrationdisturbancesthetrainingisratherunsuitable.

Indications


Training material


TaskThetrainingisconstructedanaloguetotraditional„puzzle“games.Inthebeginningofataskapictureis

displayedwhichhastobememorizedasdetailedaspossible.WhentheclientpressestheOK-button,orafter

adefinedtime,thepictureisdividedintoacertainamountofpuzzlepiecesandhastobereconstructed.

Thepicturesappearinveryhighresolution(256colormode)onthescreen.Picturesofhouses,faces,paintings,

landscapes etc. are used.

Altogether18levelsofdifficultyareprovided.Themaincriteriaforthechangeinthelevelisthenumberofpuzzle

piecesthepictureisdividedinto(rangingfrom4to36pieces).

The procedure “Visuo-constructive abilities”

trains visual reconstruction of concrete

pictures. The client memorizes a picture

in every detail. Afterwards the picture is

displayed divided into several pieces as in

a puzzle. Then the puzzle has to be recons-

tructed correctly.

Visuo-Constructive Abilities (KONS)

EffectivenessEffectivenessstudiesarenotyetavailable.However,manyinvestigationsofneuropsychologicalrehabilitationreport

goodtrainingeffectsafterregularpuzzleplaying(oftenalsoincombinationwithotherprogrammsandexercises).

Onecanassumethat the resultsof these investigationsarealso true for thisRehaComproceduresince it is

constructed in analogy.


Attention and Concentration (AUFM)

Functionally and organically caused attention disturbances represent the most widespread neuropsychologi-

calperformancedeficitafteranacquiredbraindamage.Theyarefoundin80%ofthepatientsafterstroke

(apoplexy),braintrauma,diffuseorganicbrainimpairments(e.g.causedbychronicalcoholabuseorintoxica-

tion),aswellasinotherdiseasesofthecentralnervoussystem.Thetrainingissuitableforadultclientsandfor

children with attention and concentration disturbances from 6 years on.

Besidesthecomprehensionofeasyinstructiontexts,theabilitiestoperformvisualdifferentiationtasksandto

handle the big buttons of the patient panel are necessary.

Indications


Training material


TaskA picture presented separately on the screen is compared to a matrix of pictures. The one picture exactly

corresponding to it has to be found.

Atotalof49picturepools-eachcontaining16pictures-hasbeensetup.BecauseoftheuseofVGA-graphicswithhigh

resolution,thepicturesappearingonthescreenareofgoodquality.Theyrepresentdifferenttypesofobjectsaccording

totheparametersettings:eitherconcreteobjects(fruits,animals,faces,etc.),geometricalobjects(circles,rectangles,

trianglesindifferentsizesandorders),orlettersandnumbers.

Theadaptivechangeinthedifficultyofthetasksguaranteesthattheclientwillbeconfrontedwithneithertoo

difficultnortooeasytasks.Altogether24levelsofdifficultyareavailable.Withincreasingcapability,three,latersix,

andfinally9similarpicturesaredisplayedonamatrix.Onlyoneoftheseisidenticalwiththecomparisonpicture.

The RehaCom procedure “Attention &

concentration” is based on the pattern-

comparison-method. The patient has

to find the picture from a matrix which

corresponds exactly to the „comparison

picture“.

EffectivenessFor detailed information please refer to the section „Effectiveness Studies“, especially to the studies of

GÜNTHNER,BECKERS,HÖSCHEL,POLMIN,PREETZ,FRIEDL-FRANCESCONI,PUHRandPFLEGER.


Divided Attention (GEAU)

Problemsinfocusingattentiontowardsseveraldifferentobjectssimultaneouslyoccurwithalmostalldiffuse

braindamages(e.g.intoxicationoralcoholabuse)aswellaswithlocaldamagesoftherighthemisphere,espe-

ciallyoftheparietalpartsofthebrain.Effectedpatientshavedifficultiestofocustheirattentiontodifferent

objectsatthesametime.Becauseoftheanimatedpresentationthetrainingisverymotivatingandsuitable

also for children from 11 years on.

The client should be able to understand and comply with easy instructions independently.

Indications


Training material


TaskOnthelowerpartofthemonitoradriver’scabinisrepresented.Above,onecanobservethetrack(likethrough

thewindshieldoftheengine).Theclienthastoreactsimultaneouslytowardstheelementsinthecabandtowards

certainsignalsonthetrack.

Thedriver’spanelcontainsaspeedometer,asocalled„deadmanlamp“andthe“emergencybreaklamp”.Onthe

speedometeratargetspeedissettheclientshouldcomplywith.Ontheflashingofoneofthelampstheclient

mustpressthecorrespondingbuttonontheRehaCom-panel(e.g.thestop-button).Ifanimportantsignappears

onthetracktheclientalsohastoreact(e.g.stoppingataredblocksignal).

Thetrainingcontains14levelsofdifficulty.Inthebeginningtheclientneedstoregulatethetrain’sspeedonly.

Fromleveltwoonwardnewtasksareaddedstepbystep.Thisimpliesreactionstowardsdifferenttrainsignals,the

deadmanlampandemergencybreaksignals.

In this attention training - like in every day

life - several circumstances must be observed

simultaneously. Like an engine driver the

patient monitors the driver‘s cab, regulates

the speed and reacts towards different

signals „during the journey“.

EffectivenessFordetailedinformationpleaserefertothesection“EffectivenessStudies”,especiallytothestudyofPUHR.


Patientswith disturbances in focussing on certain aspects of a task, in fast reacting on relevant impulses

andatthesametimeignoringirrelevantimpulses.Thesedisturbancesoccurin80%ofpatientsafterstroke,

craniocerebralinjury,diffusebrainorganicimpairment(e.g.asaresultofchronicalcoholabuseorintoxication)

as well as other diseases of the central nervous system.

Therearesimpletextsofinstructiontocomprehend.Thepatienthastopushthebuttonsonthepanelorkeybord

by himself. Supported by instructions appropriate for children also children up from age 10 are able to train with

this procedure.

Indications



Task und Training materialOnyourmonitor youwill have simulated a look througha frontalwindowof a car aswell as look at the car‘s

dashboard. Through the window you see the street in front of the car, which trails away in the distance of a

landscape.Lefthandisshownthespeed-indicator.Withinthetachometerthereisagreenareawhichmarksthe

speedyoushoulddrive.Belowthegreenareathereisaredarrow,whichshowsyouthecurrentspeed.Theredarrow

mustalwaysbelocatedinthegreenarea.Thecarmovesonthestreetonafixedtrack,alsoincurves,sothatthe

patienthasnottopayattentiontokeepthecaronthestreet.Tospeedupthecaryouhavetopushthearrowkey

up,toslowdownthearrowkeydown.Thereisadisplayforthewaytogoandtheexpiredtime.Theaimistodrivea

certaindistanceinalimitedtime.Itistopayattentionthatthedisplayforthewayisalwaysinfrontofthedisplayfor

thetime.Alevelisfinishedwhenthetimeisoverorthewayisdone.Whilethecarissetinmotionthroughpushing

thearrowkeysontheRehaCompanel,relevantaswellasirrelevantobjectsaremovingperspectivelytowardsthe

user.Onlytherelevantobjectsandacousticstimuliarecountingasresultsforthetrainingofthepatients.

Theprocedureworksadaptive.Intotalthereare22levelsvalidated.Withinthetrainingthedifficultiesvarybyadding

more and more levels of attention and by modifying the interval of the stimuli.

Driving a car the patient has to pay attention

parallel on several issues: observing atten-

tively the landscape and car dashboard as

well as reacting differentiated on acoustic

information. In the beginning there is only

the speed to keep. Later on, with growing

level of difficulty, there are further tasks,

which wait for certain reactions of the

training person in other area of attention.

Divided Attention 2 (GEA2)

EffectivenessGood results of rehabilitation can be estimated because the client is trained specifically to his disturbances.

Studies are in process.


The indication for this training is given for all memory disorders or impairments regarding verbal and non-verbal

contents.Amnesiacsyndromescanbeobservedforalldiffusecerebro-organicdiseases(dementia,intoxication,

chronicalcoholabuseetc.)aswellasforallleftorbothsidedlesionsofthemedialorbasolaterallimbiclemniscus.

Moreovervasculardiseases,braintrauma,orbraintumoursinprefrontal,temporaluptoparietalcorticalareas

canleadtomemorydeficits.

BesidebasictaskcomprehensionthehandlingofthebigbuttonsoftheRehaCompanelisaprecondition.

Indications


Training material


TaskInthesocalled„memorizingphase“anumberofcards(dependingonthelevelofdifficulty)withconcrete

picturesorgeometricfiguresaredisplayed.Theclientmemorizesthepositionofthepictures.Afterapreset

time-ormanuallybypressingtheOK-button-thepicturesofthematrixarehidden(turned„upsidedown“).

Attheedgeofthescreenapicturewillbedisplayedandtheclient indicateswhichofthehiddenpictures

corresponds to it.

In total464pictures (picturesof concreteobjects, geometricfiguresand letters) areavailable. Thenumberof

simultaneously displayed pictures varies from 3 to a maximum of 16.

Thereare20degreesofdifficultydefinedbyanumberofcardsandcomplexity.

This procedure trains topological memory.

Like in a memory-game the position of

cards with pictures (e.g. a lion, a flower,

a house, a car, etc.) or geometric figures

should be memorized. Once the cards are

turned “upside down”, their position has to

be remembered.

Topological Memory (MEMO)

EffectivenessFor detailed information please refer to the section „Effectiveness Studies“, especially to the studies of

GÜNTHNER,BECKERS,HÖSCHEL,PREETZ,FRIEDL-FRANCESCONI,PUHRandPFLEGER.


Withprosopagnosiatheabilitytorecognizefacesandestablishmeaningfulassociationswiththemisimpairedor

lost. The problem can also be related to memory components that are responsible for remembering faces. This

disorderiscausedbylesionofthetemporallobe(moreoftenlefthemispheric).Thetrainingisthereforeindicated

for all clients with right-sided or bilateral temporal lobe damage of different pathogenesis if the above mentioned

impairments are observed.

Itisnecessarythattheclientisabletoperformeasyrecognitiontasksandhandlethepatientpanel.

Indications


Training material


TaskFacesarememorizedduringa„learningphase“.Afterwardsthesefacesarepickedoutfromanumberofdifferent

facespicturedfromdifferentsides.Inhigherlevelsofdifficultyanameandaprofessionaretobememorized

additionally.Itistheclient‘staskthentofindoutthefacecorrespondingtothenameortheprofession.

Altogether 47 persons have been photographed from four different views. The pictures almost reach photo

quality(16,7millioncoloursintheSVGAmode;24BPP).Toadaptthetrainingtolocalspecialitiesorthefamiliar

surrounding of the patient there is an editor to embed own pictures.

Threelevelshavebeendesigned:

•Memorizingfaces(1-6pictures:level1to6)

•Connectingfacewithaname(2-6pictures:level7to11)

•Memorizingfaceswiththecorrespondingnameandprofession(2-6pictures:level12to16)

•Memorizingfaceswiththecorrespondingnameandphonenumber(2-6pictures:levels17to21)

With this training the recognition of faces and

the pairing of faces to a name and a profes-

sion is practiced very realistically. Faces are

displayed from different sides. The client deci-

des whether the picture of a person has been

shown before. In higher levels of difficulty

additional verbal information regarding the

person (name, profession) has to be memorized.

Physiognomic Memory (GESI)

EffectivenessWiththistrainingprocedureexactlythoseabilitiesaretrainedthatareimpairedinclientswiththeabovementioned

lesions. Therefore a high effectiveness of the training can be expected.


The training is especially suitable for clients with an impairment of the word span or reduced recognition

capability - especially for clients with a beginning amnesic syndrome. This syndrome occurs of patients with

diffusecerebro-organicdamageandlefthemisphericorbilaterallesion(especiallyofthelimbiclemniscuswith

damageofthethalamicparts).Thetrainingisalsosuitableforclientswithfunctionallycausedimpairments

and for children from 11 years on.

Besidetheabilitytoreadwords,itisapreconditionthattheclientisabletomastereasyrecognitiontasksandto

presstheOK-buttonontheRehaCompanel.

Indications


Levels of difficultyThedisplayedwordsaredividedintothreegroupsof200wordseach.Thesegroupsinclude:easyandshort,

easycompound,andcomplexcompoundwords.

Training material

TaskInthelearningphasealistofwordsismemorized(from1upto10words).Thehigherthedegreeofdifficulty,

the higher are the number and the difficulty of thewords to bememorized. Thewords presented in the

learningphaseshouldbeselectedafterwardsfromanumberofother(irrelevant)words.

The words appear big and plainly visible on the screen. The moving of the words on the screen is carried out

continuouslyandwithoutjerking.Thespeedofthewords„rollingby“canbeadapted.

This RehaCom procedure trains the recog-

nition capability for individual words. In

the so-called „learning phase“ a certain

number of words is shown. Afterwards a

variety of words „roll by“ like on a conveyor

belt. The client‘s task is to recognize and

pick out the words shown in the learning

phase.

Memory for Words (WORT)

EffectivenessFordetailedinformationpleaserefertothesection„EffectivenessSudies“,especiallytothestudiesofHÖSCHEL,

POLMIN,PREETZ,FRIEDL-FRANCESCONIandPUHR.


This training is indicated for all memory disturbances (especially for the working memory) for verbal

and non-verbal contents. The procedure can also be used in clients with an - organically or functionally

caused-impairedabilitytonameobjectsanddifficultiesinconceptualpairing.Averagevocabularyassumed,

Figural Memory is suitable for children from 11 years on.

Itisrequiredthattheclientisabletonameconcreteobjectsandreadeasywords.Forindependenttrainingthe

clientmustbeable,regardinghismotorskills,topressthebigbuttonsonpanel.

Indications


Training material


TaskPicturesortermsofconcreteobjectsaredisplayed.Alltermsorpicturesoftheseobjectshavetobememorized

now.The„learningphase“isterminatedbypressingtheOK-button.Afterwardsaccordingtothedisplayedterm

variouspicturesoraccordingtothedisplayedpicturevariousterms„rollby“onthescreenfromthelefttothe

rightlikeonaconveyorbelt.Wheneveratermorpictureofanobjectofthelearningphaseappears–termsor

picturesthathadtobememorized-theclientpushestheOK-button.

Because of VGA-graphicswith high resolution the pictures appearing on the screen are of good quality.

Regardingtheterms,abigandeasytoreadtypefacehasbeenselected.Themovingofthewordsthroughthe

screeniscarriedoutcontinuouslyandwithoutjerking.Thespeedofthewords„rollingby“canbeadapted

to reading speed.

Thenumberofdisplayedobjectsinthe„learningphase“correspondsexactlytotheninelevelsofdifficultyprovided.

Inthelowestleveltheclientshouldmemorizeoneobject-inthehighestlevelnineobjects-andlaterrecognizethe

correspondingterm(s).

This procedure trains the medium-term

non-verbal and verbal memory (working

memory). The patient memorizes pictures

with concrete (describable) objects or terms.

After the „learning phase“ according terms

or objects roll by like on a conveyor belt. The

patient presses the OK-button whenever a

term or picture of an object of the „learning

phase“ rolls by.

Figural Memory (BILD)

EffectivenessFordetailedinformationpleaserefertothesection„EffectivenessStudies“,especiallytothestudiesofHÖSCHEL

andFRIEDL-FRANCESCONI.


The procedure is recommended for clients with a disturbance or an impairment of their short-time or medium-

termmemory.Thesemightbeconsequencesofalmostanydiffusebraindamage(dementia,alcoholabuseetc.)as

wellasoffullorleft-hemisphericlesion.Thetrainingcanalsobeusedtoimprovememoryskillsinchildrenfrom

11 years on.

Theclientmustbeabletoreadandunderstandsimplelanguage.Forindependenttraininghe/sheshouldbeableto

use the RehaCom panel.

Indications


Training material


TaskA short story is displayed on the screen. The client is required to memorize as many details of the story as

possible(dates,numbers,events,objects).The“memorizingphase”canbedeterminedthroughpressingtheOK-button.

Finallyquestionsaboutthecontentofthestoryareasked.

Morethan80shortstoriesareavailable.Dependingonthesetting,eitherthecomputerorthetherapistselects

a story for training. The pool of stories available can be extended by virtue of an integrated editor.

There are 10 levels of difficulty. The higher the level of difficulty, the greater the length and information

contentofthestory.Thenumberofnames,numbers,eventsandobjectstoberecalledalsoincreases.

Aim of the procedure “Verbal memory” is to

improve the short-time memory for verbal

information. Short stories displayed on the

screen contain a range of details the client

is asked to memorize and later reproduce

when questioned by the PC.

Verbal Memory (VERB)

EffectivenessFor detailed information please refer to the section “Effectiveness Studies”, especially the studies by

REGEL&FRITSCH.


Thisprocedureisrecommendedforclientswithdeficitsinworkingmemory,conceptattainmentorplanning

anactionsequence.Trainingwithchildrenfrom11yearsonispossible,andwithelderlypersonsinorderto

maintain their mental abilities.

Clients should be able to read and understand a shopping list. To work on his own the client needs the

dexterity tohandleamouseor theOKbuttonon thepanel.Training isnot recommended forclientswith

attentiondeficits.

Indications


Training material


TaskTheclientgetsashopping listwitharangeofgoods.Thenhe/shemovesthroughasymbolicsupermar-

ketwithshelvesdisplayinggroupsofgoods(e.g.fruits,dairyproducts,stationery).Inordertopickouta

particularitem(e.g.abucket)heneedsto“enter”thegoodsdepartment(inthiscasehouseholdarticles)

byclickingontheshelf.Theshelvescontentwithavarietyofproductsisdisplayedthenandgoodsare“put

intothetrolley”byclickingatthem.Checkingthetrolleyscontent,taking itemsoutagainaswellas– if

adjusted-havingalookattheshoppinglistispossible.Aftertheclienthascollectedallthegoodshethinks

hewassupposedtobuyhefinishesshoppingbymovingtothecheckout.Herethegoodsinthetrolleyare

comparedtothoseontheshoppinglist.Atahigherleveltheclient“receives”anamountofshoppingmoney.

Thegoodsthenaremarkedwithprices.Thetaskistocheckwhetherthereisenoughmoney.

Theprogrammecurrentlyusessome 100articles illustratedphoto-realistically (foodstuffs,householdobjects,

etc.)Thesearticlesappearonshelves,fromwhichtheymustbeselectedbythepatient.Thetrainingprogramme

featuresavoiceresponse;inotherwords,allofthearticlesarenamedwhenselected.

Theprocedureprovides18levelsofdifficultywith2modes.Inthefirstmodethegoodsontheshoppinglist

havetobeboughtonly.Inthesecondmodeacertainamountofshoppingmoneyisavailableandtheclienthas

tocheckwhetherthereisenoughmoney.Inbothmodeswithincreasingdifficultytheshoppinglistgrows.

This procedure realistically trains an

everyday situation: shopping in a super-

market. All steps necessary are just like in

reality. Planning and coordinating an action

are trained as well as the short-time memory

(interval between looking into the trolley

and looking at the shopping list).

Shopping (EINK)

EffectivenessAtthemomentstudiesareconducted.Atransfertoactivitiesofdailylivingisexpected.


Usingthistrainingisrecommendedtoadultclientswithdisturbancesoftheexecutivefunctions,especially

oftheabilitytoplan.Thisabilitytoplanandtoorganizeeverydaylifebelongstothemostcomplexhuman

skills.Thisskillcanbeimpairedasaresultofanybraindamage,especiallyofdamagesoffrontalstructuresor

indiffusecerebraldamages.TheprocedurePlanadaymayalsobeusedfortrainingmemoryskills.However,

it is not recommended in cases of very heavy serious disturbances.

Theclientneedstobeabletounderstandthetaskandmovehandsaccordingtothetask.Thetherapist’s

presence is strongly recommended for seriously effected clients.

Indications


Training material


TaskThetrainingrequirestheclienttorealizeasetoftasksinoptimalorder.Onthescreena“town”frombirds-eye-

viewisdisplayed,itshowsbuildingswhichtheclientneedstogotoaccordingtohistimeschedule.Thereare

threekindsoftasks:

•Realizepriorities

•Minimizepathlengths(andthusthetimeneeded)

•Maximizethenumberoftaskscarriedoutsuccessfully

Thelevelsofdifficultyarecharacterizedbyvariationofdifferentparameters.

Theprocedurecangenerateanalmost infinitenumberofdifferent tasks throughevernewcombinationsof

rasks,thusprovidingchangeandvariety.

The procedureworks adaptively following a validated structure of 55 difficulties. Additional adjustment to the

client’s capacities is possible via the parameter window.

This procedure is very closely related to the

daily routine in which the patient has to

organize a day following time schedules. It

aims at improving the executive functions or

rather at establishing strategies how to plan. It

practices basic and – in higher levels of

difficulty – complex cognitive skills.

Plan a Day (PLAN)

EffectivenessPlanadayisafollow-updevelopmentofaproceduresetupincooperationwithProf.Dr.JoachimFunke(University

ofHeidelberg).Prof.Funkeprovedanimprovementofclients`planningskillswithaDOS-Versionoftheprocedure.

Evaluationstudiesfortheprocedureareinprogress.


Most authors relate the frontal lobes above all with abstract reasoning. However, isolated lesions of the

frontal lobe seldom appear separately. For that reason there is a high degree of disagreement about which

corticalpartsareresponsibleforsolvingreasoningtaskswithnon-verbalmaterial.Thetrainingisindicatedfor

patientswith acquired cerebro-organic (frontal lobe) damage,whenan impairment in logical thinking can

beobserved.Thosedeclinesinperformanceoccure.g.quitefrequentlyasacauseofchronicalcoholabuse,

dementiaandinsult,butalsoschizophrenia.

The precondition for using the training is the ability in the client to focus attention over a longer period

of time. He/she should be able to draw easy abstract-logical conclusions. In order to perform the training

independently, the comprehensionofeasy instruction textsandbasicmotor skills tohandle theRehaCom-

panel are preconditions. The training can also be usedby children from 12 years on if they are capable of

performing abstract-logical conclusions.

Indications


Training material


TaskFromvarioussymbols(„responsepool“)theclientisaskedtoselecttheonewhichcorrectlycontinuesa

givensequence.

Asequenceofsymbols(circles,triangles,squares,etc.)ofdifferentshape,colour,andsize,interconnectedbya

rule,aredisplayedonthescreen.Forafalserespondspecifichintsconcerningthetypeoferror(shape,colour,

and/orsize)aregiven.

23 levels of difficulty are available. With increasing difficulty the client must observe various levels of

abstractioninordertofindthesolution.Intheeasierlevelsthesymbolsmaintaine.g.sizeandcolour.Onlythe

shapeofthesymbolchanges.Inhigherlevelsallthreecomponents-shape,colorandsize-changeaccording

to sophisticated rhythms.

This training aims at improving logical

thinking (reasoning). The client picks out

the symbol correctly completing a row of

symbols which is constructed following a

logical rule, or a combination of logical rules.

Logical Reasoning (LODE)

EffectivenessFordetailedinformationpleaserefertothesection„EffectivenessStudies“,especiallytothestudyofPUHR.


Thetreatmentprogrammewasdevelopedforpatientswithimpairedarithmeticalcognitiveskills.Thesedisorders

ofcognitivefunctioncanvarygreatlyinnature.Theyrangefromrestrictedbasaldisorders,suchastheinabilityto

estimatesizesandquantities,toproblemsinapplyingbasicareasofmathematicsanddifficultiessolvingcomplex

mathematical problems.

Thepatientshouldbecapableofunderstandingthetaskandhavethenecessarymotorskillstocomplete

it. The presence of a therapist is strongly recommended in the case of severely affected patients.

Indications


Training material


TaskThetraininginvolvesawidevarietyoftasks.Thepatientbeginswithsimplecomparisonsofsizeandquantity,

andwithsortingtasks.Thenthebasicmathematicaloperationsofaddingandsubtractingarepractised,both

mentallyandinwriting.Atmoreadvancedlevels,thepatientistrainedinveryreal-lifesituationstohandle

money;hemustbeabletoshowthathecancount,givechangeorcheckhisownchangetotheappropriate

standard.Finallytherearemultiplicationanddivisiontasks.

Sizeandquantitytasksarepractisedusingpicturesofsimpleobjects,untilthepatientprogressestocounting

withnumbers.Duringwrittenadditionandsubtraction,thenumberscarriedoverareshowninasmallerfont.

Moneyhandlingispractisedusingpicturesofgenuinebanknotesandcoins.

Theprogrammecomprises42levelsofdifficultyandworksadaptively.

Mathematical training enables patients to

improve their arithmetic skills. Such skills

are essential in many areas of daily life. The

problems to be solved are very varied in na-

ture. Thus, depending on the type of disorder

concerned, training can be given in basic

mathematical operations or more complex

tasks. The basic mathematical problems in-

clude size comparisons, quantitative compa-

risons, arranging according to quantity and

basic mathematical operations at various

levels of difficulty. Tasks relating to money

handling and written addition and subtraction

are included to train patients to solve complex

mathematical problems.

Calculations (CALC)

EffectivenessAs the trainingwas developed in accordancewith precise pedagogic principles, a high level of validity can be

assumed. Studies are currently being conducted into mathematical training.


This procedure is designed for patients with contra-lateral visual neglect phenomena on one-side and

representationdisorders.Alowervisualexplorationonone-sideofthesightoccursoftenwithvisualneglect

orextendedcerebralinfarctsintheareaoftheArteriacerebriorposterior.Alsootherhear-organicdisorders

could be the cause of these lower functions.

Thisprocedureislesssuitableforpatientswithstrongdefectivevisionorganicbased.Patientsmustbeableto

push the large reaction button.

Indications


Training material


TaskThepatientlooksatthehorizonofasimple(2-dimensional)landscape.Abigsunisplacedinthemiddleofthe

screen.Afigureappearsleftorrightofthesunwithirregulardistances.Everytimethepatientspotsafigure,he/

she must push the appropriate reaction button on the panel.

Onthescreenyoucanseeahorizon.Inthesimplerlevelsasunisinthemiddleofthepricture.Afigureappears

onthishorizonleftorrightofthesunwithirregulardistances,differentfiguresorsymbols,i.e.animals,cars,

bikes.Thesymbolsgetsmalleratthehigherlevels,thehorizonvanishesandadditionaldiversionsappear.Itis

advisable to use the chin rest.

Threelevelsofdifficultyareavailablewiththreesizesoftheobjects(big,middle,small).Theyarevariabledefined

bythebackgroundcontrast(blackorgrey)andthemovingposition(fixedormoving)oftheobject.Alltogether

thereare28levelsofdifficulties.

This procedure is devoloped for patients

with reduced visual capacities and visual

neglect phenomena (neglect, hemianopsis,

hemiamblyopis e.g.). The patients are in-

structed to push the left or right reaction

button, when left or right from the centre a

figure (e.g. animal, vehicle, person …) appears.

Saccadic Training (SAKA)

EffectivenessWiththisRehaComprocedurethevisualexplorationistrained„symptom-orientated“.Thereisaprioriexpected

that with this computer assisted procedure at least the same good training effects are being accomplished as with

conventional training with patients who suffer from visual neglect phenomena on one-side.


The training is recommended for patients with a homonymous restriction in their field of vision, and for

patientswhohaveproblemswiththeirvisualexplorationduetofailureintheirfieldofvision,visualneglect.It

isalsorecommendedtopatientswhosufferfromBalintsyndromeoracombinationofseveralofthesetypesof

disturbances as a result of some type brain damage. The procedure can also be used to help patients who suffer

fromlinguisticrestrictionsandrestrictionsintheirabilitytounderstandwords,bycombiningtheuseofnone

verbal material with the procedure.

The training programm is less suitable for patients with strong defective vision. The patient must be able to

pressthelargereactionkeysontheRehaCompanel.Seriousdisturbancesinmemory(inabilitytoremember

strategies) limits the success of the training. It appears that childrenof8 years andolder could use this

trainingprocedure.However,practiceisencouragedsothatexperiencecanbegained.

Indications



Task and Training materialThe objects are in lines and columns and are divided up in a pre-arranged manner. The patient searches over

the given fieldwith a circular cursorwhich is the size of a singlematrix unit. In thisway, the exploration

movementofthepatientiskeptundercontrol.Therelevantobjectsarenotalwaysdistributeduniformlybut

arefrequentlytobefoundinanunusualareaofthefieldofvision.Itisadvisabletousethechinrest.

Theexplorationtrainingprocedurecanbeadap-tedtosuitupto30differentlevelsofdifficulty.Inorderto

adaptcertainstrategies,thefollowingmodificationsofdifficultyareincluded:

•thenumberandthedistancebetweenthenumberoflineswhichhavetobe

•thewidthoftheexplorationfield(numberanddistancebetweencolumns)

•therecognisabilityofthedifferentsymbols

•thedistancebetweenthesymbolswhichhavetoberecognisedandtherefore,thesizeandclarityofthecursor

Itsspeedcanbesetupbythetherapisttosuiteachindividualpatient.

The procedure deals with problems in visual

exploration. The procedure uses a slow serial

search for objects which must undergo a

precise interpretion or analysis.

Exploration (EXPL)


The programmes are not suitable for patients with serious ametropia (visual acuity < 20%) or with

alexia.Seriousmemorydisorders(forgettinginstructionsandstrategies)aswellasattentiondisorderswill

adverselyaffectthesuccessoftrain-ing.Trainingappearstobepossibleforchildrenaged8andover.

DieVerfahrensindfürPatientenmithoherFehlsichtigkeit(Visus<20%)sowiemitAlexienichtgeeignet.Schwe-

reGedächtnisstörungen(VergessenvonInstruktionenundStrategien)sowieStörungenderAufmerksamkeit

beeinträchtigendenTrainingserfolg.DieAnwendungistbeiKindernabdemachtenLebensjahrmöglich.

Indications


Training material


TaskReading:Wordsornumbersofdifferentlengthsappearonthescreen,andarereadaloudbythepatient.The

displaytimeisrestricted,sothatthewholewordornumbermustberegistered.Responsesaregiventothe

therapist,whoalsomonitorstheprogressofthenewreadingstrategy.

Visual search: Combinations of stimuli appear on the screen, with a predefined stimulus serving as the

targetstimulus,andtheotherstimuliasdistractions.Thepatientmustsearchthescreenquicklyandcarefully

and indicate the presence or absence of the target stimulus by pressing a button. Responses are given to the

therapist,whoalsomonitorstheprogressofthecompensationstrategy.

Words of different lengths (3-16 letters), short sentences (2-4 words) and numbers (3-6 digits) are used

for reading training; their lengthand the time theyaredisplayed canbe tailored to the individual patient.

Different-colouredlettersandshapescanbeusedforvisualsearches.Itisadvisabletousethechinrest.

Readingtrainingandvisualsearchtrainingincreaseindifficultythroughseverallevelsdependingonthepatient’s

progressuntilpredefinedperformancecriteriaareachieved.Thefollowingparameterswhichinfluencethelevelof

difficultyareincorporatedintheadaptationstrategy:

•thelengthanddisplaytimeofthewordsandnumbers,

•thedifferencebetweentargetanddistractionstimuliandthedensityofstimuli.

Both programmes are used to treat non-

aphasic reading disorders (e.g. in the

case of homonymous visual field defects

near the fovea) and overview and/or

visual search dysfunctions in patients with

homonymous visual field defects, visual

neglect or Balint’s syndrome. They were

developed and clinically tested by Prof.

Zihl, Professor of Neuropsychology at the

University of Munich.

Overview and Reading (ZIHL)

EffectivenessScientificresultsareavailableonthelevelofeffectivenessofbothtrainingprogrammes.


InVISTA™ was specifically designed for patients experiencing vision loss such as hemianopia following

neurological lesions. Functional improvements have been observed in patients with visual neglect, impair-

mentsofvisualperceptionandprocessing,andproblemswithreadingandattention.Patientswithlongexisting

impairmentshavebeenshowntoalsobenefitfromthetraining.Itisapplicableforpatientswithaphasiatoo.

ToperformInVISTA™thepatientshouldbemotivated,compliant,andbeabletoconcen-trateforatleast10to

15 minutes. There is no age limit to the training. The patient should always wear prescribed visual correction.

Aheadrestforheadstabilizationandkeepingcorrectdistancetothemonitor ishighlyrecommended.The

patientshouldbeabletopressthespacebuttonofthekeyboardorthebuttonsoftheRehaCompanel.

Indications


Training material


TaskPatientssitinfrontofthecomputermonitorandputtheirchinandforeheadinachinresttoensuretheireyes

focusonthecenterofthescreen.Eachtimethefixationpointchangescolorpatientsareaskedtorespondby

pressingabutton.Abrightstimulusispresentedonthemonitor,movingfromtheintactintothedefectvisual

field.Patientsareinstructedtorespondtothemovingstimulusbypressingakeyaslongastheystillperceiveit.

Whenthestimulusisnolongerrespondedto,itwillchangedirectionandmovefromdefecttointactvisualfield

until the patient sees the stimulus again and responds.

InVISTA™comprisesoffourversionstoaccommodatefordifferentpatternsofimpairment.Theparameterization

isbasedonclinicalexpertknowledge.

Theprocedureconsistsoffourversionsforright-andleftsidedvisualfielddefects.Versions3and4differfrom

1and2byemployinghigh-contrastfixationcolorchangesandlongerdelaytimesforresponses.Thisisespecially

helpfulforpatientswithproblemsinattentionandconcentrationordeficitsincolorperception/cataract.Areas

of stimulation are self-adaptive and adjust to the individual patient’s results and progress.

Vision Restoration Training (InVISTA™) is

a computer based programm to initiate

restorative processes in patients with visual

impairments due to neurological lesions. The

self-adapting programm presents kinetic s

upra-threshold stimuli on a dark background.

The patient is asked to respond to these sti-

muli by pressing a key. The therapy progress

can be monitored by means of CentraVIEW™

(computer based visual field screening with

static supra-threshold stimuli).

Visual Restitution Training (VIST)

EffectivenessClinicalstudieshaveshownthataftersubsequentperformanceofseveralmonthsofcustomizedVisionRestoration

Therapy(VRT),65%ofpatientsachievedimprovementsinvisualperception.


Inextremevisualdisordersaswellasinlossofonevisualfield,theprocedureislesssuitable.Demandsto

the attention capabilities are also made. For very serious apraxia the training is indicated only if the client is

capableofhandlingthejoystick.

Visuo-Motoric Coordination (WISO)

Damagesofthemotorcortex(frontallobe)leadtodeficitsinthecontroloftheminutemotoractivitywhich

canbeobservedmostclearlyincoordinationdisordersofthehandandfingermovement.Inmanycerebro-

organicdiseasesanddamages,likecerebralinsults,hemorrhage,extensivetumours,braintrauma,etc.,visuo

motor functions are effected as well. The training is indicated for all disorders of the minute motor activity.

Indications



TaskOnthescreenadotandacolouredcircle(abstractmode)arepresented,ore.g.abutterflyandaflower(concrete

mode).Thedotandthebutterflyarecalled“cursor”,thecircleandtheflower“rotor”.Theclientmovesthecursor

intotherotorbymeansofthejoystick.Thentherotorstartsmovingalongapredictabletrack.Theclienttriesto

followthemovementswiththejoystick(representedbythecursor).TheRehaCompanelisrequiredtousethis

programme.

Thedifficultylevelisadaptedtothecurrentperformanceleveloftheclient.Theparametersare:

•thesizeoftherotor,

•thespeedoftherotor,and

•thetypeofmovement(e.g.predictableorunpredictable,curves)

The object here is to train clients with

disorders in visuo-motor coordination.

A cursor and a rotor (both abstract or

concrete) are displayed on the screen. The

client moves the cursor into the middle of the

rotor and tries to keep it there following the

movements of the rotor.

EffectivenessThetraining“Visuo-motorcoordination”followstheobjectpersecutionparadigm.Thereforeonecanexpectatleast

the same training success as under conventional training conditions.


Notes


Effectiveness Studies

Evaluation Study Conducted on Computer-Assisted Cognitive Training of Psychological Basic Functions

Is the Neuropsychological Treatment of Memory Specific or Unspecific? – Comparing Treatment Effects on Memory and Attention.

RehaCom has evolved since it was first launched 25 years ago. It was developed by therapists and is meant to

be used by therapists. RehaCom’s origins date back to 1986 when Professor Hans Regel first started doing

research in the field of attention. Since then, numerous studies and results of research covering diverse areas

have proven the effectiveness of RehaCom. You can read these studies on our website at www.rehacom.com.

Final reportona fundedresearchproject:Bonn.Cu-

ratorshipCNS. 120 cerebrally impaired patients (88of

them had a stroke, 21 had an acquired brain injury,

11 had other causes of damages) were treated with

occupational standard therapies, standard logot-

herapy and computer-based training programmes

(RehaComprocedures)foratleastfourweeks.Theeva-

luationincluded182differentpsychometricmeasures.In

pre-post-comparisons, significant improvements in

performance were made.

Regel distinguishes between three transfer effects:

Primary objective and research design: In order to

analyzewhether neuropsychologicalmemory therapy

acts specificallyon thememorydomainor inamore

generalized fashion on further cognitive domains,

27patientswithorganicmemorydeficitsduetodiffe-

rent etiologies (cerebrovascular, traumatic, infectious,

etc.)wererandomlyassignedtotwodifferentmemory

treatment programs and investigated for changes in

memory and attention.

Prof. Regel, H. and Fritsch, A. (1997)

Spahn, V., Kulke, H., Kunz, M., Thöne-Otto, A., Schupp, W., Lautenbacher, S. Source: Zeitschrift für Neuropsychologie , 21 (4), 2010, 239-245

trained attention leading to a high increase of attention

capabilities. In many cases there was a correlation

between improvements in performance and the course

of training using RehaCom. This correlation proved the

positive impact computer-assisted cognitive training

has on patients’ performance. Surveys and interviews

with patients as well as results of observing patients’

behavioursuggestatransfereffectofthirdrank.

Transfereffectsoffirst rankwereproventhanksto

subsamplesinvolving24patients.Thesepatientsonly

Methods and procedures:Patientstreatedbyaspe-

cificcomputer-basedtrainingofstoryrecall(Training

ofVerbalMemory,TVM)werecomparedtoagroup

in which compensational strategies for everyday

memoryproblemsweretrained(MemoryTherapyin

Groups,MTG). Both therapieswere conducted over

12to15sessions,4-5timesperweek, inadditionto

standard program of neurorehabilitation. Training

effectswereaccessedforverbalandfiguralmemory

(VerbalLearningTest,NonverbalLearningTest)and

forattention(AlertnessandDividedAttentioninTest

Battery of Attentional Performance). Results and

conclusions: Both treatment groups resulted in im-

provement in tests of memeory but not attention. This

findingprovidesgoodevidencefortheassumptionof

specificityofeffectsinneuropsychologicaltreatment

of memory.

•

•

•

Transfereffectoffirstrank(trainingeffect):Training

cognitive functions leads to improvements in the

particulartests(e.g.trainingofattentioncapabilities

bringsbetterresultsinattentiontests).

Transfereffectofsecondrank(generalisationeffect):

Training cognitive functions leads to improvements

of those cognitive abilities which were not rained

(attentiontraining,checkingmemoryfunctions)

Transfer effect of third rank: Training cognitive

functionshelpstobettertackleeverydayproblems


Effectiveness Studies

Efficacy and specificity of intensive cognitive rehabilitation of attention and executive functions in multiple sclerosis.

Flavia, M., Stampatori, C., Zanotti, D., Parrinello, G., Capra, R. (2010) Journal of Neurological Sciences 288 (2010) 101-105

Objective: Toevaluatetheefficacyofacomputer-ba-

sed intensive training programof attention, informa-

tion processing and executive functions in patients

withclinically-stablerelapsing–remitting(RR)multiple

sclerosis(MS)andlowlevelsofdisability.

Design, patients and interventions: Atotalof150pa-

tientswithRRMSandanExpandedDisabilityStatus

Scale(EDSS)scoreof≤4wereexamined.Information

processing,workingmemoryandattentionwereasses-

sedbythePacedAuditorySerialAdditionTest(PASAT)

andexecutivefunctionsbytheWisconsinCardSorting

Test (WCST). Twenty patientswho scored below cer-

tain cut-off measures in both tests were included in

thisdouble-blindcontrolledstudy.Patientswerecasu-

allyassignedtoastudygroup(SG)oracontrolgroup

(CG)andunderwentneuropsychologicalevaluationat

baselineandafter3months.Patients in theSGrecei-

ved intensive computer-assisted cognitive rehabilita-

tionofattention,informationprocessingandexecutive

functions for 3 months; the CG did not receive any

rehabilitation.

Setting: Ambulatory patients were sent by the MS

referral center.

Outcome measures: Improvement inneuropsycholo-

gical test and scale scores.

Results: Afterrehabilitation,onlytheSGsignificantly

improved in tests of attention, information proces-

sing and executive functions (PASAT 3" p=0.023,

PASAT2" p=0.004,WCSTte p=0.037), aswell as in

depressionscores(MADRSp=0.01).Neuropsychological

improvement was unrelated to depression improve-

ment in regression analysis. Conclusions: Intensive

neuropsychologicalrehabilitationofattention,infor-

mation processing and executive functions is effective

inpatientswithRRMSandlowlevelsofdisability,and

also leads to improvement in depression.


Team of Development

Prof. Hans Regel (†)

Medical faculty

University of Magdeburg

Idea, theoretical concept RehaCom,

Attention, memory

Dr. Peter Weber

HASOMED GmbH

Magdeburg

Ideas and concepts RehaCom

Dr. Andreas Krause

Medical faculty

University of Magdeburg

Theoretical concept RehaCom,

Attention, memory

Dipl.- Ing. Frank Schulze

HASOMED GmbH

Magdeburg

Product manager

Conceptual design and

development software

Prof. Dr. Joachim Funke

Psychological institute

University of Heidelberg

Executive functions

PD Dr. Sandra Verena Müller

Neuropsychology Stroke Unit

Clinical centre

Bremen-Mitte gGmbH

Occupational rehabilitation

Dr. Thomas Krüger

Centre for evaluation

and methods

University of Bonn

Executive functions

Dipl.- Psych. Johannes Werres

Organisation of integration

Occupational rehabilitation centre

Sachsony-Anhalt

Occupational rehabilitation

Dr. Stefan Frisch

Clinical Neuropsychologist GNP

Psychological Psychotherapist

Clinic for Neurology

Clinic of J. W. Goethe University

60528 Frankfurt am Main

Prof. Dr. Josef Zihl

Clinical neuropsychology

Department psychology

University of Munich

Visual disorders

Dr. DP Angelika Thöne-Otto

Clinical Neuropsychologist GNP

Psychological Psychotherapist

University Leipzig KöR

Medical Faculty

Daytime Clinic for Cognitive Neurology

Dipl.-Psych., Dipl. Soz.-Päd. Petra Rigling

Petra Rigling Reha-Service

Waldbronn

Attention

The company HASOMED GmbH thanks all partners who are and were involved in the development of RehaCom. Without your collaboration the development of such a sophisticated system for cognitive therapy wouldn´t have been possible.


Team of development

Paul-Ecke-Str. 139114 MagdeburgGermany

T: +49 391.61 07 645F: +49 391.61 07 640

[email protected]

Documents

Αγγλικό Εγχειρίδιο RehaCom