Brain Games: Using Evidenced Based Cognitive Interventions for the RT Field Jennifer Zumwalde, LRT/CTRS Novant Health Rowan Medical Center Salisbury, NC Presentation Overview •  PresentaBon goals •  Define cogniBve intervenBons •  Rehab research, benefits, and intervenBons •  Long Term Care research, benefits, intervenBons •  Mental Health research, benefits, intervenBons •  LimitaBons •  QuesBons Learning Objectives •  IdenBfy 2-­‐3 evidence based cogniBve intervenBons that can be used in RT services •  IdenBfy 2-­‐3 benefits of using evidence based cogniBve intervenBons in RT pracBce •  IdenBfy 2-­‐3 RT pracBce seLngs that would benefit from the use of evidence based cogniBve intervenBons Cognitive Interventions •  “Brain Games” •  Specific acBviBes or tests that sBmulate cogniBve funcBons PercepBon
ASenBon
Visual and SpaBal Processing AnBcipaBon EmoBonal Self-­‐RegulaBon
Sequencing Motor Skills
Problem-­‐Solving Language
InhibiBon Working Memory
Decision making (Michelon, 2006) Duel N-­‐Back •  Improving Fluid Intelligence with Training on Working Memory (Jaeggi, Buschkeuhl, Jonides, Perrig, 2008) •  Fluid intelligence: “ability to reason and to solve new problems independently” •  Improve fluid intelligence through working memory tasks (duel n back task) •  70 healthy individuals, average age of 25.6 •  Pre-­‐ and post-­‐ test of fluid intelligence on experimental and control groups (Raven’s Advanced Progressive Matricies and Bochumer Matrizen-­‐Test) •  Dosage dependent (Fig. 1. Jaeggi, Buschkeuhl, Jonides, Perrig, 2008) Dual N-­‐Back Task Online • hSp://brainscale.net/dual-­‐n-­‐back/training Rehab Internal Memory Strategies (I-­‐
MEMS) •  Controlled Treatment Study of I-­‐MEMS following TraumaBc Brain Injury (O’Neil-­‐Pirozzi, 2010) •  94 adults with TBI (mild, moderate, severe) one year post injury •  Experimental group: 12 90 minute group sessions, twice a week for 6 weeks •  Control group: no I-­‐MEMS intervenBons •  Focus on internal memory strategies •  SemanBc memory, categorizaBon, elaboraBng or linking knowledge •  Error free learning and metacogniBve strategy training (planning, monitoring, evaluaBng learning process) •  Pre/post test: Hopkins Verbal Learning Test-­‐Revised and Rivermead Behavioral Memory Test II I-­‐MEMS Results Pretest Pos(est 1 Pos(est 2 6.09 (3.55) 8.13 (3.22) 8.5 (3.01) 18.25 (4.9) 18.22 (4.28) 7.52 (3.5) 7.34 (3.54) 14.9 (4.81) 14.82 (5.14) Experimental: Hopkins VLT-­‐R Rivermead BMT-­‐II 15.92 (4.89) Control: Hopkins VLT-­‐R 7.82 (3.4) Rivermead BMT-­‐II 15.65 (4.76) Hopkins VLT-­‐R: 0-­‐12
Rivermead BMT-­‐II: 0-­‐24 Internal Memory Rehab Strategies •  Internal Memory RehabilitaBon Strategies in the Context of Post-­‐acute Brain Injury: A Pilot Study (Perna and Perkey 2016) •  11 individuals with acquired brain injuries within 12 months with cogniBve impairments •  5 weeks, twice weekly individual sessions, once weekly memory group •  Pre/post test of Repeatable BaSery for the Assessment of Neuropsychological Status (RBANS) •  Immediate memory, visuospaBel/construcBonal, language, aSenBon, immediate and delayed memory •  Taught and pracBced internal memory strategies using Workbook of AcBviBes for Language and CogniBon 10: Memory WALC 10: Memory •  Word/mental picture associaBons •  Chaining word lists •  Following wriSen and oral direcBons •  Recalling informaBon •  First leSer mnemonics •  Word list retenBon •  Associated visual pairs •  Memory and mental manipulaBon (Tomlin, 2007) •  Name-­‐picture associaBon •  Memory for numbers and sentences •  Picture associaBons •  Memory for shapes and pictures •  SorBng and remembering categories •  FuncBonal memory tasks Internal Memory Results RBANS Test Ini4al Tes4ng Memory Retes4ng Word List 71 (12.1) 97 (14.1) Story Recall 72 (22) 107 (10.6) List Recall 66.1 (13.4) 99 (12.7) List RecogniBon 65 (20) 105 (11.1) Standard mean score of health adults is 100, standard deviaBon of 15 UAB Home Stimulation Program •  Program designed to assist those post brain injury paBents in recovery •  Varying acBviBes and games designed for specific tasks •  Fine motor control, aSenBon/concentraBon, memory-­‐
orientaBon, reasoning/problem solving, visual spaBal skills, language, •  Varying levels of difficulty •  (Blankenship and Novack, 2002) UAB Game Index Game A(en4on/ Memory Reasoning Visual-­‐ Speed of Concentra4on Spa4al Processing BaSleship X X X X Clue X X X X Connect Four X X X Guess Who X Jenga X Memory X Outburst X PicBonary X ScaSegories X Scrabble X X X X X X X X X X X X X X BeneRits: Rehab • 
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MulBtasking Remembering mulBple pieces of informaBon Finding missing paSerns Sequencing InterpreBng mulBple sBmuli ConcentraBon Memory Processing speed Visual spaBal navigaBon Recall Language Interventions: Rehab • 
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Duel N Back computer games Mnemonic Strategies Memory/ConcentraBon Word in Word Guess Who Categories Grocery List Recreational Conference Long Term Care ACTIVE Study •  Ten-­‐Year Effects of the ACTIVE CogniBve Training Trial on CogniBon and Everyday FuncBoning in Older Adults (Rebok et al. 2014) •  Wanted to determine effects of cogniBve training on cogniBve abiliBes and funcBon over 10 years •  2,802 healthy 65+ community dwelling individuals •  Verbal Episodic Memory, Problem Solving, Visual Search •  3 intervenBon groups and control group •  10 sessions of training, 4 booster sessions at 11 and 35 months aper training •  ACTIVE parBcipants reported less decline in instrumental acBviBes of daily living (IADLs) •  Reasoning and speed (not memory) training resulted in improved abiliBes for 10 years ACTIVE Method •  Problem Solving through InducBve Reasoning •  InducBve Reasoning •  PaSern idenBficaBon •  Verbal Episodic Memory through Memory Training •  AcquisiBon and retrieval of informaBon •  Mnemonic strategies •  Speed of Processing/Visual Search •  IdenBfy and locate informaBon quickly •  Increasing complexity •  With and without distracBon ACTIVE Results (Figure 3, Training effects on self-­‐reported Instrumental AcBviBes of Daily Living (IADL) difficulty scores, Rebok et al., 2014) BeneRits: Long Term Care • 
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Promotes independence and funcBoning Decreases decline of ADLs Decreased at fault driving accidents Maintains mental capabiliBes NavigaBon Interventions: LTC • 
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Word Recall Games Quick ReacBon Games Timed AcBviBes Logic Games Scavenger Hunts Who am I? Cow Snake Mental Health Thinking Skills Work Program •  CogniBve Training and Supported Employment for Persons With Severe Mental Illnesses: One-­‐Year Results From a Randomized Controlled Trial (McGurk, Muser, Pascaris, 2005) •  44 parBcipants with schizophrenia, bipolar disorder, depression with a history of job failure •  Severe mental illness determined by the state, not employed, desire for work, enrolled in supporBve employment program, prior job failure, willingness and capability of giving consent •  Received cogniBve training and supported employment or supported employment services only •  CogniBve Training with supported employment group worked more jobs, more hours, and earned more Thinking Skills Work Program •  Method: Cogpack, version 6.0, Marker Sopware • 
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Visomotor Skills Comprehension, ReacBon, Vigilance Language Material Memory Numbers, Logic, Problem Solving Knowledge, OrientaBon, Everyday Live Special Elements •  24 hours total, 45-­‐60 minutes, 2-­‐3 per week, 12 weeks Thinking Skills Work Program Work Outcome: Total Jobs: Total Hours:
Total Wages:
Hours/Month:
Wages/Month:
CT+SE Avg. SE Only Avg. 0.96 379.91
2,207.91
34.48 199.11
0.05 30.95 182.05 2.58 15.17 Casual Video Games and Depression/Anxiety •  Casual Video Game Play in Reducing Clinical Depression (Russoniello, Fish, O’Brien, 2013) •  59 ParBcipants 18-­‐74, mean age of 29, 31 screened for depression •  Control group surfed NaBonal InsBtute of Mental Health •  Experimental group chose popular casual video games •  Bejeweled II, Peggle, Bookworm Adventures •  Significant decreased in depression symptoms according to PaBent Health QuesBonnaire-­‐9 •  Casual Video Game Play in Reducing Symptoms of Anxiety (Russoniello, Fish, O’Brien, 2014) •  Same method as above •  Experimental group showed decrease in anxiety symptoms according to The State Trait Anxiety Inventory Applications: Mental Health • 
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Coping skills Reduce symptoms Increase independence BeSer decisions EmoBonal regulaBon Interventions: Mental Health • 
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Casual video games Reproduce a drawing Catch a moving item Using cues to find words Mental math Mazes Reading (and reading comprehension) Pink Blue Green Purple
Black Red Orange Yellow Green Blue Red Black Purple Yellow Pink Orange Yellow
Blue Red Pink Purple Orange Green Black Measuring Outcomes •  Mini Mental State ExaminaBon (MMSE) •  Brief Interview for Mental Status (BIMS) •  St. Louis University Mental Status Exam (SLUMS) •  Time •  Speed •  Percent accuracy •  Minutes focused on task •  Self rated anxiety or stress level Cognitive Interventions Ideas •  Trivia, Jeopardy •  Group Crossword Puzzles •  ObservaBon Games •  Can You Spot the Difference •  Memory/
ConcentraBon •  Reminiscing •  Group juggling •  PicBonary •  Using Non-­‐dominant Hand •  Puzzles, Riddles, Logic Games •  Connect 4 •  Catchphrase •  ScaSergories Limitations •  Research can be difficult to obtain and understand •  May not outline specific exercises •  Transfer of gains •  CogniBve intervenBons are not “one Bme fix” •  Increased difficulty is a requirement •  May not be appropriate with certain populaBons •  Modified due to paBent needs References Michelon, P. (2006). What are cogni-ve abili-es and skills, and how to boost them? Retrieved from hSp://sharpbrains.com/blog/2006/12/18/what-­‐are-­‐cogniBve-­‐
abiliBes/ Jaeggi, S., Buschkeuhl, M., Jonides, J., Perrig, W. (2008). Improving fluid intelligence with training on working memory. Proceedings of the Na-onal Academy of Sciences, 105(19), 6829-­‐6833. doi: 10.1073/pnas.0801268105 O’Neil-­‐Pirozzi, T., Strangman, G., Goldstein, R., Katz, D., Savage, C., Kelkar, K. … Glenn, M. (2010). A controlled treatment study of internal memory strategies (I-­‐
MEMS) following traumaBc brain injury. The Journal of Head Trauma Rehabilita-on, 25(1), 43-­‐51. Retrieved from hSps://www.researchgate.net/
publicaBon/
40850720_A_Controlled_Treatment_Study_of_Internal_Memory_Strategies_I-­‐
MEMS_Following_TraumaBc_Brain_Injury Perna R., Perkey H. (2016) Internal memory rehabilitaBon strategies in the context of post-­‐acute brain injury: A pilot study. Interna-onal Journal of Neurorehabilita-on, 3(199), doi:10.4172/2376-­‐0281.1000199 Tomlin, K. (2007). Workbook of acBviBes of language and cogniBon: Memory. AusBn, TX: PRO-­‐ED, Inc. Tennstedt, S. & Unverzagt, F. (2014). The ACTIVE study: Study overview and major findings. Journal on Aging and Health, 25(80), 3-­‐20. doi: 101177/0898264313518133 Blankenship, J., Novack, T. (2002) Home based cogni-ve s-mula-on program. Retrieved from hSp://www.biaoregon.org/docetc/pdf/familymedlinks/cogrehab-­‐
UofAL-­‐home_based_program.pdf References Rebok, G., Ball, K., Guey, L., Jones, R., Hae-­‐Young, K., King, J. …Willis, S. (2014) Ten-­‐year effects of the ACTIVE cogniBve training trail on cogniBon and Everyday FuncBoning in Older Adults. Journal of American Geriatrics Society, 62(1), 16-­‐24. doi:10.1111/jgx.12607 Willis, S., Tennstedt, S., Marsiske, M., Ball, K., Elias, J., Koepke, K. … Wright, E. (2006) Long-­‐term effects of cogniBve training on everyday funcBonal outcomes in older adults. Journal of American Medical Associa-on, 296(23), 2805-­‐2814. doi:10.1001/gama.296.23.2805 Wolinsky, F., Unverzagt, F., Smith, D., Jones, R., Wright, E., Tennestedt, S. (2006) The effecBve of the ACTIVE cogniBve training trial on clinically relevant declines in health-­‐related quality of life. Journal of Gerontology: SOCIAL SCIENCES, 61B(5), S281-­‐S287 Retrieved from hSps://
www.ncbi.nlm.nih.gov/pubmed/16960242 Ball, K., Edwards, J., Ross, L., McGwin, G. (2010) CogniBve training decreased motor vehicle collision involvement of older drivers. Journal of the American Geriatrics Society, 58(11), 2107-­‐2113. doi: 10.1111/j.1532-­‐5415.2010.03138.x McGurk, S., Mueser, K. & Pascaris, A. (2005) CogniBve training and supported employment for persons with severe mental illnesses: One-­‐year results from a randomized controlled trial. Schizophrenia Bulle-n, 31(44), 898-­‐909. doi: 10.1093/schbul/sbi037 Fish, M., O’Brien, K., and Russoniello, C. (2013) The efficacy of casual videogames play in reducing clinical depression: A randomized controlled study. Games for Health Journal, 2(6), 341-­‐346 doi: 10.1089/g4h.2013.0010 Fish, M, O’Brien, K, and Russoniello, C. (2014) The efficacy of prescribed casual videogame play in reducing symptoms of anxiety: A randomized controlled study. Games for Health Journal, 3(5), 291-­‐295 doi: 10.1089/g4h.2013.0092 Image Citation Goal Clip Art Free [digital image]. (2014). Retrieved on April, 7 2017 from hSp://
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