Center for Life Management

Computer-assisted Remediation Therapy

Computer-assisted cognitive remediation is born from the idea that people use parts of the executive functioning system of the brain to play a computer game well. For example, many strategy based games require sustaining attention on a conceptualized set of data, while selectively attending to many different rules and stimuli, remaining vigilant to potential changes, keeping a memory log of what has happened, anticipating what may happen and sequentially needs to happen, and then calling on episodic and procedural memory to play the game in the future. Further error detection, error correction, and processing speed are required to change pace as a person moves up difficulty phases of the game. In addition, visual, auditory, and motor processing has to all be combined to win these games or move up the level system.

The computer-assisted remediation therapeutic regimens work similar to the thought-remediated therapies. Specific issues, such as attention or memory, are targeted. Tasks are gradated starting with low degree of difficulty and then moving to assignments which necessitate more complex executive functioning skills (Klingberg, Forssberg, & Westerburg, 2002). Data on dependent measures is tracked via the computer regarding success. Clients must master one part for 20-30 minutes before they move on to the next phase of treatment (Butler & Mulhern, 2005). Clients use the programs for 17-20 hours, depending on the treatment plan, and the therapies last from 5-20 weeks (Klingberg et al., 2002).

Cognitive remediation has been shown to be an effective intervention since the 1930’s. Computer assisted cognitive remediation has been used since the 1950’s. In the advent of better technologies and computers this treatment has seen a huge growth since 1989. Research where a functional MRI was taken after a course of cognitive remediation therapy for people with traumatic brain injury indicated 89% of participants showed an improvement in executive finctioning of over one standard deviation from baseline measures. Studies on computer assisted cognitive remediation show as many as 60% of children no longer met the criteria for an ADHD/ADD diagnosis following 20 training sessions with the computer assisted cognitive remedial software. In addition studies also indicate computer assisted cognitive remediation significantly improves sustained and selective attention, and complex memory processes in individuals with an acquired brain injury.

Computer-assisted remediation has been utilized for people with learning disabilities, ADHD, memory impairments, developmental delays, autism spectrum disorders, fetal alcohol effects disorders, acquired and traumatic brain injuries, bipolar disorder, and schizophrenia (Braintrain, 2007) The interventions have been shown to increase working memory, sustained attention, and selective attention, in studies around the world, even at a three-month follow-up (Rabiner, 2007). Children with ADHD have further benefited when computer-assist modalities have added auditory cues and then titrated the cues to extinction (O’Connell et al., 2006). The cues alerted the children to focus attention to discriminate and selectively attend to stimuli. The results show the cue signals are increasing self-regulatory error detection and correction, and decreasing impulsivity (pp. 661-662).

Computer-assisted remediation can be used with the therapist without other techniques. The first 30 minutes of the session involves joint interaction between the therapist and client at the computer. The remaining part of the session would be utilized as a debriefing or process period (O’Connell, Bellgrove, Dockree, & Robertson, 2006). Many clinicians employ these games as one component in an overall treatment package (Butler & Mulhern, 2005).

Since this approach requires repetition and one-to-one instruction, the computer is the easiest and most cost-effective way to implement this type of program. The use of the computer can also facilitate self-esteem and increase the fun of learning which has often been lost by children with ADHD. People receive immediate reinforcement, which works best for children and adults with brain impairments; the therapist gets immediate scoring and the ability to record progress. The computer can provide both structured exercises and a reward system in the form of games.

Computer assisted cognitive remediation is advocated for use by Oregon State Health Sciences University, the University of Oregon, Duke University, the Veteran’s Administration, as well as many clinics and hospitals which employ rehabilitation services for individuals who suffer brain and learning impairments.

Regulatory Issues

The use of computer assisted cognitive testing, evaluation, and remediation techniques requires a current state licensure and the individual overseeing these activities be at least a doctoral student in psychology, who has completed several doctoral level courses approved by the American Psychological Association in testing and evaluation, and supervision by a Ph.D level psychologist.

Trends and Changes

Current research in psychology, neuroscience, genetics, and physiology is focused on pinpointing exactly how the human brain works in concert with the body to complete simple and complex tasks, to learn, and utilize this new learning. This includes knowledge of what is the exact etiology behind of brain impairments and how does society alter these problems. Traditional medicine focuses on the use of medicine to alter problems. Medication is not a panacea and people are not always in agreement with the use of medication, especially medicating children.

Computer assisted cognitive remediation promote long-term functional recovery of the many chemical and neuro-physiological processes within the brain. The basic unit of communication within the brain is the synaptic connection. The creation of the correct network of synaptic connections is crucial to learning, thinking, reasoning, and judgment. Computer assisted cognitive remediation creates and strengthens the necessary synaptic network while formulating a foundation for the brain to prune and remove the synaptic connections which facilitate brain impairment.

Individuals, families, schools, and payor sources (such as insurance companies) are interested in effective treatments which can be applied with the quickest margin of improvement. Computer assist cognitive remediation offers these aspects and will be the sought out treatment for the future.

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