Computer Programs for Cognitive Rehabilitation

ATTENBAS: Basic Attention and Coma Emergence

          The Basic Attention programs are designed for individuals who have sustained severe brain injuries and are cognitively in the most elementary stages of their recovery, including the individual regaining consciousness who can produce only one identifiable response, such as a finger flexion. This last group may be characterized as coma emergent.
         The state of the art in coma rehabilitation is known as "sensory stimulation". Important as stimulation might be, it alone does not supply a progressive system for capturing and reinforcing the individual's response capabilities. This series of programs emphasizes the gradual establishment of directed intentional acts on the part of the person emerging from coma. The strategy is to begin with whatever limited responding is available, and to build on that ability via definable steps we characterize as milestones:

• 0 Baseline -- inconsistent, ambiguous responding
• 1 Single discrete response
• 2 Controlled repetition of a response
• 3 Temporal pattern of responding
• 4 Contingent responding
• 5 Differential responding

          In addition to programs identified explicitly with the coma emergence milestones, the Basic Attention series includes programs, such as KEYBDACC (Keyboard Accuracy), SOSH (Search for the Odd Shape) and FASTREAD (Tachistoscopic Reading), which can be useful for treating patients who are just beginning to use the keyboard.

PRICE

• Cat. #10, ATTENBAS -- complete set -- $450.00
• Individual Programs -- $50.00 each.
• Add $7.95 S&H in the continental U.S.

Ordering Info

RESPONSES: keyboard., mouse, external switch

967.2 -- BASELINES: Signalled & Unsignalled

          "BASELINE" actually consists of two tasks: UNSIGBAS (Unsignalled Baseline) and SIGBAS (Signalled Baseline)
These help determine if responses are occurring prior to and without intervention. The signalled baseline procedure permits a quantitative appraisal of responding which occurs to triggering stimuli prior to intervention or training, for example, an eye blink to a puff of air or a loud noise. Unsignalled baseline is a procedure to facilitate a quantitative appraisal of spontaneous response production without triggering stimuli and before training.

967.4 -- POUNCE: Milestone 1 - Single Discrete Responding

          At the first milestone of response competency is the ability to make a simple consistent response. Stimuli may be auditory, visual, or both. This task was developed to work with persons at Milestone 1 (Single consistent response) of coma emergence. The intent is to bring the process of responding into an objective sphere. Responses can be anything a switch can measure - limited only by the ingenuity, resources and technical expertise of the therapist. A momentary contact switch, an input interface (e.g., LSA's switch input box), and a game port (or equivalent, e.g., Notebook Game port) are needed to input response occurrence to the computer. Particular attention should be paid to the positioning of the patient and the mounting of the switch. The services of a Rehabilitation Engineer and Occupational Therapist. POUNCE presents visual or auditory stimuli to which a single response is made. The visual portion of POUNCE is simple and centered on the screen. Look for and attempt to train:

1. rapid onset of response
2. prompt release and
3. no repeats.

967.5 -- HOW MANY: Milestone 2 - Controlled Repetition of a Response

          HOW MANY requires response competency at the second milestone, namely a controlled number of repetitions of a single response. Switch or mouse presses can be used. HOW MANY requires response competency at milestone #2 (Controlled repetition of a response). This level of response competency is a precursor to training yes-no communication where one tap means "no" and two taps means "yes The HOW MANY program presents a series of flashing squares or tones, or both, followed by an opportunity to tap out a corresponding number of times, e.g., hear three beeps, tap three times on the switch. An example would be: S = BEEP BEEP BEEP -- R = TAP TAP TAP
          In order to do the HOW MANY task, one must a) keep track of number and b) stop responding when number is reached.

967.3 -- PATTERNS: Milestone 3 - Temporal Pattern of Response

          Here, a patterned response sequence must be produced in response to a model. Not only the number, but the timing of the responses is important. This task reflects competency at the third milestone of response competency. PATTERNS calls for the ability to repeat a patterned series of responses. This task requires memory for the pattern and the ability to execute it. It is the defining task for the third milestone of response competency. Because stimuli can be visual (light flashes) or auditory (beeps), the PATTERN procedure can be conducted as the AVIT (Auditory Visual Integration Task). Added to the requirements HOW MANY is the ability to control the timing of the response. For example: Stimulus = BEEP (PAUSE) BEEP BEEP Response = TAP (PAUSE) TAP TAP (not TAP TAP TAP) Appropriate pausing is now required. Visual and auditory stimuli can be selected.

967.6 -- GONOGO: Milestone 4 - Contingent Responding

          This task calls for contingent responding, the 4th milestone of response competency. A switch or mouse press is to be made only to certain stimuli. In GONOGO inhibitory control is required. A practical example is continuing through the intersection if the light is green, but pressing the brake when the light is red. In GO-NO GO the individual is required to respond only if certain conditions are present, and inhibit the response otherwise. For example: + stimulus or high tone --> Respond - stimulus or low tone --> Don't respond.

967.7 -- DIFFERN: Milestone 5 - Differential Responding

          This task addresses the fifth and final milestone of response competency: the ability to make different (but equivalent) responses to different stimuli. This program requires switch input. The last milestone is represented by the ability to make differential responses depending on the nature of the stimulus. Operationally, it differs from milestone #4 (contingent responding) by the addition of another switch. For example: + stimulus or high tone --> Respond, right hand - stimulus or low tone --> Respond, left . A series of trials proceeds with random inter trial intervals. Although the exact series is unpredictable, overall, there is a balance between the two types of stimuli. Throughout the series of programs, the computer keeps track of the individual's scores and conditions selected. At any time, one can exit from the procedures, retaining whatever results are already obtained.

967.1 -- REACT: Reaction Time Measure of Visual Field

          This program detects slowed response to visual stimuli in all quadrants of the computer display. Respond with switch/joystick or mouse button. Accurate (machine-speed independent) response times mapped in patient comprehensible display. This procedure can be used to detect slowed response to visual stimuli-either on the right or left side or both sides, as well as the top, middle, and bottom. With eyes free to move, the procedure is a 'functional' visual field, more like everyday life than conventional visual field measurement which involves fixation. Immediate response time feedback is reinforced by the final results, which include a map of slowed responding in various parts of the visual field. This feedback, unlike any traditional visual field measurement procedure, offers the patient information which may improve their awareness (and ultimately insight) of their sensory loss. In this program, the patient simply presses the mouse or joystick button to "stop the runaway numbers" on the screen. The quicker the button is pressed, the better the score will be. The computer keeps track of where on the screen the stimuli (numbers) were and the reaction times. Settings can be adjusted so that there is a fixation point or, without one, the patient may look anywhere on the screen.

959.4 -- SOSH: Search for the Odd Shape

          An 8 by 8 array of homogeneous shapes ("Martians") is searched for one different shape (a "sleeping" Martian). Search times are recorded from when the display appears to when the ultimately successful response was initiated.


          This program is designed to detect differences in attention and responsiveness on the two sides of the visual field. It is particularly designed to identify those persons who have a spatial hemi-imperception which affects their ability to scan both sides of a display efficiently and, used in conjunction with SEARCH, it differentiates this skill from shape examination and matching.


          The display contains an intermediate level of information compared to REACT (one stimulus in an otherwise empty display) and SEARCH (an 8 x 8 array of heterogeneous shapes). This variation in information density enables one to differentiate hemi-inattention and hemi-imperception. The patient searches an array of identical patterns (which can be interpreted as the heads of little space people) for the "odd" one (the one which appears to have closed its eyes). Using this analogy and the instruction "Find the one that fell asleep", SOSH becomes simple to understand. From trial to trial, the display stays the same; only the location of the target shape changes. Locations throughout the array are sampled and search times are reported and recorded for each. Median search times are computed for left side and right side targets, respectively.

967.8 -- KEYBDACC: Keyboard Accuracy

          Keyboard Accuracy addresses fine motor control for movements prompted sequence of random letters. Available sets range from the simple (Left side 'home' keys) to the more complex (All keys). Keyboard Accuracy is a program which is mostly used to evaluate elementary keyboarding skills and specific fine motor finger control through the selection of most typing programs which progress from the right hand keys (JKL:). You can begin with a small set of user-defined keys and progress to a larger set.
          However, it can be used for other purposes. For example, with some aphasics: turn off the CAPS LOCK (ordinarily left on during the program) and use lower case stimuli. Profoundly aphasic individuals can then practice learning the equivalency of the stimulus letter and upper case letters on the key caps. At one level, Keyboard Accuracy is a simple visual - visual (screen - keyboard) simultaneous Matching task. It can also be used as a simple very short term memory / keyboard learning task. Finally, Keyboard Accuracy can be used to evaluate the effectiveness of devices, training and techniques for keyboard access.

965.5 -- FASTREAD: Tachistoscopic Reading

          The computer flashes a word and asks that it be typed in. The task speeds up as long as one can keep up, and slows down after errors. Word lists come with the program; custom word lists can be created with a text editor. The program is included as a brief visual memory exercise, but it also is useful for persons with deficits in attention, foveal perception, and verbal apraxia (difficulty planning and articulating words). The task offers feedback for visual imperception, reinforces attention and alertness, and exercises the typing and production of words. A "copy" mode is also an option.