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Technology for
Restitution
Derek Jones PhD, MBA
FIXXL Ltd and Anatomical Concepts (UK) Ltd
Evidence
TBI survivors - can experience
decades of debilitation and
functional loss
Attention Deficits?
Memory impairments?
Executi...
A link
between
severity of
injury
& likely
long term
impairment
But
It’s a fuzzy
&
weakening
link
The percentage of TBI patients with
unmet cognition needs 1 year
post-injury?
Corrigan et al (2004) “Perceived needs follo...
Even if we do have all
“the pieces”
they don't always fit
together as
well as they should
Compensation - assistance
Restitution - Once
it’s gone can it be
recovered?
Strategies to
compensate
for what is lost
“Meaningful
” Goals
Strategies to
recover what can
be recovered
•Know-how
•Techn...
Cognitive Training Cognitive Rehabilitation
Versus
Retraining
Improving Everyday
Functioning
Improve Cognitive
Function
General Aim
Compensating - Rebuilding - Stabilising
those functions that endanger self determination and place in society
...
Basic Principles
First - Encourage functions
that are still in good condition
Second - Training disorders specifically
• B...
Basic Principles
Variety
• Variety of therapy
content
• Variety of material
(motivation)
• Different functions
• To reflec...
Computer Technology
Is NOT the Complete Answer
to Either Cognitive Training
or Rehabilitation
However….
Computer Technology like RehaCom
Can provide some effective
tools for the clinician
Challenges & Opportunities
• Computer training gains might
not automatically transfer to
real-life
• Training alone may no...
What do we mean by
Evidence?
it’s not so simple
Evolution of Evidence-Based Healthcare
Quality
Improvement
Doing things
better
Increased
Effectiveness
Doing the right
thi...
Seeking Evidence - It’s about “Cause” and “Effect”
“Black Box
Problem”
Lies, Damn Lies and Statistics
Great technology alone doesn’t guarantee a great “result”
No quick fixes
It can enable better therapy but it’s
hard to iso...
Derek Jones PhD MBA
Anatomical Concepts (UK) Ltd - Masters of Rehabilitation Engineering
Fixxl Ltd - Bringing Technology t...
Attention Disorders - Meta Analysis
Walter Sturm (2010)
“Evidence-based procedures in neuropsychological rehabilitation: t...
Memory Disorders - Meta Analysis
A. Thöne-Otto
Neurol Rehabil 2010; 16 (2): 63-74
“Evidence-based procedures in neuropsych...
Executive Function - Meta Analysis
SV Müller (201)
Evidence-based methods in the rehabilitation of executive interference
...
Available Literature on RehaCom Applications
• Stroke/Visual Field
• ADHD
• Multiple Sclerosis
• Traumatic Brain Injury
• ...
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Technology for restitution

An examination of technology to support restitution strategies following a brain injury

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Technology for restitution

  1. 1. Technology for Restitution Derek Jones PhD, MBA FIXXL Ltd and Anatomical Concepts (UK) Ltd Evidence
  2. 2. TBI survivors - can experience decades of debilitation and functional loss Attention Deficits? Memory impairments? Executive impairments? Visual field?
  3. 3. A link between severity of injury & likely long term impairment But It’s a fuzzy & weakening link
  4. 4. The percentage of TBI patients with unmet cognition needs 1 year post-injury? Corrigan et al (2004) “Perceived needs following traumatic brain injury” J Head Trauma Rehabil, 2004; 19: 205-216
  5. 5. Even if we do have all “the pieces” they don't always fit together as well as they should
  6. 6. Compensation - assistance
  7. 7. Restitution - Once it’s gone can it be recovered?
  8. 8. Strategies to compensate for what is lost “Meaningful ” Goals Strategies to recover what can be recovered •Know-how •Technology •Systems •Processes Retraining Stem Cells Pharmacological Enhanced Learning Mnemonics External Aids Environmental Mods
  9. 9. Cognitive Training Cognitive Rehabilitation Versus Retraining Improving Everyday Functioning Improve Cognitive Function
  10. 10. General Aim Compensating - Rebuilding - Stabilising those functions that endanger self determination and place in society Other Aims •Improve brain performance and motor abilities •Strategies for learning and problem solving •Perform activities of former life once more •Social reintegration •Processing and gaining awareness of the injury
  11. 11. Basic Principles First - Encourage functions that are still in good condition Second - Training disorders specifically • Building confidence • Increase readiness to deal with deficits • Training specific functions • Tasks “concrete” then “abstract” later • Increase difficulty with care Self confidence?
  12. 12. Basic Principles Variety • Variety of therapy content • Variety of material (motivation) • Different functions • To reflect client interests • Multiple modalities •Visual - linguistic - tactile - auditory
  13. 13. Computer Technology Is NOT the Complete Answer to Either Cognitive Training or Rehabilitation However….
  14. 14. Computer Technology like RehaCom Can provide some effective tools for the clinician
  15. 15. Challenges & Opportunities • Computer training gains might not automatically transfer to real-life • Training alone may not improve all aspects of cognition - evidence suggests attention issues and working memory benefit more than long term memory for example. • Evidence in support has grown but more high quality English language studies would be ideal • Effective tool in the care process - not an alternative to a therapist • Helps training to be specifically targeted to client deficits, to be frequent, intensive & cost effective. Clients can work with supervision - even at a distance with tele-health methods • Can highlight current deficits - strengths and weaknesses and provide leverage for the therapist to develop coping strategies. • Tools like RehaCom have “assessment modules” built-in to help identify deficits
  16. 16. What do we mean by Evidence? it’s not so simple
  17. 17. Evolution of Evidence-Based Healthcare Quality Improvement Doing things better Increased Effectiveness Doing the right things Efficiency Doing things cheaper Doing the right things - right 1970’s 1980’s 1990’s 2000’s
  18. 18. Seeking Evidence - It’s about “Cause” and “Effect”
  19. 19. “Black Box Problem”
  20. 20. Lies, Damn Lies and Statistics
  21. 21. Great technology alone doesn’t guarantee a great “result” No quick fixes It can enable better therapy but it’s hard to isolate it’s specific impact
  22. 22. Derek Jones PhD MBA Anatomical Concepts (UK) Ltd - Masters of Rehabilitation Engineering Fixxl Ltd - Bringing Technology to Life
  23. 23. Attention Disorders - Meta Analysis Walter Sturm (2010) “Evidence-based procedures in neuropsychological rehabilitation: treatment of attention deficit disorders” (German) Neurol Rehabil 2010; 16 (2): 55-62 Evidence-based evaluation of the efficacy of neuropsychological rehabilitation measures dealing with Attention Deficits have revealed that therapy has to be tailored to the specific attention impairment. This holds especially true for deficits in attention intensity (alertness, sustained attention, vigilance). Administration of too complex therapy methods with deficits in attention this domain might lead to even further impairment due to an "overload" of the system. In contrast to other cognitive domains computerised attention retraining programs which address specific attention in everyday-like domain scenarios have proven to be efficient. Both a high frequency and sufficient duration of training measures have proven to be inevitable for efficacy. Further therapeutic approaches based on behavioural therapy help with the organisation of everyday situations but also the involvement of the patient's social surrounding adds the above mentioned measures in primary aim of a restitution of function.
  24. 24. Memory Disorders - Meta Analysis A. Thöne-Otto Neurol Rehabil 2010; 16 (2): 63-74 “Evidence-based procedures in neuropsychological rehabilitation: treatment of memory disorders” (German) Within the last years there has been an increase in methodological quality of published studies in the field of memory rehabilitation. Thus evidenced-based practice guidelines meanwhile can rely on a number of high quality studies. The following review summarises studies on memory rehabilitation published in the years 2000 – 2010. Randomised control-group studies, meta-analyses, systematic reviews, as well as relevant class II or III studies are presented. A number of studies show that patients with mild to moderate memory deficits, especially after traumatic brain injuries, benefit from a training of internal learning strategies. There was a positive correlation between the number of training sessions and training effects. In addition there is high evidence for the application of external memory aids, i.e. memory books or electronic devices, in order to compensate everyday memory deficits. In patients with severe memory deficits, however, a caregiver may be necessary in order to enter relevant information into the patient’s memory aid. In order to teach patients with memory deficits domain-specific personally relevant information or skills errorless learning seems to be a relevant technique. Avoiding errors can be achieved by the method of vanishing cues or by spaced retrieval. Those learning techniques, which seem to rely on implicit memory, are especially relevant for brain injured patients with severe memory deficits.
  25. 25. Executive Function - Meta Analysis SV Müller (201) Evidence-based methods in the rehabilitation of executive interference Neurol Rehabil 2010; 16 (2): 75-81 The paper reviews therapeutic approaches for the treatment of executive dysfunction with special emphasis on therapy trials in the decade (2000 - 2010) introduced. Randomised controlled group studies, meta- analyses and systematic review work were considered. Importance case studies with lower levels of evidence were also considered. A narrowing of focus to a specific etiology was not carried out. In summary, most convincing evidence was found for cognitive repetitive training like working memory tasks or double tasks. When using the methods of behaviour management there is clear evidence of efficacy.
  26. 26. Available Literature on RehaCom Applications • Stroke/Visual Field • ADHD • Multiple Sclerosis • Traumatic Brain Injury • Stroke - cognition • Education • Schizophrenia • Other psychiatric • Dementia • Parkinson’s disease • Elder person - cognitive decline • Downs Syndrome • Telehealth • Epilepsy • Working memory www.rehacom.co.uk

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