Cognitive stimulation therapy for people with mild cognitive impairment

A cognitive stimulation therapy (CST) session will be conducted in a group of 15 people with mild cognitive impairment (MCI) and without cognitive impairment using the NeuronUP platform.

General objective

Restoring clients’ impaired cognitive functions and, once recovered, preserving those that have been regained.

Specific objectives

• Improve selective attention.
• Restore sustained attention
• Train short-term memory and semantic memory
• Improve processing speed.
• Improve color and detail discrimination.
• Enhance visual acuity.
• Promote reality orientation and spatial orientation
• Train planning and concentration.
• Enhance number and word sequencing.
• Improve reasoning.
• Improve hemineglect.

The Occupational Therapy Practice Framework (AOTA) (2) will be used to carry out this intervention.

The intervention approaches that will be used to achieve the desired outcomes are: restoration (restore the clients’ skills that have been impaired) and maintenance (to provide the supports that will allow clients to preserve the capabilities they have regained) (2).

The type of activities will be based on several areas of occupation:

• Instrumental activities of daily living (IADLs)
• Education (environment)
• Play
• Social participation (since it is a group intervention) (2).

In addition, three types of activities will be carried out:

• Fun activities that clients may like such as a “Card pyramid” and “Word search”, which will be addressed below.
• Other activities to help clients integrate new concepts into their lives (e.g., “Pick up your luggage” and “Recycle your trash”).
• Activities related to concepts (e.g., “Word association” and “Emotion recognition”).

The activities can be adjusted to clients’ pace of work; in addition, they are short so clients do not lose focus or become tired and discouraged. Finally, it should be noted that clients will be encouraged and helped during each activity.

Activities

Moving colors

This activity consists of finding, as quickly as possible, the squares that remain still among a group of squares that are in constant motion.

Clients have three lives, losing one life every 3 mistakes until they run out of them. The activity ends when the client identifies the squares that are not moving and clicks on them. Stage 4 has been chosen as the starting point for this intervention: if clients make no mistakes, they will be prompted to move to the next stage; if they make mistakes, they will go back to the previous stage.

Pick up your luggage

In this activity, participants must select, among the suitcases coming out on the luggage carousel, only the suitcases that are identical as the one(s) shown in the model (with the same characteristics). Depending on the stage, more model suitcases will be presented. In this case, clients will start in stage 7, so they will have to select those suitcases that are identical to the two given as models. Clients must pay close attention to the features as very similar suitcases may appear.

As in the previous activity, clients have three lives. Each time they lose a life, the model suitcases change and the suitcases on the luggage carousel change as well. The activity will end when clients have selected all the suitcases coming out on the carousel that match those shown in the model, that is, those with identical features.

Word search

This activity involves finding all the words hidden in a grid. Words can be located horizontally, vertically, or diagonally and they can be found in any direction.

Clients can choose between three game modes: correction mode, meaning that if clients make a mistake and it’s not the word they had to find, then it’s marked as incorrect; or free mode, when clients get to know at the end of the activity if they did it correctly or if they didn’t.

A third game mode is a personalized mode. In this mode, the game can be modified according to the client by selecting either the correction or the free mode as well the maximum number of errors. The maximum time to complete the activity can also be modified by choosing how many minutes the client can spend on the activity. Similarly, it is possible to include an inactivity warning so that if clients spend, for example, one minute without finding a word, they will be prompted to continue the game, as they may have been distracted; the warning will be visual and auditory. A timer counting down or upwards can also be selected so that clients can see the time remaining to complete the activity. Finally, it is possible to give specific instructions to make the task easier for the client (e.g., to create a customized word search with the names of the client’s grandchildren, which will be found in the box).

The settings that can be adjusted to increase or decrease the difficulty are: the size of the grid (columns and rows can be removed or added), the direction in which the words are placed (horizontal, vertical, diagonal or even backwards), the number of words to be found and finally, what words the therapist wants the client to find, sorted by word length, subject or, as mentioned above, a customized word search (e.g., name of client’s grandchildren).

Emotion recognition

This activity involves recognizing the emotions depicted and matching them to their definition. There are three levels of difficulty: once the level has been selected, the task starts: the participant must look at the image of a person whose facial expression depicts a specific emotion and match it to its definition. The client must click on the word he believes matches the emotion from the depicted facial expression, as seen below.

A medium difficulty level will be selected in this case since it is not highly complex. At this level, it is possible to select one of the 11 sub-levels. If participants see that they can increase the difficulty, there is the possibility of selecting another level of greater difficulty with its corresponding sub-levels. Click on “correction mode” to start playing (that way participants receive positive feedback regarding their choices). Clients only have one life in each level.

Word association

This activity is aimed at improving executive functions. It involves matching words that are associated to each other. These words are placed in three different columns. This activity has three levels of difficulty and multiple sub-levels depending on the chosen level of difficulty.

Participants select a medium difficulty level and the correction mode (to check whether their answers are right). They have three lives. If participants feel they can improve their performance in terms of difficulty, they can move up a stage to increase the complexity.

Recycle your trash

This activity consists of placing different types of waste in their corresponding recycling containers.

This activity relates to activities of daily living (ADLs), more specifically to instrumental activities of daily living (IADLs), as it deals with issues related to cooking, cleaning, and environmental education.

Clients must complete four exercises. They have a maximum time of 4 minutes to do so.

The game will display an inactivity warning after 2 minutes. To manage time better, a timer counting upwards will be displayed on the left top side of the screen. The activity’s description will be as clear as possible to help clients understand it.

The difficulty level increases as the exercises are completed. Therefore, clients should start with those displaying a house scenario with a total of 4 items to be placed in different containers and should be allowed a high number of errors.

Card pyramid

This activity consists of arranging the cards that are presented in either ascending or descending numerical order (suits do not matter). Spanish playing cards are numbered from “as” (ace) to 7, then the “sota” (jack), “caballo” (knight), and “rey” (king). This activity concerns play (one of the areas of occupation).

Participants must pass 5 exercises. They have a maximum time of 5 minutes to do so. The game will display an inactivity warning after 2 minutes. To manage time better, a timer counting upwards will be displayed at the left top side of the screen. The activity’s instruction will be as clear as possible to help clients understand it. As clients move up, the difficulty level increases, thus increasing the number of rows and columns, the number of decks, the correction criteria, and the number of errors. Additionally, the time limit to complete the activity will be progressively reduced.

Bibliography

• NeuronUP. NeuronUP [sede Web]. La Rioja: Neuronup; 2012 [acceso el 15 de noviembre de 2018]. Disponible en: https://www.neuronup.com/en
• Ávila Álvarez A, Máximo Bocanegra M, Martínez Piédrola R, Matilla Mora R, Méndez Méndez B, Talavera Valverde MA et al. Marco de trabajo para la práctica de la Terapia Ocupacional: dominio y proceso. 2da Edición [Traducción]. www.terapia-ocupacional.com [portal en Internet]. 2010 [consultado el 20 de noviembre de 2017]; [85p.]. Disponible en: http://www.terapiaocupacional.com/aota2010esp.pdf. Traducido de: American Occupational Therapy Association (2008). Occupational therapy practice framework: Domain and process (2nd ed.).

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Olalla Sáiz Vázquez

Área de Terapia Ocupacional
Departamento de Ciencias de la Salud
Investigadora y profesora Asociada Universidad de Burgos
[email protected]

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