We suggest six principles that should guide the elaboration of a tech-tool for cognitive rehabilitation. These principles aren´t concrete, but they produce better results in our clinical practice and therefore in the effectiveness of the treatment.
NeuronUP aims to provide the therapist or neuropsychologist with a wide database of flexible materials, susceptible to modifications due to existing heterogeneity in clinical practice.
1. Meaningful materials
New technologies in cognitive rehabilitation should be made of meaningful materials. What does this mean and what are the implications?
– The activities are related to and focused on real daily living.
– They´re integrated in reality (we avoid formal materials similar to existing neuropsychological tests.)
– Materials should be motivational. This will produce lasting connections in learning processes.
– Your materials should take care of your users “succeeding feelings” while providing adequate feedback.
– Materials should be balanced and calibrated.
– Your materials should also be made of meaningful photos, music, reading materials…
Remember: Meaningful means the user is able to remember his/her birthday, or he/she is able to maintain a conversation with his/her daughter without losing their train of thought.
2. Culture- and development-adapted materials
Children, teenagers, middle-aged adults and the elderly are not equally motivated. They understand and interpret materials in a different way. And they face each task with different developmental abilities that demand a wide range of different cognitive processes.
Therefore, your materials shouldn´t be the same for all your users. You should distinguish what kind of material your user needs.
This affects your materials´ adaptability. With older populations, using paper & pencil may be more appropriate than using computer videogames. You should also take into account motor disabilities or attention deficits when designing the activities.
We have seen many cases of childish materials being given to adults, and view this as a misunderstanding of key issues in developmental psychology that are important.
3. Your technology should be supervised by clinicians
Who are the technicians in cognitive rehabilitation? Neuropsychologists and occupational therapists. They have the knowledge and the experience that are necessary for designing/customizing the materials.
Functional rehabilitation (in which we include cognitive rehabilitation) is a complex reality and a global concept that requires the participation of various professional profiles. The goal is the same (the nervous system), but the perspectives are different. So it seems obvious that a good technological tool with a global purpose should be designed by experts.
They can customize and disentangle real world activities in neuropsychological processes in order to calibrate the levels of demand.
They know which activities are best for the user´s improvement and when to ask the user to go a step further.
4, Your tool MUST be evidence-based.
It has to be designed in terms of effectiveness and validity. From single-case studies to double-blind studies, you must review a wide range of clinical trials, meta-analysis, and experimental designs. If you have the information, then you can decide what is effective and what is not.
You also need a global functioning theory: understand how cognitive functions emerge from the brain, and how brain recruits and combine them to make cognition, movement, perception and emotions possible. You must also know about the automatic and goal-directed resources needed to overcome environmental requirements.
And you should know about why cognitive rehabilitation has an impact in cognitive functioning: plasticity, neurogenesis, neural models of learning and memory.
5. Technology is a part of functional rehabilitation, but it can´t replace all the interventions
Technological tools for functional rehabilitation should be an aid, not our finality. Computers (at least today) can´t replace a therapist´s ability to integrate and understand cognitive, emotional, and social variables involved in the rehabilitation process.
And they can´t make a qualitative analysis of cognition, which is what defines some aspects of real cognitive rehabilitation.
We believe that a good tool must be flexible and constructive, and that´s why we have suggested a cloud computing technology: our clients –the pros- can provide us with quick feedback, so together we can improve NeuronUP.
6. Cognitive functions and tasks are a continuum…
…And they are all mixed in real life. Your tool should take into account that rehab is a multi-step process. Daily life activities should have steps too, and complexity must be understood in this continuum.
We welcome your comments.