Computer-based Cognitive Rehabilitation

RehaCom Training Modules

The RehaCom system has been developed by and for neuropsychologists. Each module has been designed to train a specific deficit. Years of research, testing and adapting has gone into making this the most deficit specific software on the market.

The design may look simplistic but this is intentional. Any extra, unimportant stimuli may affect the performance of the client. This gives them the best chance for success. There are no sudden or negative stimuli that could upset or frighten a patient. This is a nurturing and supportive system.  Each module begins at Level 1 which can be used even at the most acute stages of recovery. Modules can progress upwards of 50 levels and remain challenging all the way through recovery. Each module is adaptable through its own specific set of parameters giving you incredible control.

Attention Training Modules

Alertness

Indications
Symptoms from attention deficit disorder, chronic fatigue syndrome, depression. Aim: to increase intrinsic alertness, causing attention to be entirely cognitively controlled. It is necessary to improve the phasic alertness first, and then proceed to work on intrinsic alertness. For early phases of rehabilitation, this module can be used as a criterion for driving suitability or as supplementary training for clients with Neglect; ages 6 and above.

Training Task
The client´s task is to observe a realistic street scenario and react quickly after a stimulus appears. The maximum response time can be set with two preselectable variants. RehaCom recognizes right, missed, and false reactions.

Training Material
The client will see objects (vehicles, animals, people, etc.) appearing in their line of sight. As the level increases, the complexity increases as well. The stimuli appears in different points on the screen (centrally, laterally, etc.). This produces a demand on anticipation and intrinsic reactivity similar to real life scenarios. Clients should train at least 10 mins (recommended).

Reaction Behaviour

Indications
Reduced reaction speed (e.g. as a result of insult, ischemia dementia, craniocerebral trauma, tumor development, etc.) mostly occurs in diffuse brain damage as well as in frontal and prefrontal lesions. Suitable for persons aged 8 and up.

Training Task
The task is to press the corresponding reaction button as fast as possible whenever a relevant stimulus - a traffic sign - is shown on the screen.

Training Material
During the learning phase, the client has to memorize traffic signs and the corresponding reaction buttons. During the training phase, relevant traffic signs are presented to the client who must react within a certain time interval. In higher difficulty levels also irrelevant traffic signs are shown which require no reaction.

Responsiveness

Indications
Impairment of responsiveness after cerebral lesions, disorders of selective attention performances, disturbances of visual and acoustic discrimination, cognition, and/ or behavioral performance. Suitable for persons aged 8 and up. The module is less suitable for persons with severe ametropia (visual refractive error) or poor hearing.

Training Task
Responsiveness is trained using simple reactions, simple choice, and multiple choice reactions with visual and/ or acoustic stimuli. The training contains either only visual (module 1) or visual and acoustic stimuli (module 2). After a stimulus has appeared, the client must press a particular button on the RehaCom panel as fast as possible. During acquisition phase, the client memorizes the assignment of relevant stimuli to corresponding buttons. Reaction speed and accuracy are measured and evaluated.

Training Material
More than 200 visual stimuli and 6 acoustic stimuli in 3 variations each are included in the training. The therapist can add visual and acoustic stimuli (pictures and sounds) through the integrated program editor.

Vigilance 2

Indications
The training is indicated for clients with problems maintaining attention performance under the condition of a stimuli with a relatively low density over a longer period of time.

Training Task
The client’s task is comparing the objects on the conveyor belt, which pass by with varying spaces between them, with the original object. Objects on the conveyor belt that do not correspond to the originals must be sorted out. In the beginning of the training, the density (number of total objects) and the number of objects that need to be sorted out is rather high, however, it decreases during the course of training.

Training Material
Pictures with specific, real objects are available in 9 levels. Each original object comes with 3 modifications (differentiations in colour, outline and object details). The belt’s direction of flow and speed are adjustable.

Sustained Attention

Indications
The training is indicated for clients with problems maintaining attention performance under the condition of a stimuli with a relatively high frequency and an increasing number of reaction choices over a longer period of time.

Training Task
As in module Vigilance 2, the client’s task is comparing the objects on the conveyor belt. Objects which do not match the original ones must be sorted out. Contrary to the training Vigilance 2, the stimuli density (number of total objects) and the percentage of objects that need to be sorted out, are increased.

Training Material
Graphic pools with specific, real objects are available in 9 levels. Each original object comes with 3 modifications (differentiations in colour, outline and object details). Adapting the difficulty is affected by the number and resemblance of the objects, the increasing stimulus interval as well as the number of wrong objects. The belt’s direction of flow and speed are adjustable. 

Spatial Operations

Indications
For training of basic cognitive functions of spatial perception. Due to non-verbal material, even clients with restrictions in language and understanding words can work with the module. The training is less suitable for clients with highly intellectual impairment or distinct attention disorder.

Training Task and Training Material
When estimating the position, two big fields are indicated on the screen. One field shows a fixed position. The other one shows the same object in a different position. The task is to move the picture in the right field to the same position. When estimating angles, 2 angles are shown in both fields which have to be adjusted to the same size by means of the arrow buttons of the RehaCom panel. When estimating relations, vessels with a given amount of liquid have to be filled or emptied. When estimating size, objects of different size are shown in both fields which must be brought to equal size with the arrow buttons. This task is available in a one- or two-dimensional version. The shortterm memory for spatial perception is trained in higher levels of difficulty when the reference object disappears with the first changes to the object.

Spatial Operations 2

Indications
All disorders of visual and spatial perception, especially clients with parietal lobe lesions and/or neglect.

Training Task 
This module consists of nine different tasks, which differ greatly from each other depending on spatial perceptive performances. Usually the training is carried out by comparing and adapting a spatial property to a reference object. The following performances can be trained: position estimation, angle estimation, relations estimation, one- and two-dimensional size estimation, parallelism estimation, length estimation, lines splitting and velocity and distance estimation.

Training Material
Multiple photorealistic and everyday graphics are available for each task. The short-term memory for spatial perception is trained in higher levels by fading out the reference object. The reconstruction must then be performed from memory.

Spatial Operations 3D

Indications
For treatment of cognitive disorders, especially of spatial perception functions. In addition, the module can be used to continue attention training on a high level. By using non-verbal material, the client can work with the module even with restrictions in language and understanding words. The training is less suitable for clients with severe intellectual impairment or distinct attention deficit disorder. Suitable for persons aged 10 and up.

Training Task and Training Material
In the upper half of the screen, a three-dimensional object is shown. In the lower half, three to six objects are shown which are more or less similar to each other depending on the level of difficulty. The client has to find the object below which matches exactly the object in the upper half of the screen. All objects on the screen can be rotated in three dimensions and thus can be viewed from all sides. As training material, a total of 432 3D bodies in 67 groups are available.

Two-Dimensional Operations

Indications
Loss of performance in visual-constructive tasks, items of the position-in-space-exploration as well as in spatial orientation in clients with damages of the frontal lobe and with right hemispheric temporal and parietal damage. The training is indicated for clients with lesions in this area, with diffuse brain damage or low intellectual abilities. The training is less suitable for clients with severe intellectual impairment or distinct attention deficit disorder.

Training Task
On the screen, several objects are displayed which have to be compared to an object on the edge of the screen. The client has to find the object matching the “comparison picture” in every detail. Regarding the corresponding picture in the matrix, the “comparison picture” in the plane is rotated.

Training Material
Geometric figures like triangles, squares, hexagons, etc. are used as objects. In high levels of difficulty, the training material becomes more complex up to concrete objects and maps.

Attention and Concentration

Indications
Attention disorders (functionally and organically caused) after acquired brain damage. They are found in 80% of all persons affected by stroke, TBI, diffuse organic brain impairments (e.g. caused by chronic alcohol abuse or intoxication), as well as in other diseases of the central nervous system. Suitable for clients with disorders in attention and concentration and for children aged 11 and up.

Training Task
A picture shown separately on the screen has to be compared to a matrix of pictures. The client must find the picture in the matrix matching exactly the “comparison picture”.

Training Material
A total of 77 picture pools are available, each with 16 colored illustrations. All pictures are optimized concerning visibility and differentiability. According to parameter settings, either concrete objects (fruits, animals, faces etc.), geometric objects (circles, rectangles, and triangles of different size and order) or letters and numbers are displayed.

Divided Attention

Indications
Disorders in divided attention occur with almost all diffuse brain damages (caused by e.g. intoxication or alcohol abuse) as well as with local damage of the right hemisphere, especially of parietal parts. Affected clients have difficulties in focusing attention to multiple objects at the same time. Also suitable for children aged 11 and up.

Training Task
On the lower part of the screen, a driver’s cabin is shown. Thus, the client can observe the railway like looking through the windscreen of the driver’s cab. He must react to the elements of the cabin and to relevant objects on the railway.

Training Material
The driver’s panel contains a speedometer, a so-called “Deadman’s lamp” and the “emergency stop lamp”. On the speedometer, a “target speed” is set that the client must keep. As soon as a lamp lights up, the client has to press the corresponding button on the RehaCom Panel (e.g. the stop button). If a relevant object appears on the railway, the client also has to react to it (e.g. stopping at a red signal).

Divided Attention 2

Indications
Disturbances in focussing on certain aspects of a task, such as reacting quickly to relevant stimuli while ignoring irrelevant stimuli. This occurs in 80% of all patients after stroke, TBI, diffuse organic brain impairment (e.g. as a result of chronic alcohol abuse or intoxication) as well as in other diseases of the central nervous system. Also suitable for children aged 10 and up without significant developmental deficits.

Training Task and Training Material
On the screen, the view through the windscreen of a car as well as at the car’s dashboard is simulated. On the left, the speedometer is shown. A green area marks the speed the client should drive. For accelerating the car, you push the arrow key up, for slowing down push the arrow key down. There is a display for the way to go and for the expired time. The aim is to drive a certain distance within a limited time. Irrelevant as well as relevant objects move towards the user. Additionally acoustic stimuli are presented.

Visuo-Constructional Ability

Indications
Constructional apraxia is mainly caused by parietal lesions. For managing the tasks constructive abilities, attention and memory performances are needed. Therefore, these cognitive functions are also demanded and trained. The training is indicated for clients with light or medium performance loss in the visuo-constructive field or with generalised functional disorders. This performance decrease is often found in diffuse organic brain damage caused by intoxications, alcohol abuse, etc. The training is particularly suitable for clients with serious apraxia, amnesia, and concentration disturbances.

Training Task
The training is made like a puzzle. At the beginning of a task, a picture is shown with which the client has to memorise as many details as possible. Once the client presses the OK button or after a defined time, the picture is divided into a certain number of puzzle pieces and has to be reconstructed.

Training Material
For this module, photographs and drawings are used, e.g. houses, faces, everyday objects or paintings. The pictures appear on the screen in very high resolution.

Memory Training Modules

Working Memory

Indications
Disorders of the working memory after brain damage due to stroke or TBI. The training module can be used for training the visuo-spatial sketchpad for short-term storage of visual impressions, for training the phonological loop for storing nonverbal information, and for training the central executive for linking information to the long-term memory. Since non-verbal material is used, the training is suitable for persons aged 10 and up.

Training Task
The client has to memorize and manipulate an increasing number of cards. The content to be memorized can be presented visually or acoustically. Initially, the client only has to memorize the items. In higher levels, additional tasks influence the memory process. Thus, this task trains not only the working memory, but also accompanying abilities such as problem solving, reasoning, deductive reasoning, speech comprehension, calculation performances, and intelligence.

Training Material
For the training, a complete deck is used. Training material is completed by diverse distractors on the cards, animated distractors for training the resistance to interference as well as graphics for increasing the performance feedback.

Memory Strategy Training

Indications
The training is suitable for clients with light and moderately severe disorders of learning abilities.

Training Task
The task is to memorise terms that are displayed on the monitor. These are either presented as pictures or as words. With the help of an offered learning strategy (visualisation and storage on a body route, or visualised writing of a word) the terms have to be memorised and recognised after a simple distraction task.

Training Material
Approx. 200 objects are displayed as high-resolution photos or words in 18 levels. The two different learning strategies are taught as tutorials.

Topological Memory

Indications
All memory disorders or impairments for verbal and nonverbal contents. Amnestic syndromes can be observed for all diffuse cerebro-organic diseases (dementia, intoxications, chronic alcohol abuse, etc.) as well as for all left-sided or bilateral lesions of the medial or basolateral limbic lemniscus. Furthermore, vascular diseases, TBI or brain tumors in prefrontal, temporal or parietal cortical areas can lead to memory deficits.

Training Task
In the so-called “memorizing phase”, a variable number of cards (depending on the level of difficulty) with concrete pictures or geometric figures are displayed on the screen. The client has to memorize the position of the pictures. After a preset time – or manually by pressing the OK button – the pictures of the matrix are hidden (turned face down). The client must find the picture matching the one indicated on the right side of the screen.

Training Material
Altogether, 464 pictures of concrete objects, geometric figures, and letters are available. The number of simultaneously displayed cards varies from 3 to a maximum of 16.

Physiognomic Memory

Indications
Suitable for clients with visual prosapognosia where the ability to recognize faces and to connect meaningful associations to them is impaired or lost. The problem can also be related to memory components that are responsible for remembering faces. The training is indicated for all clients with right-sided or bilateral lesion of the temporal lobe of different aetiology in which the mentioned impairments are observed.

Training Task
During “learning phase”, the client has to memorize a specific number of faces. Then they must pick these faces out of a ‘line-up’ of different faces. In higher levels of difficulty, a name and a profession are also shown. The client has the task now to find out the face associated with the name or the profession.

Training Material
A total of 47 persons have been photographed from four different directions. The pictures reach photo quality. It is possible to add photos from the client’s environment via an integrated editor.

Memory for Words

Indications
Impairment of vocabulary and reduced recognition performance, especially for clients with beginning amnestic syndrome. This occurs in persons with diffuse cerebroorganic damage and left hemispheric or bilateral lesion (especially of the limbic lemniscus with damage of the thalamic parts). Also suitable for clients with functionally caused impairments and for children aged 11 and up.

Training Task
During the “learning phase”, the client has to memorize a list of words (from 1 up to 10 words). With an increasing level of difficulty, the number of words in the list as well as the difficulty of the words grows. The words presented during the “learning phase” must then be selected from a number of different (irrelevant) words.

Training Material
The words appear big and clearly visible on the screen. The movement of the words across the screen happens continually and fluently. The speed of the words “rolling by” can be adapted.

Figural Memory

Indications
All memory disorders (especially disorders of the working memory) for verbal and nonverbal contents. The training module is also suitable for clients with impaired ability to name objects as well as with difficulties in conceptual classification (organically or functionally caused). With average vocabulary, this module is applicable for persons aged 11 and up.

Training Task
At the beginning, pictures of concrete objects are shown. The client has to memorize the terms of these objects. The client completes the “learning phase” by pressing the OK button. After that, different terms move by on the screen from the left to the right. Whenever the term for an object shown during the learning phase passes through the marked area, the client must press the OK button.

Training Material
About 200 pictures of concrete objects are used, of which 100 objects have a high classification safety. It is possible to adjust the speed of the terms moving by. This ensures that clients (and children) with a different speed of reading can use this module for training.

Verbal Memory

Indications
Disorders or impairments of the short-term or mediumterm verbal memory. They might occur in almost all diffuse brain damage (dementia, alcohol abuse, etc.) as well as in bilateral or left-hemispheric lesions of different aetiology. The training can also be used to improve memory performance in children aged 11 and up.

Training Task
A short story is shown on the screen. The client should memorize as many details of the story as possible (names, numbers, events, objects). The learning phase is completed by pressing the OK button. After that, the client must answer questions about the content of the story.

Training Material
More than 80 short stories are available. Depending on the setting, either the computer or the therapist selects a story for the client. An extension of the pool of stories is possible by using an integrated editor.

Executive Functions Training Modules

Shopping

Indications
Deficits in working memory and difficulties in concept development and action planning as a result of TBI, stroke, cerebral tumor surgery or cerebral haemorrhage. The module can also be used for maintaining the mental performance of elderly people as well as for children aged 11 and up. Not suitable for clients with attention deficits.

Training Task
Client gets a shopping list of articles that he has to look for in a supermarket and put into a trolley. When all articles are in the trolley, the client can leave the supermarket by using the “cash” button. Beyond a certain level of difficulty, additional demands are made on the client’s mathematical abilities (a certain amount of money is specified, the products are marked with prices, etc.).

Training Material
The training module currently uses more than 100 articles illustrated photo-realistically (food, household objects, etc.). These articles appear on shelves from which the client must choose them. The training programme disposes of a voice output, which means all articles are named when selected.
Two shops can be chosen: supermarket or hardware store.

Plan a Vacation

Indications
Disorders of cognitive functions, especially of planning skills. The ability to plan and to organise everyday life is one of the most complex human skills. It can be affected by any brain damage, especially by damages of frontal structures or diffuse cerebral damages. The module Plan a Vacation can also be used for training memory skills. It is not recommended in very heavy amnestic disorders. The presence of a therapist is strongly recommended for seriously impaired clients.

Training Task
The training task is to prioritize a list of tasks in optimal order. For this purpose, a map is shown on the screen with different buildings and roads from bird’s-eye view. Clients have to “visit” one building after another according to their time schedule and enter them in their diary. There are three different request types:
· Note priority
· Minimise travelling time
· Maximise the number of completed tasks.

Training Material
Plan a Vacation provides an almost endless number of different tasks since new combinations of tasks can be generated randomly.

Logical Reasoning

Indications
Acquired damage of the frontal lobe, where impairments in abstract logical thinking can be observed. Those losses of performance often occur in clients with chronic alcohol abuse, dementia, and insult, as well as schizophrenia. The training can also be used for children aged 12 and up, provided that they are capable of comprehending simple abstract-logical conclusions.

Training Task
From several symbols (pool of answers), the client has to find out the one that correctly continues a given sequence of symbols.

Training Material

A sequence of symbols (circles, triangles, squares, etc.) of different shape, color, and size are displayed on the screen being in a regular relation to each other. If the answer is wrong, special pieces of information about the type of error (shape, color, and/or size) are given.

Calculations

Indications
Impairments of arithmetic cognitive skills. Disorders of cognitive functions can be diverse. They range from reduced basal disorders when estimating sizes and quantities to problems in applying basic arithmetic operations and difficulties in solving complex mathematic problems.

Training Task
The training has a high diversity of tasks. The client starts with simple comparisons of size or quantity and with sorting tasks. After that, basic arithmetic operations adding and subtracting are trained, both mentally and in writing. In higher levels of difficulty, the client is instructed in very realistic situations to handle money. He has to offer the exact amount of money, give change or check their own change. Finally, multiplication and division tasks are available.

Training Material
Size and quantity tasks are trained using pictures of simple objects until the client passes on to calculations with numbers. Written addition and subtraction is shown in small numbers in the carry over. For money handling pictures of realistic banknotes and coins are used.

Visual Field Training Modules

Saccadic Training

Indications
Impairments in visual exploration on one half of the visual field. They often occur in neglects or extended cerebral infarcts in the area of distribution of the middle or posterior cerebral artery. Other organic brain disorders can also cause these functional impairments. Suitable for persons aged 8 and up.

Training Task
The client can see a horizon on the screen with a very simple structured landscape. In the middle of the screen, a big sun is displayed. At irregular intervals, an object appears left or right of the sun. Whenever the client notices an object, he has to press the corresponding reaction button (left or right arrow key of the RehaCom Panel).

Training Material
On the screen, a horizontal line is visible. At easier levels, a sun is indicated in the middle for a better orientation of the client. In irregular temporal intervals, different objects or symbols, e.g. animals, cars, bikes, motorcycles etc., appear on the horizontal line. At higher levels of difficulty, the symbols become smaller, the horizon disappears, and additional deflecting stimuli are shown and fade again.

Exploration

Indications
Homonymous restrictions of the visual field, disorders of visual exploration as a consequence of visual field loss, visual neglect, and/or Balint’s syndrome. Due to the use of non-verbal material, the module is also suitable for clients suffering from linguistic restrictions and restrictions in understanding words. Suitable for persons aged 8 and up.

Training Task
Different stimuli (symbols) appear on a black background from which the client is required to select all stimuli they memorised before by systematically searching the area. A circular cursor moves over the field line by line (with interlace). In this way, the exploration movement of the client is controlled. Each time, the relevant symbol is within the moving circular cursor, the client has to press the OK button of the RehaCom Panel.

Training Material
For exploration training, squares, triangle, circles, stars, and symbols are used.

Exploration 2

Indications
The training is recommended for clients with homonymous visual field impairments, impaired visual exploration or visual neglect.

Training Task
There are four different types of tasks. In the task „Search for missing numbers“, numbers scattered around the screen must be searched one after the other and the missing numbers must be identified. In „Search objects“, certain objects embedded in scenes must be found and clicked on. In the task „Search and count object“, the number of presented objects must be determined. The task „Superimposed figures“ is used for training the detailed analysis. Simple figures are presented superimposed. The patient must decide which basic forms the superimposed figure consists of.

Training Material
There are many detailed images and scenes available for the „Find object“ and „Find and Count objects“ tasks. The task „Superimposed figures“ contains many simple geometric figures that are differently colored or black.

Restoration Training

Indications
Neurological visual impairments such as Hemianopia and resulting perception, processing disorders, reading and attention problems, and visual neglect.

Training Task
A fixation point is displayed on the screen. When a light stimulus appears, the client should respond by pressing a key (mouse click, keyboard, etc.). The client has to react when the fixation point changes colour and respond to every visible light stimulus. If the client misses a stimulus, it will disappear, and then reappear. 

Training Material
The light stimulus is displayed by using a specific algorithm. The stimuli will move and appear in different positions on the screen, including close to, and over, the border of the impaired side of the visual field. Repeated and intensive activation of this area will encourage a positive change in the visual field over time. Audio feedback/signals will provide feedback to help sustain the client’s attention. RESE is auto-adaptive, changing the difficulty according to the client’s performance. It is recommended to use the chin rest to stabilise the head, maintaining a consistent distance from the screen.

Visuo-Motor abilities

Visuo-Motor Coordination

Indications
Damages of the motor cortex (frontal lobe) causing deficits in the control of fine motor skills. They can be observed most clearly in coordination disorders of hand and finger movements. In many cerebro-organic diseases and damages, e.g. cerebral insults, haemorrhage, spacious tumours, craniocerebral trauma, etc., visuo-motor functions are also affected. The training is indicated for all disorders of fine motor skills.

Training Task
On the screen, a circular disc (rotor type abstract) and a dot are shown differing strongly from each other due to different colours. The client has to move the dot into the circular disk by means of the joystick or mouse. Then the disk starts moving along an unpredictable track. The client tries to follow the movement with the joystick(represented by the dot). In “rotor type concrete”, e.g. a flower is used instead of the circular disk and a beetle or a bee replaces the dot.

Training Material
For operating the training, a huge circular disk describing a given movement, and a dot that can be moved with the joystick or mouse, are used. In order to make the training more variable and interesting especially for children, 25 pairs of pictures are used as rotor/cursor in the “concrete” mode.