| BRAIN TRAIN Cognitive Retraining Software | ARTICLES for Survivors & Families | OTHER SOFTWARE Freeware/Shareware |
Judith Falconer, Ph.D.
Survivors, family members and professionals are painfully aware that the most disabling consequences of brain injury are usually cognitive and behavioral deficits. Developing techniques which lessen the impact of those deficits on daily life is a major emphasis of most treatment programs. Most rehabilitation facilities use computers in their brain injury programs although the degree to which such tools are effectively used varies widely. When used properly, computers can be effective rehabilitation tools because they:
Some families view computers as miracle workers and are disappointed when instant recovery doesn't follow from the purchase of a computer. Those who plan to use computers must be willing to invest time and effort learning to select and operate equipment and programs: at least minimal computer literacy is essential to use computers effectively in brain injury rehabilitation. Most family members and many survivors are capable of learning to use computers with minimal training if appropriate software and hardware is available.
Who can use computers: Computers are not appropriate for all individuals who have sustained brain injuries. Appropriate individuals include those who have enough:
- behavior control to prevent damage to equipment and selves
- visual acuity to see the screen or specialized adaptive hardware such as screen readers
- physical control to enter responses: adaptive hardware such as alternative input devices, decelerator cards, voice synthesizers, or screen enlargers may be required to allow some clients to access computers.
In my clinical experience, clients' responses to using computers are usually quite positive. Computers may provide their first opportunity to work independently since their injuries. Many are able to attend to tasks for longer periods of time when presented via computer, perhaps because of the novelty effect. They report feeling the computer is less critical of poor performance and prefer to avoid failing yet one more time in an interpersonal situation where they are judged and found lacking. The argumentative client who disputes every statement made by the therapist or a family member/caregiver can frequently work more efficiently on the computer since computers don't respond to such challenges.
Why use computers: The nature and extent of the client's assets and deficits plays a critical role in determining appropriateness of computer usage for a given individual. Obviously, computers cannot remediate all deficits following brain injury but they can address the following:
| attention/concentration | impulsivity | distractibility |
| cognitive endurance | thinking/performance speed | eye-hand coordination |
| learning/memory | visual tracking/scanning | planning/organization |
| qualitycontrol/self-monitoring | problem-solving | sequencing |
| spatial analysis/synthesis | reasoning/abstraction | inattention/neglect |
When is the best time to use computers: There appears to be no specific post-injury time when computer usage is maximally effective. In general, the earlier rehabilitation starts, the less chance there is for the individual to develop maladaptive behaviors or compensatory strategies which do not work. I have seen individuals improve skills through computer use as long as 20 years post-injury. Individuals who have limited cognitive endurance are able to use computers for brief periods of time over the course of the day in contrast to the traditional 30 or 60 minute therapy session.
Where can computers be used: Although many individuals begin using computers as part of an inpatient or outpatient rehabilitation program, computers can easily be used in other settings. I have worked with individuals who use computers in private, group and nursing homes as well as schools/colleges and vocational rehabilitation offices. Many public libraries have installed computers with access to the public and staff who are willing to teach basic computer literacy to customers. Computers are particularly appropriate tools for use by clients in remote locations where few rehabilitation services are available and transportation logistics are prohibitive.
How much will it cost:
Hardware: Basic computer systems can be purchased for as little as $500; used systems may be available for under $250. Individuals may also rent computers or use systems available in public libraries, community centers, or schools/colleges.
Software: Freeware programs can be readily found on the internet or through user groups. Software can be obtained for as little as several dollars per program to well over $1000 for sophisticated commercial programs. Commercial cognitive retraining software is available from a variety of sources.
Clinical Support: Therapists may be available at the local rehab center or through private practitioners such as speech pathologists, psychologists, or occupational therapists. If a neuropsychological evaluation has been completed, that professional may be able to make recommendations about specific hardware/software which would be appropriate. Occupational therapists can provide specific information regarding adaptive equipment, seating, and other physical accommodations which may be necessary. Fees for such services vary widely so smart shopping is strongly recommended.
Funding: Initially it was extremely difficult to obtain funding for computer hardware and software even in rehabilitation settings. In my experience, funding has been provided by: health, disability, and auto insurance policies; vocational rehabilitation agencies; group and nursing homes; litigation settlements and private funds; and schools or community colleges. In some communities, civic organizations such as Lions Club or Rotary may provide financial support.
Selecting Software
Given the thousands of computer programs which exist, some guidelines may help in selecting appropriate software. Ultimately, however, trial and error may be the best judge of what will work and you must be willing to admit the selection was wrong for that client at that time if that is the case.
Hardware requirements: equipment required to run the program: computer type (e.g. PC or Mac), memory and drive space required, required monitor display quality, printer compatibility, input devices, etc.). It is always recommended that, given the opportunity, you select software before selecting hardware. Even the best computer is not useful if you can't find appropriate programs to run on it (unless you plan to write your own programs, that is.) In my experience, rehabilitation software for Macintosh computers is hard to find.
Programs: Single programs like Solitaire only do one thing. While you might collect 10-20 programs which work well, getting the user to select each of the programs might be problematic. It's usually better to purchase a compilation of programs where, once the user selects the program, there are multiple programs or program options available.
Feedback: Many programs which are appropriate for a given survivor may be obviously written for young children: most adults do not respond well to Kermit congratulating them on a correct answer; in fact, they may be highly insulted.
Method of recording progress: how (or whether) performance is recorded; ability to analyze performance across time
Response requirements: how user responds, e.g. mouse, keyboard, joystick, unique key combinations, etc.
User friendliness: ease of program operation; ease of modification to meet special needs; installation procedures; help screens
Technical support: availability of knowledgeable staff to answer questions regarding program operation and to provide detailed effective assistance should problems arise; availability of program upgrades
Cost: selection of the least expensive appropriate program allows purchase of greater range of software
Vocational Training: Analysis of current employment advertisements documents increasing reliance on computers in work settings: secretaries have been replaced by word processing specialists, draftsmen by CAD operators, accountants by spreadsheet programs, and "grease monkeys" by electronic ignition specialists: computer skills provide an advantage in the current job market. While traditional theory recommends utilizing "transferable skills", clients may have no transferable skills or utilization of pre-injury skills is compromised by lack of insight, difficulty upgrading skills in selected areas, and/or perceptual deficits. A total vocational shift may be necessary to fully utilize remaining assets and minimize the effect of deficits on vocational performance. When such a shift is made, the client may have no preconceptions about abilities and may be more open to learning new skills. The "mystique" of computers frequently facilitates transitioning to such employment. Training manuals, tutorial programs, and/or videotapes are available for most software used in vocational settings. Providing the individual with such material and unlimited time to practice specific relevant programs can result in successful vocational placement. Although the learning process may be extremely slow, some clients can acquire sufficient skills to be competitively employable at entry level.
Many of the skills required to use computer programs become a motor habit rather than a cognitive process: once individuals learn to type, they are hard-pressed to state which finger is used to strike a particular key or which series of keystrokes calls up a particular function or menu. Such motor learning may be relatively intact following brain injury. In our experience clients may deny ever having used a computer but demonstrate ability to do so when placed in front of the equipment.
Even if vocational placement does not require use of computers, clients may benefit from using one of the pocket-type computers to store information such as names, phone numbers, and basic job instructions. Some of these devices can be programmed to signal the individual to attend to time-relevant information (appointments, medication schedules, etc.).
Leisure Activity: Lack of cognitive stimulation has been demonstrated to result in decreased cognitive abilities over time. Daily practice on computer programs can provide sufficient stimulation to maintain hard-won cognitive gains, fill leisure time, provide respite for caregivers, and allow interaction with family members and peers. Even relatively inexpensive game devices such as Game Boy can provide hours of enjoyment for survivors while providing respite for caregivers. Solitaire has been known to provide hours of enjoyment to many professionals and caregivers as well as survivors.
| BRAIN TRAIN Cognitive Retraining Software | ARTICLES for Survivors & Families | OTHER SOFTWARE Freeware/Shareware |
| e-mail: info@brain-train.com | Postal Address: 8343 Currant Way, Parker, CO 80134 | Phone:(303) 766-6967 |