The Teletherapy System

The Cognitive Systems Teletherapy System is based on the cognitive rehabilitation exercises developed by a clinical neuropsychologist over the last 20 years. The focus of the individual exercises extends from simple attention and executive skills, through multiple avenues and modalities of visuospatial and memory skills all the way up to complex problem solving and decision-making skills.

Through an exclusive use contractual agreement Cognitive Rehabilitation LLC (dba Cognitive Systems, Inc.), the CRI Special Edition of cognitive software was developed with Internet connectivity. This innovative technological approach to cognitive development and rehabilitation provides a vehicle (the Internet) to transport the prescription/data to a client and/or Server using a computerized interface system. This Internet Enabled System provides the advantage both in the delivery of the therapy and the ongoing monitoring of client activity and performance. Client performance data and therapy activity levels can be evaluated and prescriptions can be updated more often with this method. In addition to having one central command center, the Cognitive Systems Teletherapy Server, collecting and combining data from many different treatment facilities or client homes into one database, will provide significantly more data for efficiency and effectiveness research studies than would be possible without this treatment paradigm.

Ideally, the client and caregiver will meet with the therapist for an initial session and equipment training orientation. At this time, the therapist will generate a prescription (based on the established therapy protocol) and upload it to the Cognitive Systems Teletherapy Server, download the prescription and begin the therapy program. On each subsequent call for a prescription update, the client’s data will be deposited into the Cognitive Systems Teletherapy System’s database. The therapist will periodically call the Cognitive Systems Teletherapy System’s Server to download the client’s data for review. Based on this clinical review, the prescription will be updated according to the therapy protocol and again uploaded to the Server to complete the whole client – Cognitive Systems Teletherapy – therapist cycle of activity. Participating in cognitive rehabilitation through this method enables the client to practice his/her therapy exercises as often as he/she is motivated without having to worry about scheduling, transportation to an appointment, money, or other possible barriers. The end result is better treatment that is deliverable to greater numbers individuals with brain injuries, requiring cognitive rehabilitation prior to returning to work or school.

The Executive Skills

Sub-Group #1 – Attentional Skills:

These set of skills are those that contribute to the interface needed to properly receive and utilize information arriving from the sensory mechanisms. Mastery of these attentional skills enables a person to

1. Constantly monitor incoming information;

2. Recognize what is important;

3. Focus on what is important and monitor it as a foreground activity;

4. Continue monitoring other information as a background activity;

5. Shift what is foreground and background as appropriate;

6. Maintain focus for the extent of the event;

7. Share focus with multiple events as required.

Sub-Group #2 – Information Processing:

The work product of these activities is the perception and the techniques of analysis include:

Separating

Combining

Sorting

Ranking

Sequencing

Categorizing

Grouping

Foundations I:

These cognitive exercises are designed to stimulate and train the visual and auditory attention shills and integrate these skills with some very basic executive functioning. These tasks address focusing, shifting, and sustaining and dividing attention in addition to tracking and targeting. The executive skills demands involve simple discrimination, initiation, inhibition and differential responding.

Tasks include Simple Visual Reaction, Simple Choice Visual Reaction, Simple Auditory Reaction, Simple Choice Auditory Reaction, Visual Reaction Differential Response, Visual discrimination Differential Response, Visual Reaction Auditory Pre-stimulus, Auditory Reaction Visual Pre-stimulus, Visual Tracking I & II, Track and Target.

Foundations II:

This module continues the activities from Foundations I. The attentional demands are much greater, involving simultaneous multiple attention, greater concentration, and longer periods of sustained attention. On the executive side, these tasks require much more information processing and the visual motor coordination demands are extremely great in a couple of exercises. A few of the programs provide some feedback about the nature of the incorrect responses that can provide information about impulsiveness and/or guessing behavior. Some require the focus of attention move back and forth from whole gestalt to detail. Tasks include Visual Reaction Multiple Stimuli, Multiple Attention / Multiple Response, Complex Attention (Even/Odd), Visual Scanning II & III, Simultaneous Multiple Attention, Auditory Discrimination I.

Visuospatial I:

These exercises introduce tasks requiring visuospatial analysis and visuomotor integration skills. Also, these exercises address complex attention and executive skills. Tasks include Mazes, Cube-In-A-Box, Paddle Ball, Visual Perception, Shape Construction, Line Orientation.

Visuospatial II:

These activities require more information than seen with Visuospatial I. To be able to respond quickly and accurately, clients will need to develop mental imagery skills. The Labyrinth program requires clients to maintain a sense of orientation and visual imagery of the pathways and positions. Figure/Ground Perception requires clients to quickly determine the whole gestalt from information provided by analysis of small pieces of the whole figures. At the complex level, clients must also be able to disconnect these pieces from a randomly colored background. Each task has a full range of difficulty levels to accommodate from severely impaired to high level but impaired functioning clients. Tasks include Labyrinth, Designer Patterns, How Many Blocks?, Guess Which Shape, Spatial Perception I, Perceptual / Motor I, Figure / Ground Perception.

Memory I and Memory II:

These exercises are designed to assist clients who have memory problems involving incidental information, information occurring in multiple stimulus situations and information such as appointments, messages, errands, etc. In Memory I & II, the cognitive exercises build up the attention and executive skills utilized in storing and retaining information and provide a means for patients and therapists to stimulate the rewiring of the neuro-pathways in the brain, resulting in higher level of cognition. Clients who have sustained brain damage that prevents the formulation or retrieval of memories and who may have trouble recalling places, persons and events even within a few minutes of the event may have greater difficulty in helping or restoring their memory skills and abilities.

Memory I :

These tasks include Spatial Memory, Visual/Spatial Memory (Shapes & Places), Sequenced Recall (Words [Visual]), Sequenced Recall (Digits [Visual]), Sequenced Recall (Graphics [Visual]), Sequenced Recall Reversed (Digits [Visual]), Sequenced Recall Reversed (Graphics [Visual]), Sequenced Recall (Digits [Auditory]), Sequenced Recall Reversed (Digits [Auditory]), Non-sequenced Recall (Digits [Visual]), Non-sequenced Recall (Graphics [Visual]).

Memory II:

These tasks include Spatial Memory (Objects and Locations), Visual Memory (Sequenced / Spatial), The Phone Message, Recognition Recall, Pared Associates Recall, Verbal Memory (Categorizing).

Problem Solving I:

These activities include a variety of problem solving tasks, becoming more difficult and the higher levels; however, clients should be ready for these challenging activities if they have mastered the basic skills earlier introduced. This is true even for those clients who have incurred severe cognitive impairments. Tasks include Number Manipulations I, II, III, Maze Puzzle I & II, Deductions, Checker Exchange, Knight’s Challenge, Cryptograms.

Problem Solving II:

In these activities, clients integrate and utilize all the attention and executive skills they have been acquiring earlier through the other more basic exercises. Clients will be challenged to perform in the area of logical thinking and deduction type skills. Some of these tasks will be very difficult. If clients must receive assistance, they must still work the problem through to see how the correct answer was derived. Therapists and caregivers are encouraged to discuss the strategy and thought processes with their clients. Tasks include Pyramids, Odd One Out, Magic Box, Mathematical Analogies, One Peg, Deduce It.