Αγγλικό Εγχειρίδιο rehacom
DESCRIPTION
Λογισμικό γνωστικής εξάσκησης RehaCom. Το εγχειρίδο του λογισμικού στα ΑγγλικάTRANSCRIPT
Cognitive Rehabilitation
2 HASOMED – Hard- and Software for Medicine
Orders, Questions, and Feedback
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T: +49 391.61 07 645
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•Screen,atleast19”,preferablytouchscreen•Printer
•Patientenpult(1990-1997)mitseriellemAnschlusswirdnichtmehrunterstützt
System Requirements
Our products are EN/ISO-13485-certified.
Further information on www.hasomed.com:
Functional Electrical Stimulation Gait AnalysisCognitive Rehabilitation
3HASOMED – Hard- and Software for Medicine
Close to Reality Motivatingfor Patients
21 Languages
Adaptive and Deficit -Specific32 Training Modules for
all Rehab Phases
Varied Therapy Material
Easy Handling
4 HASOMED – Hard- and Software for Medicine
RehaCom
Training of Attention
Training of Memory
Introduction into the system RehaCom.................................................
Alertness...............................................................................................................................
Acoustic Responsiveness (AKRE)
Reaction Behaviour (REVE)
Ability to Responsiveness (REA1)
Vigilance (VIGI)..............................................................................................................
Visuel-Spatial Attention.............................................................
Spatial Operations (RAUM)
Two-Dimensional Operations (VRO1)
Three-Dimensional Operations (RO3D)
Visuo-Constructive Abilities (KONS)
Attention and concentration (AUFM).. ...................................................
Divided Attention........................................................................................................
Divided Attention (GEAU)
Divided Attention 2 (GEA2)
Topological Memory (MEM0)...........................................................................
Physiognomic Memory (GESI)........................................................................
Memory for Words (WORT).................................................................................
Figural Memory (BILD)..........................................................................................
Verbal Memory (VERB)..........................................................................................
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12
15
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20
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2324252627
Table of Contens
5HASOMED – Hard- and Software for Medicine
Executive Functions
Training of Visual Field
Visuo-Motoric Coordination
Important Information
Shopping (EINK)...........................................................................................................
Plan a Day (PLAN)......................................................................................................
Logical Reasoning (LODE) .................................................................................Calculationsg (CALC)...............................................................................................
Compensating...........................................................................................................
Saccadic Training (SAKA)
Exploration (EXPL)
Overview and Reading (ZIHL)
Restoring...............................................................................................................................
Visual Restitution Training (VIST)
Visuo-Motoric Coordination (WISO).....................................................
Effectiveness Studies.............................................................................................
Team of Development..............................................................................................
Patient Keyboard and Chin Rest...................................................................
Overview of Training Modules..........................................................................
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Table of Contens
6 HASOMED – Hard- and Software for Medicine
RehaCom 2012 – Developed by Therapists for Therapists
For a long time the main emphasis in rehabilitation
had been put on teaching people with diseases or
those who had had an accident to relearn certain
physical functions. From today’s perspective, howe-
ver,trainingcognitivefunctionsisconsideredequally
important, particularly in the sectors of neuropsy-
chology and occupational therapy. Some basic prin-
ciplesshouldbetakenintoaccount,suchas:helping
thepatienttobuildself-confidence,offeringavariety
oftrainingmaterial,communicatingproblemsolving
strategies,givingclearlystructuredtasksandprovi-
ding for an appropriate length of training sessions.
Functions that are not damaged should be trained
first, inorder toevokeasenseofachievement lea-
dingtoabetterself-esteem.Then,therapistscantre-
atthe impairedfunctionsbygivingclear tasks, lea-
ving no room for misunderstandings. Furthermore,
it is important to use diverse training methods and
exercises,preferably involvingvisual, linguistic,tactile
and auditory elements. By observing the patient’s
actions, thetherapistcanfigureoutwaysto ideally
apply strategies to achieve best training results for
the individual situation. The length of a session de-
pendsonthepatient’sabilitytoworkunderpressure.
According to clinic guidelines patients should train
10 to 15 minutes per day in the acute phase of reha-
bilitation.Afterthisphase,trainingsessionsof45to
6o minutes should be held every day or at least three
timesaweek for a timeperiodof6 to8weeks. In
the late phase of rehabilitation patients should train
twoorthreetimesperweekforaboutthreetofive
months.
Cognitive Therapy in Rehabilitation
Therapy programmes used to be based on psycholo-
gicaltests.Therequirementprofileofatherapypro-
cedurehoweverdeviatesfromtheoneofatest.A
psychological test is not aimed to have an impact on
cognitiveperformance,whereastrainingismeantto
improve cognitive capacities. RehaCom is an ideal
tool,itmeetsthenecessaryconditions:1. adaptivity
andindividualisation,2.consistencyandmonitoring,
3.efficiencyandeconomy,4. patient-friendly input
device,5.multilingualstructureandmodularity.
Morethan25yearsagoscientificstudiesfirstproved
RehaCom’s effective functioning. Since then, more
and more studies have shown similar results. Those
studies were based on more than theoretical con-
cepts of a diagnostic test and its transfer to a similar
training tool. Find current studies on our website at
www.rehacom.com.
A good training system guarantees individual
training sessions in several dimensions. RehaCom
adapts automatically and offers the possibility to adjust
parameter settings. Every training unit is built up
in different levels of difficultywith varying training
tasks. The difficulty of a task given always corre-
sponds with the patient’s current performance level.
RehaComgivesconstantpositivefeedbackoriented
to the individual performance. Thus, it fosters to
developlearningpatternsandcontributestofiguring
out strategies.
After havingfinishedone training level in a session,
thenextonewillstartfromtheachievedlevel.Alltrai-
ningresultsaresaved.Hence,therapistscancheckon
how the patient’s overall performance develops as,
viewresultsofsingletasksandobjectivesandadjust
parameter settings promptly.
WithRehaCommanypatientscantrainindependently.
Atthebeginningandattheendofatrainingsession
the patient and the therapist can agree on particular
training aims to focus on and discuss results. There
is less patient-related work to do for the therapist
whocannowusefreecapacities,forexampletoputa
bigger emphasis on communicating strategies.
The Role of Computers in Cognitive Therapy
Effectiveness
Adaptivity and Individualisation
Consistency and Monitoring
Efficiency and Economy
7HASOMED – Hard- and Software for Medicine
RehaCom 2012 – Developed by Therapists for Therapists
A high number of our procedures are available in
different languages,freeofextra-charge.Hence,pa-
tientscantrainintheirmothertongue.Thankstothe
variety of procedures thousands of RehaCom systems
have beenused in several fields such as neurology,
psychiatrics, geriatrics, paediatrics as wells as in
vocational rehabilitation since 1992. In recent ye-
ars, therapydedicatedtohelp improvebrainperfor-
mancedeficitshasgained international recognition.
RehaComhasbecomemarketleaderinEurope.
RehaCom is a theory-based system which comprises
diverse procedures. It helps to train different areas
of cognitive functions. Starting at a low level of dif-
ficulty, patients are confronted with more complex
tasksathigherlevels.DuringtrainingRehaComgives
positive feedback on the patient’s performance.
Itsmodularstructureallowsforbasictraininginseveral
areas,suchas:
•differentiatedcomponentsofattention,
•differentareaofmemory,
•executivefunctions
•treatmentofvisualfield,and
•visuo-motorfunctions.
Moreover,patientscandomorecomplexexercises in
areassuchas:
•actionplanninganddevelopingstrategies,
•situationsfromeverydaylife,e.g.shopping,
•commercialenvironmentofvocationaltraining.
Apart from achieving particular aims of training,
RehaComhasfurtherwelcomesideeffects.Experien-
ce with RehaCom has shown that patients are much
more motivated in terms of training independently at
acomputer.Duetoits individualfunctioning,require-
ments are neither too high nor too low for the patient.
Thecomputerfunctionsasanobservermakingneutral
commentsandgivingfeedbackspecificallydirectedto
patient’serrors.Evenpatientswithsevereimpairments
benefit from improvements in performance which
leads to a stronger self-confidence. In addition,
RehaCom contributes to minimise signs of secondary
consequencesafterbraindamage,suchasdepressions
andlackofself-confidence.
Multilingual Structure and Distribution
Modularity Specific Cognitive Training for all Phases of Rehabilitation and Home TrainingRehaComfulfilsallconditionsnecessary foraspecific
and complex training during all phases of cognitive
rehabilitation. Treating cognitive impairments usually
takesquitelong.Thetherapybeguninahospitalcan
thus be continued at home under supervision of a neu-
ropsychologist in a private practice or an occupational
therapist. The therapist sets up a training schedule
withtaskswhichthepatienthastofulfilathome.After
thetraining,thetherapistcanevaluateresultspromptly
and intervene if necessary. During therapy sessions,
the focus is on communicating strategies while eva-
luating results and discussing further therapy plans.
Frequently, patients can thus receive ambulant
treatment.
Thankstoalongexperiencewithstandardiseddia-
gnostic tests, we can give recommendations for
therapy methods based on results gathered from
neuropsychological diagnostics. That is why we are
constantlyworkingonrelatingscientificallyproven
standardised tests to our RehaCom procedures.
Results then undergo a clinical trial. These recom-
mendationshoweverarenotsufficienttomakean
if-then setting. They exclusively serve as a guideline.
Diagnostics and Intervening
8 HASOMED – Hard- and Software for Medicine
RehaCom 2012 – Developed by Therapists for Therapists
RehaComcanbe licensedviaan in-housecomputer server (computernetwork inyourhouse).Theserver
versionenablestheinstallationofRehaComlicencesonanetwork(server)computer.Severalworkingstations
(clientcomputers)willhaveaccesstotheRehaComserverlicencesatthesametime.
Licencing via Network
9HASOMED–Hard-andSoftwareforMedicine
Patient KeyboardAspecialkeyboard(RehaCompanel)helpsthepatienttocommunicatewiththecomputer.
Aconventionalkeyboardismostlyunsuitablefortherapiessinceitistooconfusingandrequires
high dexterity. The RehaCom panel is reduced to the minimum necessity.
Chin Rest Inordertotrainthevisualfield, it isrecommendedtouseachinrest.Thus,thepatient
can maintain a comfortable and straight posture that is easy to reproduce. This is important
because the position in front of the screen has to stay the same during the whole training
session.
The chin rest can be adjusted individually and its height can be changed. Concerning the
material,itismadeoflightandstablealuminiumandwood.Withascrewclampyoucanfix
the chin rest at a table. The rest made of varnished wood allows for easy cleaning.
Patient Keyboard and Chin Rest
10 HASOMED – Hard- and Software for Medicine
Overview of Training Modules
GROUP
Attention
Memory
Alertness
Visual-Spatial Attention (spatial-perceptive)
Acoustic Responsiveness 20
Responsiveness 20
Spatial Operations 42
Spatial Operations 3D 24
Visual-Constructional Ability 18
Attention and Concentration 24
Divided Attention 14
Divided Attention 2 22
Topological Memory 20
Physiognomic Memory 21
Memory for Words 20
Figural Memory 09
Verbal Memory 10
Shopping 18
Plan a Day 55
Logical Reasoning 23
Calculations 42
Saccadic Training 28
Overview and Reading 69
Visual Restoration Training 00
Visuo-Motoric Coordination 96
Exploration 30
Two-Dimensional Operations 24
Vigilance 15
Reaction Behaviour 16
Visual-Spatial Attention (spatial-cognitive)
Visual-Spatial Attention (spatial-constructive)
Selective Attention
Divided Attention
Vigilance
Executive Functions
Visual Field
Visuo-Motoric Abilities
SUP-GROUP REHACOM TRAINING MODULES LEVEL
11HASOMED – Hard- and Software for Medicine
Overview of Training Modules
Severe to intermediate leveled disturbances
Intermediate to mild leveleddisturbances
Mild leveled disturbances
60 sounds
over 200 stimuli, editor
80 objects in photo quality
432 3-D bodies in 67 categories
3D, visual and acoustic
47 persons in 4 different views each
task generator
80 symbols in 2 sizes
200 photos of concrete objects
visual stimuli
43 traffic signs
88 objects in 4 variations
46 pools with each 16 photos
over 100 photos and drawings
77 pools with each 16 photos
3D, visual and acoustic
4 pools with up to 60 pictures
photos of 100 different goods
20 objects in variations
3 groups with 200 words each
geometric symbols
words, letters, numbers, forms
more than 80 short stories, editor
17 types of tasks with 76 pictures
25 pictured objects
TRAINING MATERIAL NeurologicalRehab
Multiple Sclerosis
Geriatrics Psychiatry Pediatrics
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Theprocedureisrecommendedinadultswithadiagnoseddeficitofreactionspeedandreactionprecision
butalsoinimpairmentsofacousticdifferentiationability.Furthermorethetrainingmakesastrongrequest
tomentalflexibilityandfocusedattention.Inclientsliabletointerferencesthetherapistshouldmakesure
theyarenotover-strained.Fortrainingwithchildrenfrom8yearsonchild-orientedinstructionsareprovided.
The ability to perceive sounds and to differentiate between them are precondition. For an independent training
the client needs to be able to handle the RehaCom panel.
Indications
Basic requirements of the patient
Acoustic Responsiveness (AKRE)
The aim of the procedure “Acoustic reactivity”
is to improve precision and speed of acous-
tic reactions. The sounds are familiar to the
patient from his everyday environment.
Training material
Levels of difficulty
Effectiveness
TaskDuring the preparation phase the client learns to associate the sounds with the buttons of the RehaCom panel.
Ifdesired,apractisingphasefollows.Finallytheactualtrainingstarts.Nowarangeofsounds(abarkingdog,
aringingtelephoneetc.)areheardandthecorrespondingbuttonsontheRehaCompanelhavetobepushed
asquicklyaspossible.
Atthemomentabout60differentsoundswiththeirtypicalbackgroundsounds(e.g.wavesonthebeach)are
provided.Picturesonthescreenandcertainacousticstimulicreateaparticularenvironmentorsituation(e.g.at
home,onafarmetc.).TheRehaCompanelisrequiredtousethisprogramme.Thecomputermustbeequipped
withaDirectX-compatibleSoundcardandsuitableloudspeakersorheadphones!
Thedifficultyismodifiedthroughthenumberofsoundstobedifferentiated,theuseofirrelevantstimuliandthe
useofbackgroundsounds(e.g.quietmusic).
Atthemomenttheprocedureistestedscientifically.Becauseofthehighclosenesstoreallifeagoodtransferof
theskillstrainedtoeverydaysituationscanbeexpected.
13HASOMED – Hard- and Software for Medicine
The training is indicated for all patients with reduced response speed induced by the central nervous system.
Such a reduction of response speed almost always occurs in diffuse brain dam-ages as well as in frontal and
prefrontallesions(e.g.dementia,braintrauma,insult,formationofatumour,ischemia,etc.).
The client needs to be able to understand and comply independently with easy instruction texts.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskVeryrealisticstimuli(trafficsigns)werechosenforthistraining.Thetaskistopressthecorresponding
reactionkeyasquicklyaspossiblewheneveratargetstimulus(i.e.atrafficsign)appearsonthemonitor.
Thetrainingmaterialconsistofrealistictrafficsigns.Inthelearningphasethepicturesofthetargetstimuli(traf-
ficsigns)andthecorrespond-ingreactionkeysarepresented.BypressingtheOK-buttonthelearningphaseis
terminated.Thenthetargettrafficsigns(towardswhichtheclientmustreactwithinacertaintimeinterval),and
inhigherlevelsofdifficultyalsoirrelevanttrafficsigns(whichrequirenoreaction),aredisplayed.TheRehaCom
panelisrequiredtousethisprogramme.
Threetypesoftaskswith4or6levelsofdifficultyeachhavebeenconstructed:
•Thenexttrafficsignappearsonlyaftertheresponseoftheprevious(6levelsofdifficulty).
•Fixedintervalbetweentheitems(4levels).
•Theintervalchangesadaptively.Afteracorrectresponseashorterintervalischosen,andviceversa(6levels).
Reaction Behaviour (REVE)
Respondent behaviour of single and
multiple choice reactions (speed and
accuracy) towards optical signals is trained.
On the edge of the screen traffic signs can
be seen. Next to each a key of the RehaCom
panel is displayed which has to be pressed
when the traffic sign appears in the middle
of the monitor. Thus, attention and memory
are jointly trained.
EffectivenessInvestigationresultsforthistrainingprogrammarenotyetavailable.However,goodrehabilitationresultsare
expectedfortheabovementionedindicationsbecauseaspecificdisorderistrained.
14 HASOMED – Hard- and Software for Medicine
The objective of reactivity training is to improve the speed of reactions and the speed and accuracy of reactions
followingcerebrallesions.Itisrecommendedinthecaseofdisordersofselectiveattentionperformance,andin
thecaseofdisordersofvisualoracousticdiscrimination,cognitionand/orbehaviouralperformance.
Thetrainingprogrammeislesssuitableforpatientswithseriousametropiaorpoorhearing(acousticstimulation).
The patient must be capable of pressing the large reaction buttons of the RehaCom panel accurately. Serious
memoryimpairment(forgettingstrategies)anddisordersaffectingattentionandconcentrationmayimpairthe
success of training.
Indications
Basic requirements of the patient
The objective of reactivity training is to im-
prove the speed and accuracy of reactions
to visual and acoustic stimuli. Simple, simp-
le choice and multiple choice reaction tasks
are designed to train the patient to react
as quickly and differentially as possible to
signals.
Training material
Levels of difficulty
TaskReactivity is trainedusingsimple,simplechoiceandmultiplechoicereactions,and involvesvisualand/oracoustic
stimuli.Afterapredefinedvisualstimulusappearsand/orafteranacousticstimulusisplayed,thepatientmustpress
aparticularbuttonontheRehaCompanelasquicklyaspossible.Duringanacquisitionphase,thepatientfamiliarises
himselfwiththepracticalitiesofthetask.Helearnstoassociatethestimuliwiththerelevantbuttonsonthepanel.
The assignment of stimulus to reaction which is learned can be consolidated during a practice session. Training then
proceeds with a selectable number of stimuli. The speed and accuracy of the patient’s reactions are measured and
evaluated.
Trainingincorporatesmorethan200visualstimuliand6acousticstimuliin3variationseach.Thetherapistcan
addhisownvisualandacousticstimuli(anypicturesandsoundshechooses).Thereisanintegratededitorto
create individualised training programmes.
Theprogrammeoffers20levelsofdifficultywith5tasksperlevel.Eachtaskcomprisesseveralcombinationsof
stimuli.Thevariouscombinationsarerandomlyselectedbycomputer,ensuringthateachpatientexperiencesan
extremelyvariedtrainingprogramme.Theprogrammeworksadaptivelythroughthe20levelsofdifficulty.The
higherthelevelofdifficulty,thegreaterthenumberofstimulitobedeterminedandthemorevariedthetemporal
sequenceofstimuli.
Responsiveness (REA1)
15HASOMED – Hard- and Software for Medicine
Thetrainingisindicatedforalldisordersorimpairmentsofthelong-term(continuous)attentionofdifferentetiology
and genesis. The ‘Vigilance’ training programme is particularly suitable where there are disorders affecting tonic
attention.Inthecaseofpatientswithvascularbraindamage,craniocerebralinjuriesanddementia,improvements
canbeexpectedincognitiveperformanceaswellas,tosomeextent,age-relatedtransfereffects.
Thetaskofthistrainingisverysimple.Thepatienthassimplevisualdifferentiationstosolve.Childrencanbe
trained also to appropriate instructions.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskThetaskofthistrainingisdesignedtobeveryeasy.Basicvisualdifferentiationtasksarerequiredintheclient.
Objectsmovepastonaconveyorandmustbecomparedcontinuouslywithoneormorepermanentlyvisible
specimenobjects.Thepatientmustidentifywhichobjectsarenotidenticaltothespecimens,andremove
these from the conveyor at the point indicated.
Objectsaredisplayedonaconveyorbeltandhavetobecomparedtooneorseveralfault-free„sampleobjects“.
Theclientshouldfindthoseobjectsthatarenotidenticaltothesampleobjects(=faultyobjects).
Accordingtotheparametersettingsconcreteobjects(e.g.awashingmachine,arefrigerator,etc.)orabstractfigures
aredisplayed.Childfriendlyinstructionsareprovidedtoassistinitsusebychildren.15levelsofdifficultyareavailable.
Withincreasingdegreeofdifficultythefollowingparametersgrow:
•thenumberofdiffering(„faulty“)objects,
•thenumberofdifferingelements,
•thenumberofobjectsdisplayedaswellas
•thecomplexityofthepictures.
The ability to maintain one‘s attention
over a longer period of time is trained in a
design with limited response time towards
the items. The task of the patient is to
monitor a conveyor belt and to select those
objects that differ from a sample object in
one or several details.
Vigilance (VIGI)
EffectivenessFordetailedinformationpleaserefertothesection„EffectivenessStudies“,especiallytothestudiesofBECKERS,
HÖSCHEL,PREETZandFRIEDL-FRANCESCONI,PHUR,PFLEGER,GÜNTHER.
16 HASOMED – Hard- and Software for Medicine
The procedure is recommended especially for training basic cognitive functions of spatial perception. Through
using non-verbal material it is also suitable for patients with impaired ability to understand words or language.
Visualbasicskillsbelong to thecomplexcognitiveskills.For that,on theonehand,performances inattention
areprecondition,ontheotherhand,thereprovedtobesignificantcorrelationstotheabilityofabstractthinking.
Inhighlyimpairedintellectualskillsordisturbancesofattentionthisprocedureislesssuitable.
Indications
Basic requirements of the patient
The ability to imagine something spatially is
focus of the procedure “Spatial operations”.
It is trained in 5 categories: estimating
positions, estimating angles, estimating
relations (filling of vessels) and estimating
sizes one- and two-dimensionally.
Levels of difficulty
Task and Training materialBWhenestimatingpositions,twofieldswithstructuredbackgroundsaredisplayedonthescreen.Oneofthemshows
anobject(e.g.acar)atafixedposition.Inthesecondfieldthesameobjectisdisplayedatadifferentposition.Thetask
istomovethesecondpicturetothesamepositioninitsfieldasthefirstpicturebymeansofthecursorbuttonsonthe
RehaCompanel.Photographsanddrawingsareused.Whenestimatingangles,2angleshavetobemadeequiangular.
Whenestimatingrelations,vesselshavetobefilledwith“liquid”(halffull,1/3etc.)Whenestimatingsizes,thefieldsdisplay
objects–drawingsorphotographs-ofdifferentsizeswhichhavetobebroughttoequalsizebymeansofthecursor
buttons.Thistaskisavailableinaone-andinatwo-dimensionalversion.Theshort-termmemoryforspatialperception
istrainedinhigherlevelswhentheoriginalobjectvanisheswiththefirstadjustmentofthe“copy”.Reconstructingthe
original position then has to be carried out from memory.
Theprocedureworksadaptively,foreachcategoryaseparateserialoflevelsfrom1to9hasbeenvalidated,in
total42levels.Thetasksofeachcategoryareexplainedinaninstructionphasevia“learningbydoing”.
Spatial Operations (RAUM)
EffectivenessStudies for thisprocedurearenotyetavailable.However,goodrehabilitationsuccesscanbeexpected inthe
indicationsdescribedabovesincetheclienttrainsdisturbancespecifically.
17HASOMED – Hard- and Software for Medicine
Adecline in theperformance invisual-constructive tasks, itemsof theposition-in-space-explorationaswellas
in spatial orientation are observed for right hemispheric temporal and parietal and damages of the frontal lobe.
Thetrainingisindicatedforpatientswithlesionsinthislocation,diffusebraindamageormentaldefectives.
Two-dimensionalandspatialoperations,inwhichtheposition-in-space-relationmustbeperceivedandtheobject
turned or tilted in order to find out the corresponding picture, belong to themore complex cognitive abilities.
Thereforebasalattentioncapabilitiesareaprecondition.Ontheotherhandconsiderablecorrelationwiththeability
tosolveabstract„brain-teasers“andintelligenceingeneralhavebeenfoundinvariousinvestigations.Forclients
with extreme intellectual impairments or a pronounced attention disturbance the training is less suitable.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskOnthescreenvariouspictures(objects)aredisplayedthatshouldbecomparedtoanobjectattheedgeof
thescreen.Thecorrespondingpicture,whichhastobefoundout,istwistedtowardsthecomparisonpicture.
Geometricfigures,e.g.squares,arrows,hexagons,areusedasobjects.Athigherlevelsofdifficulty,thetraining
material increases in complexity – up to concrete objects and street-maps.
With increasing difficulty the number of pictures in the matrix grows. Additionally more and more similar
objectsaredisplayed.Sothedifferentiationcapacityneededtofindthecorrespondingpictureincreases.Whilstat
lowerlevelsofdifficultythetaskscanbesolvedbyestimatingsizesandlengths,athigherlevelsthepatientmust
visualise the rotation of objects.
The procedure “Two-dimensional operations”
trains the positioned relationship with two-
dimensional presentation. The task is to
find the picture of a matrix which exactly
corresponds to a „comparison picture“. The
corresponding picture is twisted towards
the „comparison picture“.
Two-Dimensional Operations (VRO1)
EffectivenessFor detailed information please refer to the section „Effectiveness Studies“, especially to the study of
FRIEDL-FRANCESCONI.
18 HASOMED – Hard- and Software for Medicine
Theprogramme issuitablefortreatingcognitivedisorders,particularlyofspatialperceptionfunctions.The
programmecanalsobeusedasahigh-levelcontinuationofattentiontraining.Byusingnon-verbalmaterials,
itispossibletoworkwiththeprogrammeeveniflanguageisrestrictedorthereareproblemsunderstanding
words.
Aspatialsenseisoneofthemorecomplexcognitiveactivities. Itrequiresabasic levelofattention,andmany
studies have found not inconsiderable correlations with the capacity for abstract reasoning. The training is less
suited in the case of profound intellectual im-pairment or for those suffering from serious attention disorders.
Intact vision is required, particularly at higher levels of difficulty where details have to be recognised. Initial
findingsindicatethatthetrainingcanbeusedfromtheageof10years.Thepatientneedstobeabletomovethe
mouse of the computer.
Indications
Basic requirements of the patient
Spatial sense and attention performance
are trained. This is achieved by showing
several three-dimensional bodies on the
screen which must be compared with a
reference body. All of the bodies on the
screen can be rotated freely, making a
three-dimensional view possible. Stereo
glasses for a genuine 3D representation are
an additional option.
Levels of difficulty
Task and Training materialAthree-dimensionalobjectisshownontheupperhalfofthescreen.Beloware3to6objects,whosedegreeof
similarityvarieswiththelevelofdifficulty.Thepatientmustidentifytheobjectwhichmatchestheobjectatthe
topofthescreenexactly.Alloftheobjectsonthescreencanberotatedinthreedimensions,andcanthereforebe
viewedfromeveryside.Atotalof4323Dbodiesin67groupsareavailableastrainingmaterial.
Theprogrammeworksadaptively.Twenty-fourlevelshavebeenvalidatedaltogether.Trainingcommenceswith
simplebodiesandshapes,laterprogressingtocompoundobjectswithandwithoutanindicationofdirection.
Atthehighestlevelsofdifficulty,thecomplexityofthebodiesincreasesconsiderably;differentiationbecomes
increasinglychallenging.Thelevelofdifficultyisalsovariedbyusing3,4,5or6objectsofcomparison.
Three-Dimensional Operations (RO3D)
EffectivenessStudiesonthistrainingprogrammeareatapreparatorystage.Withtheindicationsdescribedabove,however,
goodrehabilitationresultscanbeanticipated,becausethetrainingthepatientreceivesisspecifictohisdisorder.
Theexperiencesandresultsobtainedusingthe‘Two-dimensionalOperations’RehaComprogrammeappeartobe
transferable.
19HASOMED – Hard- and Software for Medicine
Specialists literature claims that parietal lesions cause constructional apraxia. Formanaging tasks as in this
procedure,however,notonlyabilitiestosolvevisualreconstructiontasksareneededbutalsomemoryandattention.
The training is indicated for patients with a light or medium decline in the capacity of the visuo-constructive
fieldaswellasinothergeneralizedfunctionaldisorders.Oftensuchageneraldeclineintheperformancecanbe
observedinorganicbraindamages(e.g.throughintoxication,alcoholabuseetc.).Sinceonlypictorialmaterialis
used,thetrainingisalsosuitableforchildrenfromabout8yearson.
Forclientswithseriousapraxia,amnesia,andconcentrationdisturbancesthetrainingisratherunsuitable.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskThetrainingisconstructedanaloguetotraditional„puzzle“games.Inthebeginningofataskapictureis
displayedwhichhastobememorizedasdetailedaspossible.WhentheclientpressestheOK-button,orafter
adefinedtime,thepictureisdividedintoacertainamountofpuzzlepiecesandhastobereconstructed.
Thepicturesappearinveryhighresolution(256colormode)onthescreen.Picturesofhouses,faces,paintings,
landscapes etc. are used.
Altogether18levelsofdifficultyareprovided.Themaincriteriaforthechangeinthelevelisthenumberofpuzzle
piecesthepictureisdividedinto(rangingfrom4to36pieces).
The procedure “Visuo-constructive abilities”
trains visual reconstruction of concrete
pictures. The client memorizes a picture
in every detail. Afterwards the picture is
displayed divided into several pieces as in
a puzzle. Then the puzzle has to be recons-
tructed correctly.
Visuo-Constructive Abilities (KONS)
EffectivenessEffectivenessstudiesarenotyetavailable.However,manyinvestigationsofneuropsychologicalrehabilitationreport
goodtrainingeffectsafterregularpuzzleplaying(oftenalsoincombinationwithotherprogrammsandexercises).
Onecanassumethat the resultsof these investigationsarealso true for thisRehaComproceduresince it is
constructed in analogy.
20 HASOMED – Hard- and Software for Medicine
Attention and Concentration (AUFM)
Functionally and organically caused attention disturbances represent the most widespread neuropsychologi-
calperformancedeficitafteranacquiredbraindamage.Theyarefoundin80%ofthepatientsafterstroke
(apoplexy),braintrauma,diffuseorganicbrainimpairments(e.g.causedbychronicalcoholabuseorintoxica-
tion),aswellasinotherdiseasesofthecentralnervoussystem.Thetrainingissuitableforadultclientsandfor
children with attention and concentration disturbances from 6 years on.
Besidesthecomprehensionofeasyinstructiontexts,theabilitiestoperformvisualdifferentiationtasksandto
handle the big buttons of the patient panel are necessary.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskA picture presented separately on the screen is compared to a matrix of pictures. The one picture exactly
corresponding to it has to be found.
Atotalof49picturepools-eachcontaining16pictures-hasbeensetup.BecauseoftheuseofVGA-graphicswithhigh
resolution,thepicturesappearingonthescreenareofgoodquality.Theyrepresentdifferenttypesofobjectsaccording
totheparametersettings:eitherconcreteobjects(fruits,animals,faces,etc.),geometricalobjects(circles,rectangles,
trianglesindifferentsizesandorders),orlettersandnumbers.
Theadaptivechangeinthedifficultyofthetasksguaranteesthattheclientwillbeconfrontedwithneithertoo
difficultnortooeasytasks.Altogether24levelsofdifficultyareavailable.Withincreasingcapability,three,latersix,
andfinally9similarpicturesaredisplayedonamatrix.Onlyoneoftheseisidenticalwiththecomparisonpicture.
The RehaCom procedure “Attention &
concentration” is based on the pattern-
comparison-method. The patient has
to find the picture from a matrix which
corresponds exactly to the „comparison
picture“.
EffectivenessFor detailed information please refer to the section „Effectiveness Studies“, especially to the studies of
GÜNTHNER,BECKERS,HÖSCHEL,POLMIN,PREETZ,FRIEDL-FRANCESCONI,PUHRandPFLEGER.
21HASOMED – Hard- and Software for Medicine
Divided Attention (GEAU)
Problemsinfocusingattentiontowardsseveraldifferentobjectssimultaneouslyoccurwithalmostalldiffuse
braindamages(e.g.intoxicationoralcoholabuse)aswellaswithlocaldamagesoftherighthemisphere,espe-
ciallyoftheparietalpartsofthebrain.Effectedpatientshavedifficultiestofocustheirattentiontodifferent
objectsatthesametime.Becauseoftheanimatedpresentationthetrainingisverymotivatingandsuitable
also for children from 11 years on.
The client should be able to understand and comply with easy instructions independently.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskOnthelowerpartofthemonitoradriver’scabinisrepresented.Above,onecanobservethetrack(likethrough
thewindshieldoftheengine).Theclienthastoreactsimultaneouslytowardstheelementsinthecabandtowards
certainsignalsonthetrack.
Thedriver’spanelcontainsaspeedometer,asocalled„deadmanlamp“andthe“emergencybreaklamp”.Onthe
speedometeratargetspeedissettheclientshouldcomplywith.Ontheflashingofoneofthelampstheclient
mustpressthecorrespondingbuttonontheRehaCom-panel(e.g.thestop-button).Ifanimportantsignappears
onthetracktheclientalsohastoreact(e.g.stoppingataredblocksignal).
Thetrainingcontains14levelsofdifficulty.Inthebeginningtheclientneedstoregulatethetrain’sspeedonly.
Fromleveltwoonwardnewtasksareaddedstepbystep.Thisimpliesreactionstowardsdifferenttrainsignals,the
deadmanlampandemergencybreaksignals.
In this attention training - like in every day
life - several circumstances must be observed
simultaneously. Like an engine driver the
patient monitors the driver‘s cab, regulates
the speed and reacts towards different
signals „during the journey“.
EffectivenessFordetailedinformationpleaserefertothesection“EffectivenessStudies”,especiallytothestudyofPUHR.
22 HASOMED – Hard- and Software for Medicine
Patientswith disturbances in focussing on certain aspects of a task, in fast reacting on relevant impulses
andatthesametimeignoringirrelevantimpulses.Thesedisturbancesoccurin80%ofpatientsafterstroke,
craniocerebralinjury,diffusebrainorganicimpairment(e.g.asaresultofchronicalcoholabuseorintoxication)
as well as other diseases of the central nervous system.
Therearesimpletextsofinstructiontocomprehend.Thepatienthastopushthebuttonsonthepanelorkeybord
by himself. Supported by instructions appropriate for children also children up from age 10 are able to train with
this procedure.
Indications
Basic requirements of the patient
Levels of difficulty
Task und Training materialOnyourmonitor youwill have simulated a look througha frontalwindowof a car aswell as look at the car‘s
dashboard. Through the window you see the street in front of the car, which trails away in the distance of a
landscape.Lefthandisshownthespeed-indicator.Withinthetachometerthereisagreenareawhichmarksthe
speedyoushoulddrive.Belowthegreenareathereisaredarrow,whichshowsyouthecurrentspeed.Theredarrow
mustalwaysbelocatedinthegreenarea.Thecarmovesonthestreetonafixedtrack,alsoincurves,sothatthe
patienthasnottopayattentiontokeepthecaronthestreet.Tospeedupthecaryouhavetopushthearrowkey
up,toslowdownthearrowkeydown.Thereisadisplayforthewaytogoandtheexpiredtime.Theaimistodrivea
certaindistanceinalimitedtime.Itistopayattentionthatthedisplayforthewayisalwaysinfrontofthedisplayfor
thetime.Alevelisfinishedwhenthetimeisoverorthewayisdone.Whilethecarissetinmotionthroughpushing
thearrowkeysontheRehaCompanel,relevantaswellasirrelevantobjectsaremovingperspectivelytowardsthe
user.Onlytherelevantobjectsandacousticstimuliarecountingasresultsforthetrainingofthepatients.
Theprocedureworksadaptive.Intotalthereare22levelsvalidated.Withinthetrainingthedifficultiesvarybyadding
more and more levels of attention and by modifying the interval of the stimuli.
Driving a car the patient has to pay attention
parallel on several issues: observing atten-
tively the landscape and car dashboard as
well as reacting differentiated on acoustic
information. In the beginning there is only
the speed to keep. Later on, with growing
level of difficulty, there are further tasks,
which wait for certain reactions of the
training person in other area of attention.
Divided Attention 2 (GEA2)
EffectivenessGood results of rehabilitation can be estimated because the client is trained specifically to his disturbances.
Studies are in process.
23HASOMED – Hard- and Software for Medicine
The indication for this training is given for all memory disorders or impairments regarding verbal and non-verbal
contents.Amnesiacsyndromescanbeobservedforalldiffusecerebro-organicdiseases(dementia,intoxication,
chronicalcoholabuseetc.)aswellasforallleftorbothsidedlesionsofthemedialorbasolaterallimbiclemniscus.
Moreovervasculardiseases,braintrauma,orbraintumoursinprefrontal,temporaluptoparietalcorticalareas
canleadtomemorydeficits.
BesidebasictaskcomprehensionthehandlingofthebigbuttonsoftheRehaCompanelisaprecondition.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskInthesocalled„memorizingphase“anumberofcards(dependingonthelevelofdifficulty)withconcrete
picturesorgeometricfiguresaredisplayed.Theclientmemorizesthepositionofthepictures.Afterapreset
time-ormanuallybypressingtheOK-button-thepicturesofthematrixarehidden(turned„upsidedown“).
Attheedgeofthescreenapicturewillbedisplayedandtheclient indicateswhichofthehiddenpictures
corresponds to it.
In total464pictures (picturesof concreteobjects, geometricfiguresand letters) areavailable. Thenumberof
simultaneously displayed pictures varies from 3 to a maximum of 16.
Thereare20degreesofdifficultydefinedbyanumberofcardsandcomplexity.
This procedure trains topological memory.
Like in a memory-game the position of
cards with pictures (e.g. a lion, a flower,
a house, a car, etc.) or geometric figures
should be memorized. Once the cards are
turned “upside down”, their position has to
be remembered.
Topological Memory (MEMO)
EffectivenessFor detailed information please refer to the section „Effectiveness Studies“, especially to the studies of
GÜNTHNER,BECKERS,HÖSCHEL,PREETZ,FRIEDL-FRANCESCONI,PUHRandPFLEGER.
24 HASOMED – Hard- and Software for Medicine
Withprosopagnosiatheabilitytorecognizefacesandestablishmeaningfulassociationswiththemisimpairedor
lost. The problem can also be related to memory components that are responsible for remembering faces. This
disorderiscausedbylesionofthetemporallobe(moreoftenlefthemispheric).Thetrainingisthereforeindicated
for all clients with right-sided or bilateral temporal lobe damage of different pathogenesis if the above mentioned
impairments are observed.
Itisnecessarythattheclientisabletoperformeasyrecognitiontasksandhandlethepatientpanel.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskFacesarememorizedduringa„learningphase“.Afterwardsthesefacesarepickedoutfromanumberofdifferent
facespicturedfromdifferentsides.Inhigherlevelsofdifficultyanameandaprofessionaretobememorized
additionally.Itistheclient‘staskthentofindoutthefacecorrespondingtothenameortheprofession.
Altogether 47 persons have been photographed from four different views. The pictures almost reach photo
quality(16,7millioncoloursintheSVGAmode;24BPP).Toadaptthetrainingtolocalspecialitiesorthefamiliar
surrounding of the patient there is an editor to embed own pictures.
Threelevelshavebeendesigned:
•Memorizingfaces(1-6pictures:level1to6)
•Connectingfacewithaname(2-6pictures:level7to11)
•Memorizingfaceswiththecorrespondingnameandprofession(2-6pictures:level12to16)
•Memorizingfaceswiththecorrespondingnameandphonenumber(2-6pictures:levels17to21)
With this training the recognition of faces and
the pairing of faces to a name and a profes-
sion is practiced very realistically. Faces are
displayed from different sides. The client deci-
des whether the picture of a person has been
shown before. In higher levels of difficulty
additional verbal information regarding the
person (name, profession) has to be memorized.
Physiognomic Memory (GESI)
EffectivenessWiththistrainingprocedureexactlythoseabilitiesaretrainedthatareimpairedinclientswiththeabovementioned
lesions. Therefore a high effectiveness of the training can be expected.
25HASOMED – Hard- and Software for Medicine
The training is especially suitable for clients with an impairment of the word span or reduced recognition
capability - especially for clients with a beginning amnesic syndrome. This syndrome occurs of patients with
diffusecerebro-organicdamageandlefthemisphericorbilaterallesion(especiallyofthelimbiclemniscuswith
damageofthethalamicparts).Thetrainingisalsosuitableforclientswithfunctionallycausedimpairments
and for children from 11 years on.
Besidetheabilitytoreadwords,itisapreconditionthattheclientisabletomastereasyrecognitiontasksandto
presstheOK-buttonontheRehaCompanel.
Indications
Basic requirements of the patient
Levels of difficultyThedisplayedwordsaredividedintothreegroupsof200wordseach.Thesegroupsinclude:easyandshort,
easycompound,andcomplexcompoundwords.
Training material
TaskInthelearningphasealistofwordsismemorized(from1upto10words).Thehigherthedegreeofdifficulty,
the higher are the number and the difficulty of thewords to bememorized. Thewords presented in the
learningphaseshouldbeselectedafterwardsfromanumberofother(irrelevant)words.
The words appear big and plainly visible on the screen. The moving of the words on the screen is carried out
continuouslyandwithoutjerking.Thespeedofthewords„rollingby“canbeadapted.
This RehaCom procedure trains the recog-
nition capability for individual words. In
the so-called „learning phase“ a certain
number of words is shown. Afterwards a
variety of words „roll by“ like on a conveyor
belt. The client‘s task is to recognize and
pick out the words shown in the learning
phase.
Memory for Words (WORT)
EffectivenessFordetailedinformationpleaserefertothesection„EffectivenessSudies“,especiallytothestudiesofHÖSCHEL,
POLMIN,PREETZ,FRIEDL-FRANCESCONIandPUHR.
26 HASOMED – Hard- and Software for Medicine
This training is indicated for all memory disturbances (especially for the working memory) for verbal
and non-verbal contents. The procedure can also be used in clients with an - organically or functionally
caused-impairedabilitytonameobjectsanddifficultiesinconceptualpairing.Averagevocabularyassumed,
Figural Memory is suitable for children from 11 years on.
Itisrequiredthattheclientisabletonameconcreteobjectsandreadeasywords.Forindependenttrainingthe
clientmustbeable,regardinghismotorskills,topressthebigbuttonsonpanel.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskPicturesortermsofconcreteobjectsaredisplayed.Alltermsorpicturesoftheseobjectshavetobememorized
now.The„learningphase“isterminatedbypressingtheOK-button.Afterwardsaccordingtothedisplayedterm
variouspicturesoraccordingtothedisplayedpicturevariousterms„rollby“onthescreenfromthelefttothe
rightlikeonaconveyorbelt.Wheneveratermorpictureofanobjectofthelearningphaseappears–termsor
picturesthathadtobememorized-theclientpushestheOK-button.
Because of VGA-graphicswith high resolution the pictures appearing on the screen are of good quality.
Regardingtheterms,abigandeasytoreadtypefacehasbeenselected.Themovingofthewordsthroughthe
screeniscarriedoutcontinuouslyandwithoutjerking.Thespeedofthewords„rollingby“canbeadapted
to reading speed.
Thenumberofdisplayedobjectsinthe„learningphase“correspondsexactlytotheninelevelsofdifficultyprovided.
Inthelowestleveltheclientshouldmemorizeoneobject-inthehighestlevelnineobjects-andlaterrecognizethe
correspondingterm(s).
This procedure trains the medium-term
non-verbal and verbal memory (working
memory). The patient memorizes pictures
with concrete (describable) objects or terms.
After the „learning phase“ according terms
or objects roll by like on a conveyor belt. The
patient presses the OK-button whenever a
term or picture of an object of the „learning
phase“ rolls by.
Figural Memory (BILD)
EffectivenessFordetailedinformationpleaserefertothesection„EffectivenessStudies“,especiallytothestudiesofHÖSCHEL
andFRIEDL-FRANCESCONI.
27HASOMED – Hard- and Software for Medicine
The procedure is recommended for clients with a disturbance or an impairment of their short-time or medium-
termmemory.Thesemightbeconsequencesofalmostanydiffusebraindamage(dementia,alcoholabuseetc.)as
wellasoffullorleft-hemisphericlesion.Thetrainingcanalsobeusedtoimprovememoryskillsinchildrenfrom
11 years on.
Theclientmustbeabletoreadandunderstandsimplelanguage.Forindependenttraininghe/sheshouldbeableto
use the RehaCom panel.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskA short story is displayed on the screen. The client is required to memorize as many details of the story as
possible(dates,numbers,events,objects).The“memorizingphase”canbedeterminedthroughpressingtheOK-button.
Finallyquestionsaboutthecontentofthestoryareasked.
Morethan80shortstoriesareavailable.Dependingonthesetting,eitherthecomputerorthetherapistselects
a story for training. The pool of stories available can be extended by virtue of an integrated editor.
There are 10 levels of difficulty. The higher the level of difficulty, the greater the length and information
contentofthestory.Thenumberofnames,numbers,eventsandobjectstoberecalledalsoincreases.
Aim of the procedure “Verbal memory” is to
improve the short-time memory for verbal
information. Short stories displayed on the
screen contain a range of details the client
is asked to memorize and later reproduce
when questioned by the PC.
Verbal Memory (VERB)
EffectivenessFor detailed information please refer to the section “Effectiveness Studies”, especially the studies by
REGEL&FRITSCH.
28 HASOMED – Hard- and Software for Medicine
Thisprocedureisrecommendedforclientswithdeficitsinworkingmemory,conceptattainmentorplanning
anactionsequence.Trainingwithchildrenfrom11yearsonispossible,andwithelderlypersonsinorderto
maintain their mental abilities.
Clients should be able to read and understand a shopping list. To work on his own the client needs the
dexterity tohandleamouseor theOKbuttonon thepanel.Training isnot recommended forclientswith
attentiondeficits.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskTheclientgetsashopping listwitharangeofgoods.Thenhe/shemovesthroughasymbolicsupermar-
ketwithshelvesdisplayinggroupsofgoods(e.g.fruits,dairyproducts,stationery).Inordertopickouta
particularitem(e.g.abucket)heneedsto“enter”thegoodsdepartment(inthiscasehouseholdarticles)
byclickingontheshelf.Theshelvescontentwithavarietyofproductsisdisplayedthenandgoodsare“put
intothetrolley”byclickingatthem.Checkingthetrolleyscontent,taking itemsoutagainaswellas– if
adjusted-havingalookattheshoppinglistispossible.Aftertheclienthascollectedallthegoodshethinks
hewassupposedtobuyhefinishesshoppingbymovingtothecheckout.Herethegoodsinthetrolleyare
comparedtothoseontheshoppinglist.Atahigherleveltheclient“receives”anamountofshoppingmoney.
Thegoodsthenaremarkedwithprices.Thetaskistocheckwhetherthereisenoughmoney.
Theprogrammecurrentlyusessome 100articles illustratedphoto-realistically (foodstuffs,householdobjects,
etc.)Thesearticlesappearonshelves,fromwhichtheymustbeselectedbythepatient.Thetrainingprogramme
featuresavoiceresponse;inotherwords,allofthearticlesarenamedwhenselected.
Theprocedureprovides18levelsofdifficultywith2modes.Inthefirstmodethegoodsontheshoppinglist
havetobeboughtonly.Inthesecondmodeacertainamountofshoppingmoneyisavailableandtheclienthas
tocheckwhetherthereisenoughmoney.Inbothmodeswithincreasingdifficultytheshoppinglistgrows.
This procedure realistically trains an
everyday situation: shopping in a super-
market. All steps necessary are just like in
reality. Planning and coordinating an action
are trained as well as the short-time memory
(interval between looking into the trolley
and looking at the shopping list).
Shopping (EINK)
EffectivenessAtthemomentstudiesareconducted.Atransfertoactivitiesofdailylivingisexpected.
29HASOMED – Hard- and Software for Medicine
Usingthistrainingisrecommendedtoadultclientswithdisturbancesoftheexecutivefunctions,especially
oftheabilitytoplan.Thisabilitytoplanandtoorganizeeverydaylifebelongstothemostcomplexhuman
skills.Thisskillcanbeimpairedasaresultofanybraindamage,especiallyofdamagesoffrontalstructuresor
indiffusecerebraldamages.TheprocedurePlanadaymayalsobeusedfortrainingmemoryskills.However,
it is not recommended in cases of very heavy serious disturbances.
Theclientneedstobeabletounderstandthetaskandmovehandsaccordingtothetask.Thetherapist’s
presence is strongly recommended for seriously effected clients.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskThetrainingrequirestheclienttorealizeasetoftasksinoptimalorder.Onthescreena“town”frombirds-eye-
viewisdisplayed,itshowsbuildingswhichtheclientneedstogotoaccordingtohistimeschedule.Thereare
threekindsoftasks:
•Realizepriorities
•Minimizepathlengths(andthusthetimeneeded)
•Maximizethenumberoftaskscarriedoutsuccessfully
Thelevelsofdifficultyarecharacterizedbyvariationofdifferentparameters.
Theprocedurecangenerateanalmost infinitenumberofdifferent tasks throughevernewcombinationsof
rasks,thusprovidingchangeandvariety.
The procedureworks adaptively following a validated structure of 55 difficulties. Additional adjustment to the
client’s capacities is possible via the parameter window.
This procedure is very closely related to the
daily routine in which the patient has to
organize a day following time schedules. It
aims at improving the executive functions or
rather at establishing strategies how to plan. It
practices basic and – in higher levels of
difficulty – complex cognitive skills.
Plan a Day (PLAN)
EffectivenessPlanadayisafollow-updevelopmentofaproceduresetupincooperationwithProf.Dr.JoachimFunke(University
ofHeidelberg).Prof.Funkeprovedanimprovementofclients`planningskillswithaDOS-Versionoftheprocedure.
Evaluationstudiesfortheprocedureareinprogress.
30 HASOMED – Hard- and Software for Medicine
Most authors relate the frontal lobes above all with abstract reasoning. However, isolated lesions of the
frontal lobe seldom appear separately. For that reason there is a high degree of disagreement about which
corticalpartsareresponsibleforsolvingreasoningtaskswithnon-verbalmaterial.Thetrainingisindicatedfor
patientswith acquired cerebro-organic (frontal lobe) damage,whenan impairment in logical thinking can
beobserved.Thosedeclinesinperformanceoccure.g.quitefrequentlyasacauseofchronicalcoholabuse,
dementiaandinsult,butalsoschizophrenia.
The precondition for using the training is the ability in the client to focus attention over a longer period
of time. He/she should be able to draw easy abstract-logical conclusions. In order to perform the training
independently, the comprehensionofeasy instruction textsandbasicmotor skills tohandle theRehaCom-
panel are preconditions. The training can also be usedby children from 12 years on if they are capable of
performing abstract-logical conclusions.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskFromvarioussymbols(„responsepool“)theclientisaskedtoselecttheonewhichcorrectlycontinuesa
givensequence.
Asequenceofsymbols(circles,triangles,squares,etc.)ofdifferentshape,colour,andsize,interconnectedbya
rule,aredisplayedonthescreen.Forafalserespondspecifichintsconcerningthetypeoferror(shape,colour,
and/orsize)aregiven.
23 levels of difficulty are available. With increasing difficulty the client must observe various levels of
abstractioninordertofindthesolution.Intheeasierlevelsthesymbolsmaintaine.g.sizeandcolour.Onlythe
shapeofthesymbolchanges.Inhigherlevelsallthreecomponents-shape,colorandsize-changeaccording
to sophisticated rhythms.
This training aims at improving logical
thinking (reasoning). The client picks out
the symbol correctly completing a row of
symbols which is constructed following a
logical rule, or a combination of logical rules.
Logical Reasoning (LODE)
EffectivenessFordetailedinformationpleaserefertothesection„EffectivenessStudies“,especiallytothestudyofPUHR.
31HASOMED – Hard- and Software for Medicine
Thetreatmentprogrammewasdevelopedforpatientswithimpairedarithmeticalcognitiveskills.Thesedisorders
ofcognitivefunctioncanvarygreatlyinnature.Theyrangefromrestrictedbasaldisorders,suchastheinabilityto
estimatesizesandquantities,toproblemsinapplyingbasicareasofmathematicsanddifficultiessolvingcomplex
mathematical problems.
Thepatientshouldbecapableofunderstandingthetaskandhavethenecessarymotorskillstocomplete
it. The presence of a therapist is strongly recommended in the case of severely affected patients.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskThetraininginvolvesawidevarietyoftasks.Thepatientbeginswithsimplecomparisonsofsizeandquantity,
andwithsortingtasks.Thenthebasicmathematicaloperationsofaddingandsubtractingarepractised,both
mentallyandinwriting.Atmoreadvancedlevels,thepatientistrainedinveryreal-lifesituationstohandle
money;hemustbeabletoshowthathecancount,givechangeorcheckhisownchangetotheappropriate
standard.Finallytherearemultiplicationanddivisiontasks.
Sizeandquantitytasksarepractisedusingpicturesofsimpleobjects,untilthepatientprogressestocounting
withnumbers.Duringwrittenadditionandsubtraction,thenumberscarriedoverareshowninasmallerfont.
Moneyhandlingispractisedusingpicturesofgenuinebanknotesandcoins.
Theprogrammecomprises42levelsofdifficultyandworksadaptively.
Mathematical training enables patients to
improve their arithmetic skills. Such skills
are essential in many areas of daily life. The
problems to be solved are very varied in na-
ture. Thus, depending on the type of disorder
concerned, training can be given in basic
mathematical operations or more complex
tasks. The basic mathematical problems in-
clude size comparisons, quantitative compa-
risons, arranging according to quantity and
basic mathematical operations at various
levels of difficulty. Tasks relating to money
handling and written addition and subtraction
are included to train patients to solve complex
mathematical problems.
Calculations (CALC)
EffectivenessAs the trainingwas developed in accordancewith precise pedagogic principles, a high level of validity can be
assumed. Studies are currently being conducted into mathematical training.
32 HASOMED – Hard- and Software for Medicine
This procedure is designed for patients with contra-lateral visual neglect phenomena on one-side and
representationdisorders.Alowervisualexplorationonone-sideofthesightoccursoftenwithvisualneglect
orextendedcerebralinfarctsintheareaoftheArteriacerebriorposterior.Alsootherhear-organicdisorders
could be the cause of these lower functions.
Thisprocedureislesssuitableforpatientswithstrongdefectivevisionorganicbased.Patientsmustbeableto
push the large reaction button.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskThepatientlooksatthehorizonofasimple(2-dimensional)landscape.Abigsunisplacedinthemiddleofthe
screen.Afigureappearsleftorrightofthesunwithirregulardistances.Everytimethepatientspotsafigure,he/
she must push the appropriate reaction button on the panel.
Onthescreenyoucanseeahorizon.Inthesimplerlevelsasunisinthemiddleofthepricture.Afigureappears
onthishorizonleftorrightofthesunwithirregulardistances,differentfiguresorsymbols,i.e.animals,cars,
bikes.Thesymbolsgetsmalleratthehigherlevels,thehorizonvanishesandadditionaldiversionsappear.Itis
advisable to use the chin rest.
Threelevelsofdifficultyareavailablewiththreesizesoftheobjects(big,middle,small).Theyarevariabledefined
bythebackgroundcontrast(blackorgrey)andthemovingposition(fixedormoving)oftheobject.Alltogether
thereare28levelsofdifficulties.
This procedure is devoloped for patients
with reduced visual capacities and visual
neglect phenomena (neglect, hemianopsis,
hemiamblyopis e.g.). The patients are in-
structed to push the left or right reaction
button, when left or right from the centre a
figure (e.g. animal, vehicle, person …) appears.
Saccadic Training (SAKA)
EffectivenessWiththisRehaComprocedurethevisualexplorationistrained„symptom-orientated“.Thereisaprioriexpected
that with this computer assisted procedure at least the same good training effects are being accomplished as with
conventional training with patients who suffer from visual neglect phenomena on one-side.
33HASOMED – Hard- and Software for Medicine
The training is recommended for patients with a homonymous restriction in their field of vision, and for
patientswhohaveproblemswiththeirvisualexplorationduetofailureintheirfieldofvision,visualneglect.It
isalsorecommendedtopatientswhosufferfromBalintsyndromeoracombinationofseveralofthesetypesof
disturbances as a result of some type brain damage. The procedure can also be used to help patients who suffer
fromlinguisticrestrictionsandrestrictionsintheirabilitytounderstandwords,bycombiningtheuseofnone
verbal material with the procedure.
The training programm is less suitable for patients with strong defective vision. The patient must be able to
pressthelargereactionkeysontheRehaCompanel.Seriousdisturbancesinmemory(inabilitytoremember
strategies) limits the success of the training. It appears that childrenof8 years andolder could use this
trainingprocedure.However,practiceisencouragedsothatexperiencecanbegained.
Indications
Basic requirements of the patient
Levels of difficulty
Task and Training materialThe objects are in lines and columns and are divided up in a pre-arranged manner. The patient searches over
the given fieldwith a circular cursorwhich is the size of a singlematrix unit. In thisway, the exploration
movementofthepatientiskeptundercontrol.Therelevantobjectsarenotalwaysdistributeduniformlybut
arefrequentlytobefoundinanunusualareaofthefieldofvision.Itisadvisabletousethechinrest.
Theexplorationtrainingprocedurecanbeadap-tedtosuitupto30differentlevelsofdifficulty.Inorderto
adaptcertainstrategies,thefollowingmodificationsofdifficultyareincluded:
•thenumberandthedistancebetweenthenumberoflineswhichhavetobe
•thewidthoftheexplorationfield(numberanddistancebetweencolumns)
•therecognisabilityofthedifferentsymbols
•thedistancebetweenthesymbolswhichhavetoberecognisedandtherefore,thesizeandclarityofthecursor
Itsspeedcanbesetupbythetherapisttosuiteachindividualpatient.
The procedure deals with problems in visual
exploration. The procedure uses a slow serial
search for objects which must undergo a
precise interpretion or analysis.
Exploration (EXPL)
34 HASOMED – Hard- and Software for Medicine
The programmes are not suitable for patients with serious ametropia (visual acuity < 20%) or with
alexia.Seriousmemorydisorders(forgettinginstructionsandstrategies)aswellasattentiondisorderswill
adverselyaffectthesuccessoftrain-ing.Trainingappearstobepossibleforchildrenaged8andover.
DieVerfahrensindfürPatientenmithoherFehlsichtigkeit(Visus<20%)sowiemitAlexienichtgeeignet.Schwe-
reGedächtnisstörungen(VergessenvonInstruktionenundStrategien)sowieStörungenderAufmerksamkeit
beeinträchtigendenTrainingserfolg.DieAnwendungistbeiKindernabdemachtenLebensjahrmöglich.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskReading:Wordsornumbersofdifferentlengthsappearonthescreen,andarereadaloudbythepatient.The
displaytimeisrestricted,sothatthewholewordornumbermustberegistered.Responsesaregiventothe
therapist,whoalsomonitorstheprogressofthenewreadingstrategy.
Visual search: Combinations of stimuli appear on the screen, with a predefined stimulus serving as the
targetstimulus,andtheotherstimuliasdistractions.Thepatientmustsearchthescreenquicklyandcarefully
and indicate the presence or absence of the target stimulus by pressing a button. Responses are given to the
therapist,whoalsomonitorstheprogressofthecompensationstrategy.
Words of different lengths (3-16 letters), short sentences (2-4 words) and numbers (3-6 digits) are used
for reading training; their lengthand the time theyaredisplayed canbe tailored to the individual patient.
Different-colouredlettersandshapescanbeusedforvisualsearches.Itisadvisabletousethechinrest.
Readingtrainingandvisualsearchtrainingincreaseindifficultythroughseverallevelsdependingonthepatient’s
progressuntilpredefinedperformancecriteriaareachieved.Thefollowingparameterswhichinfluencethelevelof
difficultyareincorporatedintheadaptationstrategy:
•thelengthanddisplaytimeofthewordsandnumbers,
•thedifferencebetweentargetanddistractionstimuliandthedensityofstimuli.
Both programmes are used to treat non-
aphasic reading disorders (e.g. in the
case of homonymous visual field defects
near the fovea) and overview and/or
visual search dysfunctions in patients with
homonymous visual field defects, visual
neglect or Balint’s syndrome. They were
developed and clinically tested by Prof.
Zihl, Professor of Neuropsychology at the
University of Munich.
Overview and Reading (ZIHL)
EffectivenessScientificresultsareavailableonthelevelofeffectivenessofbothtrainingprogrammes.
35HASOMED – Hard- and Software for Medicine
InVISTA™ was specifically designed for patients experiencing vision loss such as hemianopia following
neurological lesions. Functional improvements have been observed in patients with visual neglect, impair-
mentsofvisualperceptionandprocessing,andproblemswithreadingandattention.Patientswithlongexisting
impairmentshavebeenshowntoalsobenefitfromthetraining.Itisapplicableforpatientswithaphasiatoo.
ToperformInVISTA™thepatientshouldbemotivated,compliant,andbeabletoconcen-trateforatleast10to
15 minutes. There is no age limit to the training. The patient should always wear prescribed visual correction.
Aheadrestforheadstabilizationandkeepingcorrectdistancetothemonitor ishighlyrecommended.The
patientshouldbeabletopressthespacebuttonofthekeyboardorthebuttonsoftheRehaCompanel.
Indications
Basic requirements of the patient
Training material
Levels of difficulty
TaskPatientssitinfrontofthecomputermonitorandputtheirchinandforeheadinachinresttoensuretheireyes
focusonthecenterofthescreen.Eachtimethefixationpointchangescolorpatientsareaskedtorespondby
pressingabutton.Abrightstimulusispresentedonthemonitor,movingfromtheintactintothedefectvisual
field.Patientsareinstructedtorespondtothemovingstimulusbypressingakeyaslongastheystillperceiveit.
Whenthestimulusisnolongerrespondedto,itwillchangedirectionandmovefromdefecttointactvisualfield
until the patient sees the stimulus again and responds.
InVISTA™comprisesoffourversionstoaccommodatefordifferentpatternsofimpairment.Theparameterization
isbasedonclinicalexpertknowledge.
Theprocedureconsistsoffourversionsforright-andleftsidedvisualfielddefects.Versions3and4differfrom
1and2byemployinghigh-contrastfixationcolorchangesandlongerdelaytimesforresponses.Thisisespecially
helpfulforpatientswithproblemsinattentionandconcentrationordeficitsincolorperception/cataract.Areas
of stimulation are self-adaptive and adjust to the individual patient’s results and progress.
Vision Restoration Training (InVISTA™) is
a computer based programm to initiate
restorative processes in patients with visual
impairments due to neurological lesions. The
self-adapting programm presents kinetic s
upra-threshold stimuli on a dark background.
The patient is asked to respond to these sti-
muli by pressing a key. The therapy progress
can be monitored by means of CentraVIEW™
(computer based visual field screening with
static supra-threshold stimuli).
Visual Restitution Training (VIST)
EffectivenessClinicalstudieshaveshownthataftersubsequentperformanceofseveralmonthsofcustomizedVisionRestoration
Therapy(VRT),65%ofpatientsachievedimprovementsinvisualperception.
36 HASOMED – Hard- and Software for Medicine
Inextremevisualdisordersaswellasinlossofonevisualfield,theprocedureislesssuitable.Demandsto
the attention capabilities are also made. For very serious apraxia the training is indicated only if the client is
capableofhandlingthejoystick.
Visuo-Motoric Coordination (WISO)
Damagesofthemotorcortex(frontallobe)leadtodeficitsinthecontroloftheminutemotoractivitywhich
canbeobservedmostclearlyincoordinationdisordersofthehandandfingermovement.Inmanycerebro-
organicdiseasesanddamages,likecerebralinsults,hemorrhage,extensivetumours,braintrauma,etc.,visuo
motor functions are effected as well. The training is indicated for all disorders of the minute motor activity.
Indications
Basic requirements of the patient
Levels of difficulty
TaskOnthescreenadotandacolouredcircle(abstractmode)arepresented,ore.g.abutterflyandaflower(concrete
mode).Thedotandthebutterflyarecalled“cursor”,thecircleandtheflower“rotor”.Theclientmovesthecursor
intotherotorbymeansofthejoystick.Thentherotorstartsmovingalongapredictabletrack.Theclienttriesto
followthemovementswiththejoystick(representedbythecursor).TheRehaCompanelisrequiredtousethis
programme.
Thedifficultylevelisadaptedtothecurrentperformanceleveloftheclient.Theparametersare:
•thesizeoftherotor,
•thespeedoftherotor,and
•thetypeofmovement(e.g.predictableorunpredictable,curves)
The object here is to train clients with
disorders in visuo-motor coordination.
A cursor and a rotor (both abstract or
concrete) are displayed on the screen. The
client moves the cursor into the middle of the
rotor and tries to keep it there following the
movements of the rotor.
EffectivenessThetraining“Visuo-motorcoordination”followstheobjectpersecutionparadigm.Thereforeonecanexpectatleast
the same training success as under conventional training conditions.
37HASOMED – Hard- and Software for Medicine
Notes
38 HASOMED – Hard- and Software for Medicine
Effectiveness Studies
Evaluation Study Conducted on Computer-Assisted Cognitive Training of Psychological Basic Functions
Is the Neuropsychological Treatment of Memory Specific or Unspecific? – Comparing Treatment Effects on Memory and Attention.
RehaCom has evolved since it was first launched 25 years ago. It was developed by therapists and is meant to
be used by therapists. RehaCom’s origins date back to 1986 when Professor Hans Regel first started doing
research in the field of attention. Since then, numerous studies and results of research covering diverse areas
have proven the effectiveness of RehaCom. You can read these studies on our website at www.rehacom.com.
Final reportona fundedresearchproject:Bonn.Cu-
ratorshipCNS. 120 cerebrally impaired patients (88of
them had a stroke, 21 had an acquired brain injury,
11 had other causes of damages) were treated with
occupational standard therapies, standard logot-
herapy and computer-based training programmes
(RehaComprocedures)foratleastfourweeks.Theeva-
luationincluded182differentpsychometricmeasures.In
pre-post-comparisons, significant improvements in
performance were made.
Regel distinguishes between three transfer effects:
Primary objective and research design: In order to
analyzewhether neuropsychologicalmemory therapy
acts specificallyon thememorydomainor inamore
generalized fashion on further cognitive domains,
27patientswithorganicmemorydeficitsduetodiffe-
rent etiologies (cerebrovascular, traumatic, infectious,
etc.)wererandomlyassignedtotwodifferentmemory
treatment programs and investigated for changes in
memory and attention.
Prof. Regel, H. and Fritsch, A. (1997)
Spahn, V., Kulke, H., Kunz, M., Thöne-Otto, A., Schupp, W., Lautenbacher, S. Source: Zeitschrift für Neuropsychologie , 21 (4), 2010, 239-245
trained attention leading to a high increase of attention
capabilities. In many cases there was a correlation
between improvements in performance and the course
of training using RehaCom. This correlation proved the
positive impact computer-assisted cognitive training
has on patients’ performance. Surveys and interviews
with patients as well as results of observing patients’
behavioursuggestatransfereffectofthirdrank.
Transfereffectsoffirst rankwereproventhanksto
subsamplesinvolving24patients.Thesepatientsonly
Methods and procedures:Patientstreatedbyaspe-
cificcomputer-basedtrainingofstoryrecall(Training
ofVerbalMemory,TVM)werecomparedtoagroup
in which compensational strategies for everyday
memoryproblemsweretrained(MemoryTherapyin
Groups,MTG). Both therapieswere conducted over
12to15sessions,4-5timesperweek, inadditionto
standard program of neurorehabilitation. Training
effectswereaccessedforverbalandfiguralmemory
(VerbalLearningTest,NonverbalLearningTest)and
forattention(AlertnessandDividedAttentioninTest
Battery of Attentional Performance). Results and
conclusions: Both treatment groups resulted in im-
provement in tests of memeory but not attention. This
findingprovidesgoodevidencefortheassumptionof
specificityofeffectsinneuropsychologicaltreatment
of memory.
•
•
•
Transfereffectoffirstrank(trainingeffect):Training
cognitive functions leads to improvements in the
particulartests(e.g.trainingofattentioncapabilities
bringsbetterresultsinattentiontests).
Transfereffectofsecondrank(generalisationeffect):
Training cognitive functions leads to improvements
of those cognitive abilities which were not rained
(attentiontraining,checkingmemoryfunctions)
Transfer effect of third rank: Training cognitive
functionshelpstobettertackleeverydayproblems
39HASOMED – Hard- and Software for Medicine
Effectiveness Studies
Efficacy and specificity of intensive cognitive rehabilitation of attention and executive functions in multiple sclerosis.
Flavia, M., Stampatori, C., Zanotti, D., Parrinello, G., Capra, R. (2010) Journal of Neurological Sciences 288 (2010) 101-105
Objective: Toevaluatetheefficacyofacomputer-ba-
sed intensive training programof attention, informa-
tion processing and executive functions in patients
withclinically-stablerelapsing–remitting(RR)multiple
sclerosis(MS)andlowlevelsofdisability.
Design, patients and interventions: Atotalof150pa-
tientswithRRMSandanExpandedDisabilityStatus
Scale(EDSS)scoreof≤4wereexamined.Information
processing,workingmemoryandattentionwereasses-
sedbythePacedAuditorySerialAdditionTest(PASAT)
andexecutivefunctionsbytheWisconsinCardSorting
Test (WCST). Twenty patientswho scored below cer-
tain cut-off measures in both tests were included in
thisdouble-blindcontrolledstudy.Patientswerecasu-
allyassignedtoastudygroup(SG)oracontrolgroup
(CG)andunderwentneuropsychologicalevaluationat
baselineandafter3months.Patients in theSGrecei-
ved intensive computer-assisted cognitive rehabilita-
tionofattention,informationprocessingandexecutive
functions for 3 months; the CG did not receive any
rehabilitation.
Setting: Ambulatory patients were sent by the MS
referral center.
Outcome measures: Improvement inneuropsycholo-
gical test and scale scores.
Results: Afterrehabilitation,onlytheSGsignificantly
improved in tests of attention, information proces-
sing and executive functions (PASAT 3" p=0.023,
PASAT2" p=0.004,WCSTte p=0.037), aswell as in
depressionscores(MADRSp=0.01).Neuropsychological
improvement was unrelated to depression improve-
ment in regression analysis. Conclusions: Intensive
neuropsychologicalrehabilitationofattention,infor-
mation processing and executive functions is effective
inpatientswithRRMSandlowlevelsofdisability,and
also leads to improvement in depression.
40 HASOMED – Hard- and Software for Medicine
Team of Development
Prof. Hans Regel (†)
Medical faculty
University of Magdeburg
Idea, theoretical concept RehaCom,
Attention, memory
Dr. Peter Weber
HASOMED GmbH
Magdeburg
Ideas and concepts RehaCom
Dr. Andreas Krause
Medical faculty
University of Magdeburg
Theoretical concept RehaCom,
Attention, memory
Dipl.- Ing. Frank Schulze
HASOMED GmbH
Magdeburg
Product manager
Conceptual design and
development software
Prof. Dr. Joachim Funke
Psychological institute
University of Heidelberg
Executive functions
PD Dr. Sandra Verena Müller
Neuropsychology Stroke Unit
Clinical centre
Bremen-Mitte gGmbH
Occupational rehabilitation
Dr. Thomas Krüger
Centre for evaluation
and methods
University of Bonn
Executive functions
Dipl.- Psych. Johannes Werres
Organisation of integration
Occupational rehabilitation centre
Sachsony-Anhalt
Occupational rehabilitation
Dr. Stefan Frisch
Clinical Neuropsychologist GNP
Psychological Psychotherapist
Clinic for Neurology
Clinic of J. W. Goethe University
60528 Frankfurt am Main
Prof. Dr. Josef Zihl
Clinical neuropsychology
Department psychology
University of Munich
Visual disorders
Dr. DP Angelika Thöne-Otto
Clinical Neuropsychologist GNP
Psychological Psychotherapist
University Leipzig KöR
Medical Faculty
Daytime Clinic for Cognitive Neurology
Dipl.-Psych., Dipl. Soz.-Päd. Petra Rigling
Petra Rigling Reha-Service
Waldbronn
Attention
The company HASOMED GmbH thanks all partners who are and were involved in the development of RehaCom. Without your collaboration the development of such a sophisticated system for cognitive therapy wouldn´t have been possible.
41HASOMED – Hard- and Software for Medicine
Team of development