Cognitive Remediation

What is Cognitive Remediation?

Cognitive dysfunction has been recognized in people who suffer from traumatic brain injury, learning disabilities, and serious mental illness. Computer-Assisted Cognitive Remediation (we call it “CogRem” for short) is a behavioral intervention program designed to improve cognition in people who have suffered a decline in neuropsychological functioning. Computer-based cognitive training emphasizes the educational and cognitive aspect of remediation, and encourages participants to reflect on their unique learning styles and take an active role in their training experience. The program uses commercially available educational software that was selected for its merits in stimulating various neuropsychological functions. It features a diverse range of sensory stimuli, provides immediate feedback, and may be easily graded in difficulty by the participant. Learning tasks are designed to be engaging, enjoyable, and intrinsically motivating. This contributes to a learning environment that fosters independence, self-efficacy, and persistence.

We were first introduced to CogRem while consulting with Dr. Carol Tamminga, Professor of Psychiatry, Vice Chair for Clinical Research, and Chief of Translational Neuroscience Research at the University of Texas Southwestern School of Medicine. With Dr. Tamminga's guidance and support, we established an outpatient CogRem program based on the Maryland Computer-Assisted Cognitive Remediation Manual, developed at the University of Maryland School of Medicine, and further perfected in CogRem programs at the University of Texas Southwestern School of Medicine. The protocols and training methods we use are directly from these sources.

What are the goals of CogRem?

• We teach techniques for focusing and sustaining attention, identifying and remembering information, planning responses, and monitoring and adjusting performance.
• We use guided, graduated computer exercises that require coordinated cognitive activity, increasing mental stamina and speed.
• We address lethargy and motivation issues by using engaging computer-based programs and a supportive, one-on-one training model.
• We stress generalization of trained and practiced skills from training sessions to help our clients concentrate, learn, remember, reason, and solve problems better in their everyday lives.

What is cognition?

Cognition is the mental activity of gaining and using information, including learning, thinking, knowing, remembering, judging and problem-solving. These are higher-level functions of the brain and are related to language, imagination, perception and planning.

People are constantly processing information from wide-ranging sources, encompassing:

• the variety of things we see, hear, and otherwise experience from moment to moment,
• memories of past events and episodes in our lives,
• academic knowledge of language, history, and other topics,
• other knowledge that we have gained in work and social settings, and
• current personal needs and goals, among other things.

Cognitive abilities are the collection of mental faculties that allow individuals to process this ever-changing stream of information: that is, to absorb, organize and interpret information from the environment; combine it with past experience, existing knowledge and current goals; and use the information to guide ongoing behavior.

The spectrum of cognitive operations ranges from “bottom-up” functions that are fairly automatic responses to the environment, to “top-down” operations that require sustained effort and concentration. The more basic processes are the ability to focus and sustain attention, the ability to hold and manipulate information in mind, and the ability to learn new information and recall old information. The higher order abilities, sometimes referred to as “executive” or “cognitive control” functions, regulate, coordinate and integrate more basic cognitive abilities in the service of reasoning, planning, and problem-solving.

A simple example will help to illustrate these ideas. Suppose you encounter an unleashed dog while walking in your neighborhood. A great deal of information is potentially relevant to this situation:

• specific characteristics of this dog and its behavior,
• your knowledge of dogs in general,
• your past history with dogs, and
• your goals in the current situation, such as where you are headed and how quickly you want to get there.

Cognitive processing abilities allow you to access and manipulate this information in order to respond. (In the following discussion, areas of cognitive activity are shown in parentheses.)

• For example, you must first focus on the part of the visual world that includes the dog (attention).
• You must perceive and interpret details of the visual scene (perceptual organization).
• You must be able to remember and access your store of general information about dogs (semantic memory) and relevant experiences from your life (episodic memory).
• You must be able to hold the most relevant pieces of information in mind and resist distractions while you decide what to do (short term, active or “working” memory).
• You must generate and evaluate alternative responses, choose a course of action, and sort out how to put that response into effect (initiation, reasoning, decision making, planning).
• You must continue to monitor the situation as your response unfolds and be ready to modify the response if the situation warrants it (self-monitoring).
• And you must do all this with quickness and efficiency (processing speed).
• Finally, you will likely want to mentally record important details of the experience and lessons learned, and add them to your store of information for future access (abstraction and learning).

Who might need CogRem?

We offer CogRem primarily to people who have suffered traumatic brain injury (a stroke, tumor, or a head injury), and people who have learning disabilities, long-term depression, or serious mental illness. Before starting treatment, our clients are expected have some work habits in place, and to attend CogRem sessions regularly (usually 2-3 times a week for 25 t0 36 weeks). Using computer-based, strategy-oriented exercises, and the support of experienced mentors, we help them translate CogRem achievements into real-life success.

References:
(1) Maryland Computer-Assisted Cognitive Remediation Manual, University of Maryland School of Medicine
(2) Dr. Carol Tamminga, Professor of Psychiatry, Vice Chair for Clinical Research, and Chief of Translational Neuroscience Research at the University of Texas Southwestern School of Medicine

CogRem is not intended to be a substitute for a healthcare provider's consultation or a substitute for medication that a doctor may have prescribed. Results may vary, and specific effects or results in each individual can never be guaranteed.

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