What should cognitive rehabilitation be like? What phenomena surround the context of rehabilitation and affect the results in a contrasting way?
How should the objectives of rehabilitation be? Should we formulate them from the beginning together with the patient, or should we adapt them little by little? What role does the family play? Should the elements used in rehabilitation be ecological? Or should we use a real context directly? What is the use of tracking data?
Knowledge is like a black hole: it absorbs information, becomes bigger and bigger and theoretically takes us through a portal to the unknown. A good congress usually leaves more questions than satisfactory answers, because each of those who go there deals with a specific topic that enriches the debate.
That’s what it’s all about, debating ideas. We were fortunate enough to be able to debate ideas on rehabilitation last week at the 13th Rehabilitation Congress, organized by Division 22 of the APA and held in Jacksonville, Florida (pictured). In fact, we were very fortunate to be able to show what we do to professionals in one of the countries with the longest tradition in Neurorehabilitation.
What impressions did you get from NeuronUP in the USA?
Excellent. Without falling into complacency, some of the phrases we heard were: “we have nothing like it”, “excellent”, “a great idea”, “you are the avantgarde of Neuropsychology”… and the one we liked the most “I am going to tell it to another person who is going to be interested in seeing this”. The team can be proud.
With solid premises and a practical proposal we have come this far. Nobody knew us when we arrived, and as a company we were interested in word-of-mouth, making contacts, talking about us.
We have been with very important centers (worldwide) and they have given us a great feedback on the tool. In fact, the other phrase we heard the most was “what you teach me we discussed at this morning’s conference”.
And what issues were discussed at the Jacksonville congress?
Especially the new technologies in rehabilitation, which is also the field that concerns us. New technologies in rehabilitation must meet a number of essential requirements. Surely many will sound like NeuronUP to you. But we promise you that we are not to blame. Or yes, because that means we are moving in the right direction.
What are the requirements for appropriate rehabilitation technology?
Technologies must be useful, meet a number of objectives in rehabilitation. One can be evaluation. Another different patient support. Or intervention, which is what we are concerned with.
When we talk about intervention, we must ask ourselves if the technology we use is exclusive for the clinical environment, or it can also be used in an intervention outside the clinical environment.
The latter is much more ecological and rational, and focuses on processes rather than functions. Especially in processes that take place in social settings, and in personal care.
In addition, technological tools in rehabilitation must be adapted to the goals of the people receiving the intervention.
Flexibility and continuity
Tools in rehabilitation must be flexible. And they must have continuity. When we talk about continuity we mean continuity in the leveling of contents, but also that they are comprehensive in a process of intervention (holistic), through the sessions.
It seems that what best adapts to these characteristics are mini-games, rather than a game in which they have to follow a complicated story.
Flexibility allows for individualized exercises. On a personal note, I would like to make a reflection: how much personalization are we willing to support in a rehabilitation technology? As the current data we have support, we are not interested in maximum customization.
We don’t want to “waste” so much time in manipulating certain game variables. We are interested in levels, perhaps to a certain extent the personalization of contents -including photos or materials meaningful to patients.
But do not manipulate the speed, the position, the number of items, the task to be carried out, the specific message… Something logical and acceptable in daily practice, or something that we should review? We leave the question open.
Serious games, movement and socialization
There is also a concept from which we started to design NeuronUP: serious games. They are video games that involve aspects of daily life whose purpose is to improve people’s cognitive aspects.
The ideal thing would be to implant some characteristics of the videogames in the developed serious games. For example: an adequate feedback detailing the consequences of the actions that we carry out in the game, adequate/adapted guidelines that the player must follow…and social interaction.
The social interaction is given by two parameters: the interactive game with the answers of other players and the turns. So when we talk about social games we also talk about ecological aspects, flexibility, impulse control, time management, planning, mind theory…
And movement. Building games that allow motor and cognitive skills to be combined in a playful but rigorous way is a great key to the interventions to come.
Clarity of content, clarity of task
The dynamics of the games and the guidelines should be simple to learn and handle for the person receiving intervention. Feedback from the games should be appropriate in time and in the type of message given to the patient.
In addition, the games should have a tutorial (or two, one for the therapist and one for the patient). Which brings us to an important question: does the game require supervision? Or can it be done without help?
Regarding the format, the integration of audio and video is fundamental. Today, we can carry very powerful technology in the palm of our hand, and its usual format is multimedia. In addition, the visual represents an intuitive language as opposed to what is written.
Tracking the data
Therefore, when we begin an intervention with new technologies, it is necessary to take into account the context in which the tool is going to be used, the costs of that technology (to which we must add extra costs)… and the possibility of tracking data.
In the USA, they are very aware, especially with the tracking of data, for two reasons: they can carry out research with patients’ rehabilitation data, and they can maintain a continuous adaptation of the contents with respect to the variation of results. The aspect that by the socioeconomic characteristics of our country, I fear is not the same.
In our game, it must be possible to integrate quantitative data with personal impressions of the therapist and the patient. We talk a lot about decision programs based on results: algorithms that raise and lower the level based on performance, and choose tests based on the data they have of the patient. And they must be visual to get intuitive feedback. In some cases this motivates the patient.