Introduction to the Cognitive Mobile App MEMORI-net

Brain injury (such as Stroke, or TBI) produces a complex constellation of medical consequences including physical, emotional and cognitive deficits. Among them, cognitive impairments are the most critical determinants of ultimate rehabilitation outcome. Therefore, the cognitive rehabilitation represents a crucial component of brain injury/neuro-rehabilitation and the "neuropsychological rehabilitation can be described as any intervention, strategy or technique which enables patients and their families or carers to live with, manage, by-pass, reduce or come to terms with cognitive deficits".

MEMORI-net COGNITIVE PROPOSAL

The cognitive rehabilitation training MEMORI-net is performed from T1 to T3 (see details into the protocol MEMORI-net) and the duration of each cognitive session varies between 30 and 50 minutes. In the beginning, the training lasts less time (20 minutes in order to complete at least 1 exercise) and the duration is increased in the following sessions (up to 50 minutes in order to complete at least 5 exercises in each session). Three cognitive sessions are performed every week for a minimum of 4 weeks up to a maximum of 8 weeks.

We prefigured the presence of 10 different exercises, training 5 different sub-components of executive functions (working memory, planning, inhibition, shifting and attention). Every exercise can be performed directly tapping on the screen and both reaction times and accuracy will be evaluated. All exercises are designed with increasing difficulty levels and the patient passes to the next level when he correctly achieves a determined value of accuracy in the current level. As a general method of intervention, the Goal Management Training (GMT) will be offered to improve the ability to plan activities and to structure intentions.

Unlike common treatment paradigms, where only impaired sub-functions are predominantly treated, patients in the MEMORI-net rehabilitation program will perform the complete set of exercises, in order to promote the activity of fronto-parietal circuits and the increasing recovery of Central Executive Network. The expectation for this procedure is that it should enhance the transversal power of the treatment, and eventually produce wider generalization to real life.

The app, as visible in the following image, includes 5 different cognitive areas: attention, control and inhibition, working memory, planning, and shifting.

app

 

 

ATTENTION (ATTENZIONE - POZOR)

screenshot app LOOK AND YOU'LL FIND (CHI CERCA TROVA – KI IŠČE NAJDBE)
A set of tasks requiring cancellation of stimuli is proposed for the training of patients’ spatial and selective attention. The request is to mark the target stimulus/i among distractors. We prefigured 3 different scenarios (Fruits, Fishes, Mugs), with 10 levels of increasing difficulty in which the n. of targets and distractors increase as well as the type of targets and distractors (colour – shape – dimension), and complexity of the background.
screenshot app THE UNEXPECTED (L’IMPREVISTO - NEPRIČAKOVANO)
This is a target detection task where patients respond to target stimuli that occur infrequently and irregularly within a series of standard stimuli. In the urban context of a city, a bicycle moves and meets different obstacles. The subject is asked to ignore most of the stimuli, as they are harmless, and to respond only to the appearance of the target stimulus. The complexity increases in the various levels with the increase in the duration of the level itself and with the decrease in the frequency of appearance of the target stimulus.

 

CONTROL AND INHIBITION (CONTROLLO E INIBIZIONE - OBLAST IN ZAVRTOST)

screenshot app ALTOLA' (ALTO LA’ - POZOR)
This task is used to train the patient’s capacity for sustained attention and response control. The task requires participants to press a button given certain stimuli and inhibit that action under a different set of stimuli (e.g., not pressing that same button). The complexity increases in the various levels with the change in the frequency of appearance of the target stimulus and with the perceptive characteristics of the stimuli (geometrical figures, silhouettes or real images).
screenshot app DON'T GET DISTRACTED (NON FARTI DISTRARRE - NE MOTI SE)
These tasks aim to train patients to control an irrelevant automatic response and provide a relevant secondary response, creating a discrepancy with different conflicting types of information. This set of exercises can be considered as variants of the Stroop task created by replacing the word-colour conflict. In particular, we prefigured a number-magnitude conflict exercise and a dimension-word significance conflict exercise.

 

WORKING MEMORY (MEMORIA DI LAVORO - DELOVNEGA SPOMINA)

screenshot app KEEP ME IN YOUR MIND (TIENIMI IN MENTE - ZAPOMNI SI ME)
During this working memory updating task, a continuous retrieval of information is required, in order to maintain accurate representations of information changing over time. In particular, arrays of stimuli of various lengths (e.g. letters or digits) are presented sequentially. Participants are requested to keep in mind selected stimuli of the sequence. Task difficulty is gradually enhanced by manipulating memory load.
screenshot app WATCH OUT THE RULE (OCCHIO ALLA REGOLA - PAZI PRAVILO)
During this working memory manipulation task a transformation and/or substitution of presented information is required, in order to replace the memory content with the newest information. In particular, arrays of stimuli (e.g. letters or digits) are presented sequentially and must be remembered and reordered following a given rule (for example, alphabetical or arithmetic order).

 

PLANNING (PIANIFICAZIONE - NAČRTOVANJE)

screenshot app STEP BY STEP (PASSO A PASSO - KORAK ZA KORAKOM)
The exercise consists in putting in the right order a series of single sub-actions that describes the various steps to complete a complex action. The difficulty increases in the various levels with the increase in the number of steps needed to complete the action and with the decrease in the occurrence frequency of the given action in real life.

 

screenshot app PLAN YOUR MOVES (PIANIFICA LE TUE MOSSE - NAČRTUJ TVOJE POTEZE)
The goal of this task is planning and choosing the correct route from a starting point to select a given number of stimuli, following precise rules and instructions. This exercise can be considered as a variant of the Elithorn Test. The number of stimuli to be collected and instructions to follow are gradually increased to improve problem-solving skills, taking into account structured environmental feedback.

 

FLEXIBILITY (FLESSIBILITÀ - PRILAGODLIJIVOST)

screenshot app READY TO CHANGE (PRONTI A CAMBIARE - PRIPRAVLJENI NA SPREMEMBE)
These exercises train the ability to switch tasks rapidly in order to respond flexibly to a changing rule. The exercise requires patients to identify and memorize a given rule, which are arbitrarily modified during the task, and to apply it to stimuli (letters or digits) appearing in different portions of the screen (e.g., key press for even numbers or vowels, and then to odd numbers and consonants). This task switching requires participants to move attention away from one set of features in order to selectively attend to the alternative feature set.

 

screenshot app 2 IN 1 (DUE IN UNO - DVA V ENEM)
In this dual-task paradigm the “ALTOLA'” exercise from section CONTROL AND INHIBITION is combined with a novel sound detection task, thus requiring both working memory and attentional control.