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The Institute for Cognitive Prosthetics

For more Information contact:

Elliot Cole, PhD, Institute for Cognitive Prosthetics

P.O. Box 171, Bala Cynwyd, PA 19004

Email: ecole@brain-rehab.com

For Rehab Clinicians

 

At the Institute for Cognitive Prosthetics, therapists helped evolve a new treatment modality over a period of 2 decades. It has been a case-by-case process, with therapists seeing how a technology feature could help solve a particular problem for a particular patient and a particular therapy goal. We didn't start out to develop a new modality, but more and more features were added by therapists, a new modality emerged that fits Functional Rehabilitation and highly personalizes it to the patient. The technology can be easily adjusted to the changing needs of the patient during the cognitive rehabilitation process. And the technology allows the development of special features for patients who have unique and diffuse cognitive deficits. This has led to patient engagement, and recovery that progresses faster and farther. And these outcomes are primarily due to the therapist's ability to create better clinical interventions.

 

The structure of the modality has four components. First, therapy is superimposed on top of the patient's actual activities, and in particular, the patient's priority activities. Second, most of a patient's therapy is delivered to the home by the clinic-based therapist; The patient works at a desk with a computer, and shares a virtual workspace with the therapist. Most activities out of the home have a planning and preparation component that can take place in the home and as part of therapy. Third, cognitive prosthetic software is added to the therapist's toolkit. The therapist continues to use techniques that have worked in the past, and has new tools available as well. Some computer-based tools aer particularly useful for teletherapy in the home. During sessions, the therapist talks, and the patient talks, thinks, and types. And fourth, the therapy sessions ends with an assignment to be done between sessions which reinforces the sessions therapy. The patient merely picks up where the session left off.

 

This modality has a number of advantages over travelling to the clinic for rehabilitation services. The most important is the ability to have the patient's actual activities be the context of therapy sessions. This allows the therapist to fine-tune interventions. The relationship between therapy and the patient's life is more apparent. Therapy isn't just something that takes place with the therapist. It is reinforced and leveraged between sessions, both in homework assignments and in planning and preparing for activities and events. The computer link between patient and therapist means that the therapist can provide brief sessions to solve a patient problem that would otherwise fester. A close relationship develops between therapist and patient because the therapist becomes closely involved in the daily activities of the patient. The therapist can continue to treat the patient along the continuum of care, with substantial benefits to both.

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There are other benefits compared to in-clinic therapy. Travel to and from therapy is often cognitively and physically draining, which reduces the patient's capacity to gain from the therapy session. For intensive therapy programs the patient can't take a nap when tired, which interferes with recommended pacing. Poor weather in many urban and rural areas causes in-clinic therapy sessions to be cancelled. When household members need to transport the patient, there can be added stress from the need to juggle several competing roles. Finally, the patient is in a different place cognitively and physically on return home, and there is an added burden to being able to apply lessons in therapy to activities in the home. Additionally, the therapist rarely can see opportunities or barriers in the patient's home.

 

You don’t need to have good computer skills to succeed at using computer-based cognitive prosthetics.  But you do need to be a good therapist. Some of our best therapists have had minimal computer skills. You bring the clinical skills, and we can train you to use our technology.  We have designed therapist-friendly software, which encourages you to be creative and to develop your own style of therapy.  The technology is also flexible so that you can develop new techniques of therapy.

 

Our software can be used side by side with the patient in a clinic setting, side-by-side in the client’s setting, or by tele-rehabilitation. With tele-rehabilitation, you can have a face-to-face therapy session with natural video and audio. Our therapists have found that they develop strong repport with their tele-rehab clients.

 

 

We’ve been doing technology-assisted rehab for more than a decade. We have had scores of patients and tens of thousands of therapy sessions using our technology. Disciplines have included OT, SLP, neuropsychology, clinical psychology, education, vocational rehab, and peer counseling. We have developed techniques for providing full-day and half-day programs, as well as fill-in services. Tele-rehab enables you to take your patients along the continuum of care, and enjoy the satisfaction of seeing them soar. Our patients are drawn from a broad spectrum: adults, children, and adolescents; from severe/profound deficits requiring 24-hour attendants to clients who are challenged by some IADLs; some have had severe physical involvement while others have had none. Diagnoses have included TBI, mild brain injury, stroke, Parkinson’s, and vasculitis. Many have gone back to school or to work against all odds, and they did it because their therapists had the right tools.

 

Please feel free to contact us for more detailed information.

 

 

A selection of publications for clinicians (pdf format)

 

Telerehabilitation: New Tools for Providing In-Home Brain Injury Rehabilitation

A high-functioning brain aneurysm patient is used to illustrate how occupational therapy and speech therapy services are delivered. The benefits are described for (1) cognitive prosthetics, (2) in-home delivery of services, and (3) rehabilitation where neither therapist nor patient needs to travel.

 

The Future Is Now. A therapist describes treatment methods and advantages for using cognitive prosthetics and telerehabilitation with brain injury clients. With these techniques, she has been able to have faster and more substantial outcomes than with conventional therapy modalities.

 

Patient-Centered Design: Interface Personalization for Individuals with Brain Injury, 2011.  Because cognitive assistive technology can help achieve a partial recovery in patients with enduring cognitive disabilities, clinicians can and should be involved in the design process. Patient-Centered Design (PCD) is a method of customizing cognitive prosthetic software for use as a therapist's tool in treating patients. The patient is viewed as a user with rapidly changing software needs. PCD can be used to personalize the software fast enough to be an appropriate therapy tool. Two mini case-studies are presented. One used almost no features yet overcame a barrier to achieving a significant therapy goal. The second shows the significant role of therapist and patient in designing a powerful new tool that enables patients to remind themselves, in their own words and voices, of upcoming events. The paper also relates advances in neuroscience to new clinical opportunities for cognitive assistive technology.

 

Cognitive Prosthetics: Overview to a Method of Treatment This first survey article of the cognitive prosthetics area describes the different approaches of researchers in the field, presents various findings and techniques, and develops criteria for a cognitive prosthesis compared with software meant for the general population.

 

Design and Outcomes of Computer-Based Cognitive Prosthetics for Brain Injury: A Field Study of Three Subjects.  A “schedule engine” is used in very different ways for different patients. 3 plateaued outpatients used computers installed in their homes for 2-3 months. All exceeded expectations, and achieved both increases in level of functioning targeted by the study as well as a generalized increase on neurobehavioral and psychological dimensions. Patients were able to make substantial contributions to the design of their prosthetic software.

 

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