Evaluating the effect of an on-line computer assisted cognitive rehabilitation programme

xviii, 217 leaves : ill. ; 30 cm.PolyU Library Call No.: [THS] LG51 .H577P RS 2005 SoongBackground: People with brain injuries must often deal with cognitive problems, including social problem-solving. The present study evaluated the effectiveness of a 20-session, on-line, interactive, and a skill-training programme on the solving of problems using analogies. It was hypothesized that the programme can help people with brain injuries to learn better problem-solving skills through systematic, theoretically driven learning strategies. Method: This research was carried out in two phases. In phase one, an analogy problem solving training software was developed and pilot tested. The software can be delivered on an innovative tele-rehabilitation platform as well as through the computer-assisted method. The structure and content of the program was developed based on the Instrumental Enrichment model (Feuerstein, Rand, & Miller, 1980) and the hierarchy of daily problem solving as suggested by Holloran and Bressler (1983). The hierarchy is determined by (1) the amount of the stimulation; (2) the power of the stimulation; (3) the complexity of the stimulation; and (4) the level of abstraction, respectively. The pilot test involving 15 subjects with brain injuries gave evidence of the robust content validity and applicability of the three training program modes. This innovative theoretically based development is important to the cognitive rehabilitation of persons with brain injuries because of its unique features, such as progressing from training pre-requisite component cognitive skills to functional problem-solving skills; using reflective groups to substantiate learned knowledge and skills; delivering through either an optional computer-assisted mode or an innovative interactive tele-communication platform. This tele-cognitive rehabilitation platform is the first of its kind in the world and has underpinned the development of a tele-rehabilitation service in Hong Kong and the world at large. In phase two of the research, 83 subjects with brain injuries were randomly assigned to one of the three 20-session analogy problem-solving skill training groups that adopted the same training philosophy, program structure, and contents. However, the three groups deliberately adopted different modes of delivery, namely online training (through computer video conferencing with interactive software); computer-assisted training (through interactive patient-directed software); and therapist administered training (face-to-face therapist guided training activities). Twenty subjects with brain injuries formed the control group and their demographic characteristics were similar to those of the subjects who participated in the three study groups. Their problem solving skills and self-efficacy were assessed in a four-week "no treatment" interval. Monitoring was performed to ensure that they did not receive any training that would improve their problem solving skills and self-efficacy. It was shown then there were no statistically significant pre-test differences between the three groups in their pre-training knowledge, skills, and self-efficacy with regard to problem solving. The post-training problem-solving knowledge and skills, self-efficacy, and daily problem-solving performance of the three groups were evaluated and compared. Outcome measures included a session-based rating scale on hierarchical analogy problem solving; the Category Test of the Halstead Reitan Test Battery (HRTB); a daily problem-solving performance and a self-efficacy checklist.Findings and Results: The analogy problem-solving training strategies were found to be effective in improving problem-solving skills and self-efficacy, regardless of the mode of delivery. The subjects in the three groups generally demonstrated a significant improvement in their functional and overall problem-solving skills but not in their basic problem-solving skills. The subjects in the therapist-administered group who received in-person instructions with a continuous "human touch" showed a significant improvement in both their problem-solving skills and self-efficacy. The problem-solving skill training outcomes of those subjects who participated in the computer-assisted training group were significantly correlated with their pre-training self-efficacy. This might show that self-efficacy is an important psychological construct to mediate a successful self-regulatory training outcome. The on-line group also showed statistically significantly higher learning outcomes. This indicated that on-line training is an effective means for improving cognitive functions and that training outcomes comparable to those obtained with face-to-face therapist administered and computer-assisted programmes can be achieved. On the other hand, the subjects in the control group showed stable problem-solving skills and self-efficacy over a four-week interval (with no statistically significant changes). This showed the therapeutic impact of the three analogy problem-solving skills training programmes. The results of the present study also suggested that the delivery of cognitive rehabilitation programmes can be flexible enough to match the needs of individual clients and yet achieve effective outcomes. Novel, naturalistic on-line training could effectively enhance the cognitive and affective domains. The conceptualization and applicability of tele-cognitive rehabilitation and its implications for the rehabilitation of persons with brain injuries, and future studies in this research area are also discussed.Department of Rehabilitation SciencesPh.D., Dept. of Rehabilitation Sciences, The Hong Kong Polytechnic University, 2005