Family response to computerized cognitive retraining with brain injured individuals

Computerized cognitive retraining is a technique for remediation of the cognitive and behavioral changes which follow a traumatic brain injury. The technique utilizes specifically developed computer software which builds on the basic foundations of intellectual functioning. While the injured patient is the target of treatment, the method appeared to have an impact on the patient's family as well. Families of patients who participated in computerized cognitive retraining initially appeared to have fewer difficulties with anxiety, depression, and family problems. They also appeared to be more involved in the patient's treatment than were similar families who had not had this experience.The experiment evaluated the secondary psychological effects of computerized cognitive retraining on the brain injured patient's primary caretaker in the family. The dependent variables studied were perception of family involvement in patient treatment, anxiety, depression and perception of family problems.Subjects were recruited from the outpatient case load of the Psychology Department of Fort Sanders Regional Medical Center in Knoxville, Tennessee and from a local support group for families of patients who have experienced a traumatic brain injury. The injured patients and family members participated in the retraining technique. A total of seventeen patient/family member pairs participated in the study.Subjects participated in either the experimental or control treatments. The experimental group underwent five sessions of approximately one hour in length. The patient and family member worked together during the course of the retraining. Brief counseling followed each session. The treatment group used an Atari 800 computer and Bracy's "Foundations" cognitive retraining software package ( Psychological Software Services, Indianapolis, Indiana). The control group was a waiting list, minimum contact group, whose participation was limited to completion of the pre and posttest materials.Family members in both groups completed pre and posttesting packages. These included: a demographic questionnaire, the "Problem Solving Inventory" (Heppner, 1982a, 1982b), the "State/Trait Anxiety Inventory" (Speilberger, 1983), the "Beck Depression Inventory" (Beck, 1961), and the "Scale of Marriage Problems" (Swenson & Fiore, 1982).The experiment utilized Kerlinger's pretest-posttest control group design (Kerlinger, 1973). Patient/family pairs were randomly selected from the available subject pool. Control or experimental treatment groupings were assigned by stratified random sampling. Data were analyzed by the use of two way analysis of variance with repeated measures on one factor. Throughout the analysis, a level of R < .05 was required to infer statistical significance.The results of this experiment did not support the effectiveness of computerized cognitive retraining as a specific intervention method for the families of brain injured individuals. The findings revealed that there were no statistically significant differences between the control and treatment groups on measures of perception of family involvement, depression, or perception of family problems. The treatment group experienced a statistically significant increase in state anxiety following the experimental treatment. The validity, generalizability and implications for these findings were discussed in light of prior research.Recommendations for further research in the area of family response to computerized cognitive retraining include replication of the study with greater numbers of subjects and more sophisticated evaluation and treatment methodology. It is also suggested that future research address the patient's cognitive level, the utilization of varied retraining protocols specific to the patient's level of function, and premorbid psychosocial factors which may influence the process of cognitive remediation.Thesis (Ph. D.