What we're talking about is computer assisted training for mild traumatic brain injuries. And actually some of the software were going to show you can be used with mild, moderate, and severe injuries. What i thought i would do just to start out, well, the first thing i would like to do is introduce the people that are here with me from my office because we're all going to be working, I'm Dr. Mary Ann Keatley and i run a project practice where the majority of our clients are traumatic brain injuries, or learning-disabled individuals, or some people with attention deficit disorders, this is Judy Ward and Natalie Fickus, Natalie is from the rehab Institute of Chicago, and Judy is from the Mexico health shop, and they're both on my staff at the office. Just to start with I thought I would give you a couple of little histories of people who I have seen (inaudible) most of them were out-of-state, or people who came to Colorado for evaluations and some treatments and Mary (inaudable) And I were preparing this (inaudable) based on who I had talked to in years past. And one of those kids who came was a 17-year-old boy who was in high school who was in high school running track and his heart stopped, when he was running, and he actually died out in the country as he was running, he was revived and they called flight for life, but it took quite a while for them to get their even though he was barely alive, they went ahead and flight for lifed him, he died again on the way to the hospital, and they revived him again but, he managed to live. And he went back to school and he looked fine. That's probably the biggest thing about these individuals, they look fine, but there's really something going on. Now, he was more moderate than mild, but it was interesting because he decided he wanted to be an occupational therapy assistant after he was finishing high school, and it was a job he probably could do if he could get through school, so he wasn't (inaudible), so his parents and brought him down upon referral, and we tested him a little bit, and it was interesting because we started giving him these programs, and his brain started moving again like really functioning, and even though his case was overall more like an oxygen deprivation then one we normally see where a person falls and hits their head thing it was still a fascinating case because he's getting better and better. His mother stays in touch with me, and they actually moved to Denver so they came a little bit closer.
Another case that's interesting, was a woman who is a professor, and she was driving down one of the highways here at a fast speed and her heart stopped, a genetic defect, her heart stopped and his she ran into the median and had a subdermal hematoma, and had a subdermal hematoma and they flight for lifed her in, did the surgery and following that she had mild, really more than mild, moderate cognitive (inaudible), but she wanted to continue to teach. So we started working with her and doing a lot of the same kinds of programs. By and large the people that we see are ones who are sitting in their car at a stop sign and are rear ended between five and fifteen miles per hour and have really, serious, serious head injuries. And it's interesting because juries don't understand, that people don't get it, because they say that you look fine, you look fine and that's it. The important thing about the ideology of this problem is that when a head wip lashes you don't have to hit your head on the head rest or anything like that. When the head wip lashes the (inaudible) it goes forward and you get a lot of frontal lobe swelling and of those kinda things. People here are shaking their heads so I get the feeling that most of you already know what I'm talking about, so maybe we don't need to go into those things as much as we do to show the software. I'll just take a little pole, people who want a little more information on that (inaudible). That's great if we could just move right in to this, so the mild injury usually has an unconsciousness time of 20 minutes or less (inaudible) of 13 or greater, no open wounds to the head, and a post traumatic amnesia of 48 hours or less is the general criteria (inaudible). If you're doing litigations type work which I do a lot of (inaudible) the symptoms that occur with this type of injury (inaudible) and emotional, the physical symptoms a lot of times are like, headaches, neck pain, back pain, dizziness, nausea, and they're all listed on the handout, light sensitivity, sounds sensitivity, and a lot of times they'll wear their sunglasses can you turn the lights off, can you close the shades (inaudible). The cognitive symptoms are problems with memory, attention, concentration, language and word retrieval and organization planning and problem solving, executive functioning, safety features like locking your doors. And the one question and there is a symptoms questioner in their, and we're actually in the process of doing (inaudible) but, the questionnaire, the very last question is in this safety section and it says are your awareness levels less than they should be like on a five-point scale and when i see people with head injuries it's almost always the last two, the highest categories, and it's almost always less than it should be. And that is the real key, and when we see that we know that sometimes (Inaudible). The emotional part of this injury is organic mood disorder, sometimes people actually get homicidal, and there actually suicidal and of course, which is the
other side of the coin, I've seen those people, and there's depression, mood swings, anger is one of the phases of recovery from a head injury. So when people say they feel really angry, we say that's good, that's good, lets figure out how to work through it. Hypervigulance being very vigilant, Julie actualy has a client now that is the most hypervigilant patient I've ever seen, when he does these programs he is right on the computer thinking it's the thing that's going to get him better, and it is in some ways but he's going to have to let go of some of that vigilance to really move forward. Post traumatic stress, we see a lot of post traumatic stress even if somebody was hit at 5 mph, in our office we have psychologists and we have people that specialize in eye movement desensitization and reprocessing and somatic experiences, which is a big thing in Boulder that you learn how to dump the trauma out of your system in a different way.
So as far as treatment goes really you need a multi-disciplinarian treatment approach because these people get a lot of
Audience -- (inaudible)
Yes, there is chronic pain that goes along with these injuries, and most of the time it's the neck and it's kind of interesting because I'm actually certified in biofeedback as well as EEG biofeedback so for years I've treated people from a muscular standpoint to as far as neck pain and that kind of chronic pain, I mean it's interesting the head weighs a lot and when the neck is pulled back your disks get injured a lot of times a lot of muscular strain and pain, there is a lot of chronic pain that goes with that, that lasts for years.
One of the problems diagnostically is that the diagnostic tools really aren't sophisticated enough to show these problems like they should. I think MRIs show something like 9%, no CAT scans is like 9% of the people show problems, the MRIs show 13%, the pet scans now are much better they show 53% of the injuries, of the people that have this type of injury it will show information. The med school in Denver has a pet scanner, but a lot of our clients go to California to a center to have the pet scans which actually show the injuries, which is really a relief, you know, when they're getting all these tests nothing shows anything and they have the injury it's really quite devastating to them.
Anyway, as far as treatment goes I did bring a little booklet here that we have at our office, it was written by a group of women that we're actually in a group that we ran and one of them was actually quite a famous writer, her and her husband almost always have the best sellers on the New York Times list, they wrote the last book on the Ramseys, on Jeffrey Dahmer, on O.J. Simpson, so they do a lot of (inaudible) so they wrote this little book following her head injury. And it's chalked full of information that's useful, it's easy, it's simple and these sell like hotcakes over the US counter and in emergency rooms. (Inaudible) but, anyway this book goes into energy allocation, there are little charts about how much energy it takes that's why the fatigue is so great, about the filtering in the brain. How after the injury the brain, there is so much swelling the brain can filter light and sound and information, so it's like a camera shutter either it's on or it's off. And if it's on for a few minutes and you're thinking really hard a lot of times the person gets very fatigued and exhausted just rapidly. Now we have an extra thing that we do at our office and this is the reason I think you might want the handout, because it has some interesting stuff. We do brainwave biofeedback and the brain produces four different brainwave frequencies, the first is Delta, there actually listed in the handout, Delta is two to four hertz, the second one is theta which is four to seven hertz and that is a (inaudible) State, drifting, that is the healing State for the brain, and that is why when people have mild traumatic brain injuries their brain slips down into theta which is a very foggy State, and the they'll tell you I feel really drifting, and foggy and you can show them that on the biofeedback unit, the state that their brain is in and when they feel foggy that in this is what their brain looks like, and then there is alpha which is eight to 12 hertz which is eyes closed or reading, and then there is beta which is focused concentration that is what people want to learn to do which is what people want to learn to do is bump themselves into alpha or beta so we have equipment and that is brainwave equipment so they can sit and watch their brain waves and learn what it feels like to be in this frequency and when they're in the right frequency they can think and that is a really critical thing. Brain frequencies look like this and in the packet is a handout where it shows this persons theta way this before therapy, you see how jagged and a big they are, these theta way as are quite suppressed, after therapy here it is. Now the theta waves are suppressed, and now the theta waves are enhanced. So they can watch that and learn how to do it. And that is one of our....
Audience -- (inaudible)
(inaudible)
Audience -- (inaudible)
(inaudible)
Audience -- (inaudible)
This will also be online
Audience -- (inaudible)
Yeah, he has it all online, and there is a little summary paper that I get, just a couple pages that gives a real synopsis of it, but, anyway, I think what we're going to do now is since everyone wants to see the software were going to move right into the software but, the principal of therapy is to push people just a little bit beyond their physiological limit. And all of you who work with neurological injuries know that that is a no-no in this field, you don't push people passed their physiological limit because it actually makes them worse and then they backup. The purpose of cognitive rehab is to do it in the little tiny increments so that the person can recover, you know, you do it for a short time and then you rest, then you do it for a short time, then you rest, and the best effects that I see is when people work for 10 minutes take a break for a couple of hours then work a little bit longer then take a break, three times a day is maximum. You'll get dramatic improvement in doing five to 10 minutes three times a day, you'll get great improvement three times a day and will still improve if you just do that work one time a day for four days a week and take three days off. And it's really very dramatic in terms of the improvements that you can see. So what were going to do is were going to do two things. Julie is going to talk about some of the electronic compensatory items and things that we use, and then Natalie and Julie and I will all show you the software and give you an overview, OK. So, come on in.
As Mary Ann said a lot of our patients that we see and executive functioning difficulties and the executive functioning system is housed in the frontal lobe and it's involved in setting goals, assessing your strengths and weaknesses, planning, and let's see, initiating behavior, monitoring current behavior and monitoring those results. So these functions are really important for self-evaluation and self-monitoring which are involved in socially acceptable behavior. So often we have these patients we use electronic devices to treat them, some of them include the Palm pilots, which one our patients have been real successful with is Toshiba pocket PC E740, also we have the talkback Olympus TVN900 which is a system where the patients can talk into a little system and remind themselves that they need to make an appointment, or phone call, or we have a client who is a realiter and so he will often use his talkback system to make sure he makes contacts and or remembers to tell his wife something or what ever it is throughout the day, the (inaudible) speller, and also a beeping system which we have a watch which is called the illuminator, and it's a Casio and it has five beeping system's and it also has the ability to put text in, and if it is beeping the clients can look at the watch and it will say you have an appointment at this time three times a week. So that is quite helpful. And in the packet we also have some (inaudible) strategies which there is a logic puzzle, and also some analogies, some (inaudible) and synonym examples that we have for you in the packet. So that is really all I wanted to talk about. We're going to take you through some of the computer systems. Do you have any questions at all?
Audience -- (inaudible)
No it's not, but I have it written down if you want to (inaudible)
Audience -- (inaudible)
Once again, I'm going to referred to the mystery packet, that hopefully will be (inaudible) of all of you shortly. But, there is a page about halfway through the packet that delineates some of the cognitive areas that the software we use focuses on. So it includes things like speed and information, excuse me, speed and capacity of information processing, multitrack thinking, memory, logic and identification, concentration and attention, some word retrieval, and cognitive stamina. So we're going to start to look at some of the computer programs, again, as soon as they come up you'll have this to reference. Why don't we go ahead and start with.
Audience -- (inaudible)
We can do logic Master first.
Ok
(inaudible)
As far as the referal systems goes we get referals from neurologists, neurosurgeons, chiropractors, vision therapists, physical there exists, occupational therapists, massage therapists, it really comes from everywhere, from the schools. I was actually amazed after I did this talk a couple of years ago. I think I got five or six referrals from out-of-state, and it was quite fascinating to me, and they were all real appropriate. Like one (inaudible) people were really interested (inaudible) .
OK.
The first program we're going to show has to do with logic and deductive reasoning, and in the packet there is a problem with deductive reasoning, it's called a logic matrix problem. And we have three books of these, if you and of wanting to get the titles of these you can just call my office (inaudible) and they're all at different levels (inaudible) it would be simpler.
So this is a puzzle, a program called mastermind, and it's logic reasoning, it is a, and I got to be next to the computer to operate it. This is a reasoning task, and so, did anyone ever play, the game mastermind, or see the little board game mastermind? This is very similar to the game with the pegs, except it's been computerized. So I'll just start out, there are six colors. And the computer at this level is holding two of the colors in its brain, if you will. So our job is to determine which to colors the computer is thinking of. So there are different techniques and strategies you can use to determine the puzzle. So the computer will give you feedback if you made any of the right guesses. I've received no feedback here because there are no colored squares on the right side of the screen. So I can determine that black and red are not in this puzzle, so then I would go on to do say, orange and green. So now I have one Black Square, which means one of the orange and green squares is in the right place and is the right color but I have two determine which one, I have two reasons it out so I will guess that orange is the right one, I'll try orange and white.
The colors are better on my computer.
Yet, but their obviously distorted, OK, I've got no feedback on the right hand side. So I can rule out that orange was the correct color so I know that green is right now and in the right spot I have two determine what would go with green. Not pink, I've used all the colors so I determined that green is the color. Now I've run through this very quickly but, I went through this yesterday with a patient who it took us five minutes to do a two color deduction puzzle. But, it's something that the patients can work on, their reasoning, and deductive reasoning, and work on their attention, can they focused their attention long enough to complete this puzzle, can they plan what their next move should be, can they hold the information in their memory and that they've deduced long enough to help them planned their next step. And that can be very difficult for patients so this is just one example of one of the tasks we use.
One of the things that's interesting about this is there are four levels, two, three, four, five, and on the fifth level there are 7776 different possibilities and you have 10 moves to figure it out, so it's really great. A lot of the Times you'll see world class mathematicians and people like that, around here there's a lot of development of software (inaudible) so you see a lot of people (inaudible) in this is a great program (inaudible).
And that was called mastermind?
No, logic Master.
Is that something you developed?
No, that is a available through psychological software services, and once again in the packet there will be a reference list of some of the companies that we have software with today, so woefully that will come up at the end, if not I can take cards and we can send copies to people or whatever, for some reason.
(inaudible)
This is great for litigation, all the software games, you call them games you don't really, when I go to trial I can say this person took this long, they had this many errors in the beginning, (inaudible) this is like session secession information all by itself.
Usually, you will have done some sort of formalized testing, and say you will have received a (inaudible) reports so, but this is the kind of stuff you will do from day-to-day and you will see some more valuable information from that and will see the progress from what a person can do when they start therapy so you might start and get a baseline with some of these tasks and see their progress change over time of this.
There's a lot of controversy in the field over computer assisted training and whether it works, it's like a nightmare sometimes (inaudible) it works and it carries over, and many of our clients go back to work. It's like amazing so. I generally have hand out at my office, on research that we did that shows that the system works.
(inaudible) 10 minutes once or twice a day.
It depends on the level of fatigue, and the amount of homework, you might want to get up 10 minutes early, get organized, do this first when they're really fresh.
and then wait a little bit before they start doing their homework, and then if they want to do this again in the afternoon go ahead, but they just have to monitor how they feel physically, if they feel overloaded than they shouldn't do both at the same time.
(inaudible)
Oh, yeah, I have a guy right now who's really, he's a corporate something or other, he gets up every morning and if he has a meeting (inaudible) because he does this program and it makes its brain work better.
(inaudible)
Another program we were going to show you is something, as again its through psychological services software, this one is called numbers manipulation. And what you do with this task. (inaudible) what you do is keep your eyes on the box, and actually maybe I'll make you guys do it. Keep your eyes on the box in the center of the screen and you see the number there you press the space bar, you see the second number. Did you see that second number? So you add the first number five to the second number three and you enter a total, eight. You have two or member of the last number you seen which is the three, you press the space-bar to enter the total of eight, and then you see a new number. For plus the last number was, what was the last number? Three, four plus three is seven. So you remember the last number you just saw was a four. For plus one is five, etc. so you go on and it gives you a series of 20 total calculations that you have to make. And then when you complete the whole series it keeps track of how many you got, or completed accurately and how quickly you are able to complete the series so that you can check and track accuracy as well as speed. So this particular task addresses speed of processing but it's also addressing your ability to keep something in memor, alternate your attention to something else and come back to the last number to add a new number, and to manipulate information. And these are higher level cognitive skills that you frequently see impacted by this type of injury.
What is this one called?
This one is called numbers manipulation one. And it's in a program, it's in the, I think it's in foundations, problem-solving, it's in problem-solving. If you go to the psychological services software, they have a different disks or eight different programs that have a series of tasks, so this is in the problem-solving task.
How much do these programs range in cost?
That is a good question, this particular set is not inexpensive, it is expensive, I think you can, the psychological services software. I believe to buy the entire set of the disks is around $800, you can buy individual disksand then they do have a discount price program available like if you buy more than one you get a discounted rate. And I believe they have a discount if you use a credit card over paying cash. But I know, what they let you do to is you can buy one and after you have bought so many you get a discounted rate. Your patience can buy under your name to get the discounted rate, so they wouldn't have to lay out the full amount. The issue that we have come into with them, is we like certain programs were certain tasks often certain disk, so sometimes we hate to tell the patient to go out and spend $100 on one disk when there is one task on the disk. We tried to talk to them about making a disk for us that picks and chooses the ones we like but we are not have much success right there right now.
And what platforms do they run right now?
This platform, let me check my sheet cheat sheet, but I think it's only runs on PC, but I think up to Windows 98, or
I think they run in DOS?
Yes, these loans run in DOS actually, that's right.
So it won't work in XP?
No, it will work in Windows 98.
But, they have actually been doing some work on that, now when they come out there and CDs also, do you guys know (inaudible) he works at (inaudible) is actually the one that does all the psychological services software, but like a single disk, if you just buy one (inaudible) isn't it like $450.
It's very expensive. It's all included on their web site, but it's expensive.
(inaudible)
Have you had much luck with that?
The Department of rehab?
You know, we've never really asked them to do that but, that is an idea. See, if you were to buy 10 or more I think it's 65 bucks apiece.
I think it drops down to 70 apiece.
(inaudible) if we had to buy that out of our own pockets we would be spending 5 or $6,000 just to get (inaudible) the disks for people. We are trying to do sort of a loner program, where you just buy the original and then you have to sign a contract saying that you won't put it on their hard drives or anything. And I haven't checked with the lawyer on that, but then they can use it for a few months, because that's all there really going to use it for. It's not like they need it permanently.
So that is this particular task, any questions about this number numbers manipulation one? And you want to go ahead of you and show them numbers manipulation three? OK, this is numbers manipulation three, it is similar to the first one. What you're going to do for this one is, you're going to see the same box in the center of the screen, with a series of five numbers is going to be presented and your job is to total all five numbers, their single digits, so..... any answers? (inaudible) there you go, OK. So it'll take you through the series, yeah, I was going to get to level to two real quick, so it will run through and do series some more. I had a patient this week that was trying to do this at this rate, what was it 15?, and she can add the first two but couldn't get beyond the first two.
(inaudible)
You can use it, I use it in therapy with kids with ADHD to work on their attention spans, I didn't see that one it doesn't really matter, but we also have other things we use, but it can be a part of a protocol.
I would think with some cases you needed mastermind (inaudible)
What was that one, 16, 17. OK, here is level two, what you have two do that level two is the same thing, but there is two boxes instead of one, let see.
You have to add them simultaneously?
Yes, you have to add them simultaneously, answers anyone? You have to have a total for each box.
Yes you have to add them separately but simultaneously.
14, and 19, very good. So that is level two. What I do a lot of time with patience having success at level one, and can't do level two, we'll start out and just add the first three and build on some confidence with it, and add the first four, then the first five. And then there is a level three, where you have to do three boxes at the same time, which is a very difficult task. Pardon?
(inaudible)
You can't really hear it, but there is a little tone, a little bleep when you get it correct it lets you know so it has a different tone when you put the wrong response in.
This is good for multitrack thinking (inaudible).
Any questions about this? Yes, (inaudible) So, the next one we are going to look at is a program called think fast, this one will run only on PCs it will not run on Mac computers. And it is much less expensive, you can obtain this on the Internet for $49.95.
What is this called?
Think fast. And their web site is brain.com, this is a series of, it has six different tasks, I usually just use five, my friend the flying brain is at the bottom there. And this is really working on processing speed how quickly you can process information. There are also some other components in some other games but I will show you the first task, is purely processing speed. You can put in variables like mood, if you have a patient come in and their feeling more foggy you can track that, you know, take that into consideration as they're doing the game. The first task is physical reflexes and what you do is that little symbol, that little cross with the box behind it and appears on the screen, and your job is to press a certain key on the keyboard as quickly as you can once you recognized that symbol. So this also becomes an issue if you have a patient who is hypervigilant, they want to press it before it comes up on the screen, and you will see more errors.
Doesn't move around the screen?
No, it stays in the same place for this task, but there is a delay pattern. It's not necessarily displayed at a consistent pace. And then it gives you a score that you can use and once again, and this gives you something that you can track over time to see how a patience performance changes. What this score means is this is the efficiency of how quickly and how it efficiently they were working. You want to see something hopefully over 90 if you can get it over 90. I'm fuzzy this morning huh, but it tracks your errors and it gives you an estimate of their brain speed performance. And if you put your cursor there it will give you an explanation of what each area is representing. Yes?
(inaudible)
If they're actually able to make a physical response... it might, in our practice we don't see a lot of patience with that particular concern but you would know that if that was an issue for that particular patient. You would want to note, that they use their nondominant hand to respond, if they had a broken wrist or a fracture impairing their dominant hand or what have you, but you might note that as you. What I see more frequently with this series of tasks is the visual, when you have visual issues, especially, I'll show you the next.
(inaudible)
Keystroke.
(inaudible)
Yes sometimes you will want to make sure you go right through that screen, because we have patients whose self-esteem are a little bruised anyway, so you may want to get that out of their. This next task is for perceptual reflexes, you will see two sets of yellow dots, there is one on the left side of the screen and one on the right. The person completing this task, their job is to determine do you see the dots on the left side or the right side first. And that is why if you see people who are having any visual perceptual difficulties, any difficulties with peripheral vision, any difficulties tracking, you will really see it on this task.
(inaudible)
Uhuh, now it's going at a pretty slow rate today, so it's really easy to see.
(inaudible)
And I'm probably blocking you, and if I make a mistake like that it gives you a nice error.
(inaudible)
It goes a lot faster when, like you said for this computer, this is my first time on it so it's acting like I've never done this before, so it's kind of giving me an easy time today. But, it is very fast and very difficult to discern which side it comes up on once you've been playing it for a while.
I tell people to switch, if they can discern which side it on.
(inaudible)
I think it's both, I think it's both, you know because if you are able to improve your performance on this you are certainly stimulating the frequencies but, it also going to help manifest itself by improved performance in functional tasks. Which is ultimately what we are trying to achieve with our patience, we want to help them regain and restore that function back to their prior level.
(inaudible)
We do that all the time so it's critical (inaudible)
(inaudible)
It's usually one to three times a week, what is really good is for the first three months you can see them a couple times a week. And then they learn a lot of stuff and you make really rapid progress, and then they sort of become their own therapist and a lot of this stuff they can do on their own (inaudible).
The next task in this series is also processing speed but it's also alternating attention, you have to pay attention to variables. And just for the sake of time so that we can get to some of the other stuff, I am just going to show you how to do this or what a patient would have to do.
This is kind of how quickly they can make a decision (inaudible) .
(inaudible)
So you just have to make a quick decision if you're hitting one button or two buttons, and pay attention is a just a yellow light or is it the blue and the yellow and then respond accordingly so your alternating your attention between those two things. And then making the appropriate choice.
Often what I like to do is go into that data and see if there is a consistency (inaudible) you can see if their fatiguing so you can see how (inaudible) the light blue indicates (inaudible) and ideally what you want is too (inaudible)
(inaudible)
(inaudible)
(inaudible)
Let me just do this real quick to make sure, I had many patience in this next one is not their favorite. Just checking, I want to take the sound off for this one so you can see it. So what you will see is a picture and a word on the screen, if the picture and the word match press a key that is denoted as the yes key, if they don't match you press a key that is denoted as the no key. Then to make it a little more difficult sometimes you will see a red reverse sign at the top of the box when you see the reverse sign you have to press the opposite. So if if they match you press no, and if they don't match you press yes. So once again working on that flexibility and being able to hold on to information and memory.
Let's see how I do this morning.
(inaudible)
Opps
And this is a timed tests, or a timed task and I see people that it takes them so long to process that they will get through two, or three because it's time-limited.
(inaudible)
So once again this is a task that I have seen that is very frustrating for a lot of patients they will get the yes and the no, but when the reverse sign comes it just completely throws them off guard. Or you will just see a significant delay in processing, they have say the reverse, and they have bumblebee, train, no, yes and then they have to enter then, it's just a complete thought process.
(inaudible) is saying out loud (inaudible)
Excuse me.
Yes?
(inaudible) and he was saying that the game Tetris is a great processing game (inaudible) Is that true.
It's kind of boring because it's just working on the same thing over and over again but, it is good to do it because, (inaudible) .
And I find a lot of games that comes standard on your PC especially with the kids I see can really address some of these higher level cognitive skills while the kids think (inaudible)
Pinball
I have one on my computer called Jezzball that requires some planning and strategizing, the Jezzball, mine sweeper, solitaire, even solitaire, strategizing and just working quickly, but so a lot of those when you sit down and look at those and think about them in a different perspective. What was I playing with one of the kids yesterday, pipe dream, pipe something, but once again its a lot of planning, can you get your shapes formed faster, fast enough to keep the water from spilling out of the pipe. And so the kids like that because it's more of a game format but you're still working on those cognitive skills.
(inaudible)
You can use it with....
You can use it for anything....
(inaudible)
We do a lot of brain work with them, something that flashes too much.
(inaudible)
(inaudible)
I definitely have patience that I will take and choose which ones instead of running the whole series. Because if you run the whole series a just get completely overstimulated, and we have had patience call us and say I was on my way home and I had to pull over on the side of the road. And if the patience they don't like you know I'm fine and they don't give you that true feedback on how they are really doing then you might push them a little too far.
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The last one going to show you is the working memory capacity, either a set of letters or a set of symbols will flash up on the screen for a few seconds and then they'll be taken away, then you will see a second set of say letters for example, and you have two say yes it the side any of the letters in the second set or no if you did not. the same with symbols, you get asked if you saw any of the symbols in the first set no if you did not. So, I'll start doing the game you guys jump in.
What you go for here is accuracy you want to be accurate (inaudible) you want to see how many you can (inaudible).
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this task is rated by little bit differently than the other tasks in that it gives you a memory capacity which is a total number of letters and symbols that were accurately identified, and then the performance component is your speed and your accuracy.
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We have about five minutes left, did you want to look at another program or asked questions?
(inaudible) or is it a combination of therapeutic support?
(inaudible) we start working on executive functioning we start going into people's homes we help them organize (inaudible) electronic devices and watches (inaudible) And this is one aspect of the therapy that even 50% really (inaudible).
It just depends on the patient but there are a lot of sessions where you don't do the computer stuff.
This is good stuff for people to have when they're done, they've done with airline pilots over the years, and the because they can't really take medication, and they have a hard time with their flying anyway it's really important that they have something that they can go to if they wake up and they fill foggy and they're making a decision to fly this commercial plane or not, they can do something like this and see how they're doing, and make that part of their decision. I can't say yes or no.
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We have cards, we can just give to you (inaudible).
Do you have an e-mail address also.
Do you want my new e-mail address also, it's MAK7448@AOL.com. So do feel free to write if you have any questions
I'm hoping (inaudable) work because i didn't hear it when it came up, it was pretty quiet when we were testing it out before, but this is a task called sounds in a row, and it is to work on
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yeah, but that was individual to that task, this works on your auditory attention processing speed and auditory memory, so, I relate this to you, did any of you ever play the kids game Simon, where you had to put the sounds and the colorsin a row, ths is the same design you just don’t have the visual piece, you have to recall the series from your auditory memory. Let me see if it will.... nope, I don't know what happened in our set up here, because it was working prior. But anyway, it's a series of two tones and then it progresses of to 10 tones with two different sound combinations, and if a person is successful with that level you can progress to the second level where there is four different tones that they have to keep track of, and then sequence. So that can be a very challenging task if you're working on auditory memory, auditory attention. So let me just get out of this one since its not working.
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Know this is some software through psychological services.
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One more, this is called where are my keys, a memory task, you can set this up at level one to six, the first level means you only have to remember one thing, sixth level means you have to remember six, we'll take four. And then you can program in a series of distractions to try and prevent the individual from being able to just to straight from, and using rehearsal or something, indicating that they remember the information. So you could put in a delay, you could put in a visual distractions, you could put in an auditory which I'm not going to do this morning because it probably won't work, but it's just a series of beeps that an individual would have to count. And then an association distraction.
This is all visual memory.
And so you would see this map, and you would give the individual time to study the map, and your job is to remember where each of these highlighted items was located. Are the keys in the dining room, living room, kitchen Park, or closet.
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And the first time I do this with an individual I won't give them any help I'll see how they do it on their own, and go through it the second time with them and say what was your strategy how did you approach this task and let's see if we can come up with something that might be a little more efficient for you, and work on development strategies. Anyway, and then there is just a delay, if I have a patient who maybe is doing this for a while I'll maybe strike of the conversation with him during this delay, if I have a patient who maybe needs to focus little more, and is trying to retain the information , a just let them sit and repeat or rehearse what they had just seen, to get a little bit more accuracy. And the delay usually depends on the level to, it can be anywhere from 30 seconds to a little over a minute, a minute and a half of the delay.
It depends on how many items.
Yeah, it depends on the level
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Yeah, if you just put in two, it's just like a 25 to 20 second delay, it depends on the level. Then a person would have to count the shapes, again another form of distraction, I'm not going to count them but. And then the association distraction factor requires that the individual read this list out loud, and if you notice it is similar to what they were looking at, trying to provide in another level of distraction. So they read them all out loud, and then they're asked a question, where was the pen?
Kitchen
Kitchen, so I just press the number two on the keyboard and it tells me correct. The watch? Keys, the living room. And ring, the dining room. Now during that last part if you need to you can go back and review the map, obviously, without the items in it. So sometimes patients find that very helpful in just getting a reminder of what was where, and then they can answer appropriately. But, then a just give you the feedback, and the delay was 40 seconds.
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Thanks for coming, thank you.
(applause)