Innovations in Clinical Neuropsychology – Lectures
Lecture 1: Introduction .......................................................................................................................2
Lecture 2: Cognitive training and rehabilitation ...................................................................................6
Lecture 3: Innovations in motor rehabilitation .................................................................................. 13
Lecture 4: Memory and Attention ..................................................................................................... 19
Lecture 5: Screening and monitoring cognitive decline in MS ............................................................ 30
Lecture 6: Visuospatial cognition: VR and serious gaming ................................................................. 36
Lecture 7: Social cognition ................................................................................................................ 45
Practice questions............................................................................................................................. 54
Summary made by: Sacha Gevers 2024 You can do this <3
, Lecture 1: Introduction
(Technological) innovations are increasingly becoming more important!
There are a lot of brain gaming exercises! Already Nintendo games, apps, Dr. Kawashima’s brain
training.
- They don’t do nothing! But it is important to understand what they do!
- People think these little games will work to ‘get their memory better’
- The memory for example will get only better for this specific game, so the generalization is
limited.
“We find extensive evidence that brain-training interventions improve performance on the trained
tasks, less evidence that such interventions improve performance on closely related tasks, and little
evidence that training enhances performance on distantly related tasks or that training proves
everyday cognitive performance’
Daily life solutions
What we used to do on paper, we now do on a phone!
Technology development went really rapid
- 80’s: basic computers
➔ Passive becomes active becomes interactive!
- For medical studies, they are already using holograms to learn about anatomy
o VR is also used to learn procedures like echography
- Geology students are learning about waterflow and geology maps by augmented reality that
adapts to sand.
➔ Especially students who are bad at mental rotation tasks benefit most from these
visuospatial learning methods
Now VR is mostly used for motor rehabilitation, but cognitive rehabilitation is upcoming!
Metrisquare: build software platforms where you can digitize existing diagnostic materials.
In Neuropsychology there is a bit of a resistance against the technological revolution.
- Norm data is based on pen and paper administration instead of digital administration
- In digital you might get more information about responses
Why should we innovate?
- Technical development
o It is available, so let’s use it!
o Who knows what it can do!
- Scientific motivation
o Digital versions can give more information about timing or processing speed.
o You will get more data!
- Less limitation than existing materials
o Papers can get lost!
Summary made by: Sacha Gevers 2024 You can do this <3
,Categories
Diagnostic tools
Computer based assessment of a condition is already used for quite some time
- Origin in the military and in sports! Here was money so it was worth to invest in computer
based tools
- Used to measure damage and concussion in military and sports
Clinical practice
- Creating digital versions of existing standardized tests
Advantages
- More detailed measurements!
o Time
▪ Initiation, inspection, time per item
o Drawing / writing
▪ Starting point, detecting e.g. neglect
▪ Clustering
▪ You can mark where they start and how they
proceed. How does someone approach the test
▪ The build-up is sometimes more informative than the end result
▪ Rey complex figure test
• Visuospatial detail and information processing
• Informative where someone starts and how someone clusters
• Easier scoring if the test is made digital, scoring is not manual
anymore, so less mistakes are made
- We can tailor to specific needs
o Ease of use
▪ A lot of investment from companies for user interface
o Adjust to certain handicaps
- Reduction of human errors
- Mimicking everyday situations
o Measuring every functioning!
▪ It is weird to remember letters or words without context
▪ This is not how it goes in daily life. Someone experiences problems in daily
life!
- Remote and portable testing
Disadvantages
- Norm data is not directly transferable
o Validity and reliability need to be proven!
- Not all digital tests are represent for the original test
o Digital environment may rely on different processes
- Technical requirements
o Not all software is allowed everywhere (secured hospitals)
o People using it need to be trained
- Cybersickness: motion sickness in virtual environments
o Resolution is getting better and it is possible to adjust the settings to be less
cybersick
o Motion and perception need to be perfectly synced!
- It is new! Adjustment time is needed!
- Privacy issues with data storage
Summary made by: Sacha Gevers 2024 You can do this <3
, Virtual input in the real world
- Studying input in the real world (university building)
- Route with 10 turns, and 6 objects
o Reality: They needed to take pictures of the
objects they see
o VR: similar route with 10 turns and 6 objects
o Hybrid: real route and tablet for navigation
➔ Locomotion! How does the lack of locomotion affect
performance?
o Depending on the task!
o Memorize every object.
o Landmark knowledge was unaffected
▪ They all remembered the objects
o Locomotion is benefiting metric processing
▪ Sense of direction and mental map
▪ Memory for route order, what do they see first?
➔ We use our body to process space
o Careful with using virtual reality! It works, but if you are interesting in how people
use metrics in spatial environments, it doesn’t give an answer.
Treatment
Treatment tools are less developed than diagnostic tools. In rehabilitation the focus is on emotional
and physical rehabilitation. Less for cognitive rehabilitation
- Cognitive rehabilitation: in Nijmegen and in Leiden
o Is developing!
- Well studied tools focus mostly on physical therapy, and less on cognitive therapy
How do you perceive ecological validity?
- If you know what you do, is it necessary to have really realistic tests to measure memory?
o Tests are designed to test different elements of memory! This is less in realistic tests.
Ecological validity = addressing activities in natural context
- Measure goal attainment, rather than improved
cognitive function
- Health condition affects body function and
structures, activities and participation.
- Environmental- and personal factors affect these
body function and structures, activities and
participation.
o Main aim is to increase participation. Then
we can look how we can achieve that!
o Different per case
Compensation
- Function is lost/reduced → use another function to reach the same goal!
- Other function (stronger function) reduces impairment
o E.g. changing cognitive strategy
- Situations can be presented in which alternative strategy is stimulated.
- Improve a reduced function! But realise that people experiencing brain injuries, all attention
go to medical treatments. Then to rehabilitation settings to find out what is damaged.
o In early period it is possible to improve a reduced function
o After a few weeks, no improvements are expected anymore. But in the first week,
the main attention is on medical treatments, less on cognitive.
Summary made by: Sacha Gevers 2024 You can do this <3
Lecture 1: Introduction .......................................................................................................................2
Lecture 2: Cognitive training and rehabilitation ...................................................................................6
Lecture 3: Innovations in motor rehabilitation .................................................................................. 13
Lecture 4: Memory and Attention ..................................................................................................... 19
Lecture 5: Screening and monitoring cognitive decline in MS ............................................................ 30
Lecture 6: Visuospatial cognition: VR and serious gaming ................................................................. 36
Lecture 7: Social cognition ................................................................................................................ 45
Practice questions............................................................................................................................. 54
Summary made by: Sacha Gevers 2024 You can do this <3
, Lecture 1: Introduction
(Technological) innovations are increasingly becoming more important!
There are a lot of brain gaming exercises! Already Nintendo games, apps, Dr. Kawashima’s brain
training.
- They don’t do nothing! But it is important to understand what they do!
- People think these little games will work to ‘get their memory better’
- The memory for example will get only better for this specific game, so the generalization is
limited.
“We find extensive evidence that brain-training interventions improve performance on the trained
tasks, less evidence that such interventions improve performance on closely related tasks, and little
evidence that training enhances performance on distantly related tasks or that training proves
everyday cognitive performance’
Daily life solutions
What we used to do on paper, we now do on a phone!
Technology development went really rapid
- 80’s: basic computers
➔ Passive becomes active becomes interactive!
- For medical studies, they are already using holograms to learn about anatomy
o VR is also used to learn procedures like echography
- Geology students are learning about waterflow and geology maps by augmented reality that
adapts to sand.
➔ Especially students who are bad at mental rotation tasks benefit most from these
visuospatial learning methods
Now VR is mostly used for motor rehabilitation, but cognitive rehabilitation is upcoming!
Metrisquare: build software platforms where you can digitize existing diagnostic materials.
In Neuropsychology there is a bit of a resistance against the technological revolution.
- Norm data is based on pen and paper administration instead of digital administration
- In digital you might get more information about responses
Why should we innovate?
- Technical development
o It is available, so let’s use it!
o Who knows what it can do!
- Scientific motivation
o Digital versions can give more information about timing or processing speed.
o You will get more data!
- Less limitation than existing materials
o Papers can get lost!
Summary made by: Sacha Gevers 2024 You can do this <3
,Categories
Diagnostic tools
Computer based assessment of a condition is already used for quite some time
- Origin in the military and in sports! Here was money so it was worth to invest in computer
based tools
- Used to measure damage and concussion in military and sports
Clinical practice
- Creating digital versions of existing standardized tests
Advantages
- More detailed measurements!
o Time
▪ Initiation, inspection, time per item
o Drawing / writing
▪ Starting point, detecting e.g. neglect
▪ Clustering
▪ You can mark where they start and how they
proceed. How does someone approach the test
▪ The build-up is sometimes more informative than the end result
▪ Rey complex figure test
• Visuospatial detail and information processing
• Informative where someone starts and how someone clusters
• Easier scoring if the test is made digital, scoring is not manual
anymore, so less mistakes are made
- We can tailor to specific needs
o Ease of use
▪ A lot of investment from companies for user interface
o Adjust to certain handicaps
- Reduction of human errors
- Mimicking everyday situations
o Measuring every functioning!
▪ It is weird to remember letters or words without context
▪ This is not how it goes in daily life. Someone experiences problems in daily
life!
- Remote and portable testing
Disadvantages
- Norm data is not directly transferable
o Validity and reliability need to be proven!
- Not all digital tests are represent for the original test
o Digital environment may rely on different processes
- Technical requirements
o Not all software is allowed everywhere (secured hospitals)
o People using it need to be trained
- Cybersickness: motion sickness in virtual environments
o Resolution is getting better and it is possible to adjust the settings to be less
cybersick
o Motion and perception need to be perfectly synced!
- It is new! Adjustment time is needed!
- Privacy issues with data storage
Summary made by: Sacha Gevers 2024 You can do this <3
, Virtual input in the real world
- Studying input in the real world (university building)
- Route with 10 turns, and 6 objects
o Reality: They needed to take pictures of the
objects they see
o VR: similar route with 10 turns and 6 objects
o Hybrid: real route and tablet for navigation
➔ Locomotion! How does the lack of locomotion affect
performance?
o Depending on the task!
o Memorize every object.
o Landmark knowledge was unaffected
▪ They all remembered the objects
o Locomotion is benefiting metric processing
▪ Sense of direction and mental map
▪ Memory for route order, what do they see first?
➔ We use our body to process space
o Careful with using virtual reality! It works, but if you are interesting in how people
use metrics in spatial environments, it doesn’t give an answer.
Treatment
Treatment tools are less developed than diagnostic tools. In rehabilitation the focus is on emotional
and physical rehabilitation. Less for cognitive rehabilitation
- Cognitive rehabilitation: in Nijmegen and in Leiden
o Is developing!
- Well studied tools focus mostly on physical therapy, and less on cognitive therapy
How do you perceive ecological validity?
- If you know what you do, is it necessary to have really realistic tests to measure memory?
o Tests are designed to test different elements of memory! This is less in realistic tests.
Ecological validity = addressing activities in natural context
- Measure goal attainment, rather than improved
cognitive function
- Health condition affects body function and
structures, activities and participation.
- Environmental- and personal factors affect these
body function and structures, activities and
participation.
o Main aim is to increase participation. Then
we can look how we can achieve that!
o Different per case
Compensation
- Function is lost/reduced → use another function to reach the same goal!
- Other function (stronger function) reduces impairment
o E.g. changing cognitive strategy
- Situations can be presented in which alternative strategy is stimulated.
- Improve a reduced function! But realise that people experiencing brain injuries, all attention
go to medical treatments. Then to rehabilitation settings to find out what is damaged.
o In early period it is possible to improve a reduced function
o After a few weeks, no improvements are expected anymore. But in the first week,
the main attention is on medical treatments, less on cognitive.
Summary made by: Sacha Gevers 2024 You can do this <3
