Training programs using computers

The use of computers in training / rehabilitation for cognitive functioning has a relatively long history starting with the development of programs for people with brain damage. These programs improve the execution of tasks that they practice but there is little evidence on their capacity for generalization. Programs mainly focus on attention skills rather than problem-solving ones. Computer programs do appear to have advantages over methods using pencil and paper, such as, for example, they allow the degree of difficulty to be systematically changed on an individual basis: they give immediate feedback; they allow the use of various reinforcement methods and there is monitoring of the learning process. However there are also drawbacks for patients with schizophrenia because there is little or no social interaction when the program is administered on an individual basis. Rehabilitation programs using computers include the following. Gradior, is a cognitive training system designed by the INTRAS foundation(Research and Treatment in Mental Health and Services) (Franco, Orihuela, Bueno, & Cid, 2000). The program allows direct interaction between the user and the computer,which manages the evaluation and the neurocognitive training in accordance with some parameters previously established by the therapist. It is aimed at people with brain injuries, dementia, neuropsychiatric disorders with brain damage and mental illness or retardation. It aims to rehabilitate functions such as attention, perception, memory, orientation, calculation and language. So far we have been unable to find any published studies on the effectiveness of this program. RehaCom (Schuhfried, 1996) is a computer program consisting of different modules with different levels of difficulty and with a sufficient number of options to ensure that a patient is only working with skills that at that moment are relevant to him/her. Additionally it gives specific feedback to detect errors and develop strategies. Some of its modules are: attention and concentration, divided attention, working memory, spatial operations, logical thinking, visuomotor / visuoconstructive abilities, etc. This program has shown positive results in cognitive functions, in the ability to solve interpersonal problems, in autonomy and symptoms (Cochet et al., 2006). The Neuropsychological Educational Approach to Rehabilitation (NEAR) was created by Medalia, Revheim and Herlands (2002) and is based on training techniques that are intrinsically motivating, developed within educational psychology and designed to make the tasks enjoyable and compelling. Training includes participating in cognitive exercises with a computer where various cognitive skills are embedded in a contextualized format. This program has demonstrated good results when it has been applied (Choi&Medalia, 2005; Medalia & Lim, 2004; Medalia & Richardson, 2005). On the whole, it could be said that in spite of the advantages of computer based cognitive training programs, such as the fact that the level of exercise difficulty can be adjusted to suit patient performance, this method of working has its limitations. The fact that patients administer the treatment themselves, that they work individually, means that they cannot benefit from the “social” component that is afforded by working in groups. It is also important to note that few studies exist demonstrating their effectiveness and the effect on a patient’s overall functioning