title: A rehabilitation tool designed for intensive web-based cognitive training: description and usability study.
abstract: BACKGROUND
  Cognitive deficits are among the most disabling of neurological diseases and have a serious impact on the quality of life of patients and families. Cognitive training has been proven successful in improving or compensating for neuropsychological deficits after acute brain injury, but its efficacy highly depends on the intensity of treatment over an extended period of time. Therefore, cognitive training indicates expensive human resources and renders the rehabilitation process vulnerable to physical and economic barriers for the majority of patients.
  
  
  OBJECTIVE
  The aim of this study was to develop and test a new Web-based rehabilitation tool that provides intensive cognitive training at home under clinical prescription and monitoring, at affordable costs.
  
  
  METHODS
  From a pool of 60 original exercises, designed and used over the past 10 years for cognitive training at our center, we developed 27 exercises on a computer game format, with automatic increase or decrease of difficulty levels. These exercises were assembled in a clean, user-friendly design and covered various cognitive domains such as attention (n=4), memory (n=11), language (n=3), calculus (n=3), praxis (n=2), and executive functions (n=3). A Web 2.0 platform was also designed to provide medical prescription of cognitive training sessions, performed at the patient's home. These sessions included continuous monitoring of compliance, performance, and evolution; algorithms for automatic adjustment and long-term learning through use, and database recording of all activities. The end-user interaction test included 80 patients from our memory clinic from several groups including subjective memory complaints (n=20), traumatic brain injury (n=20), stroke and other static brain lesions (n=20), and mild Alzheimer's disease (n=20). During a 1-hour session, patients and their relatives were taught to use the system and allowed to practice using it. At the end of the session, they were asked to complete a questionnaire.
  
  
  RESULTS
  A total of 48/80 patients (60%) attended the training session. The mean age of the patients was 60 years (SD 13.3, range 41-78), and the mean level of formal education was 6 years (range 4-16). Of all the participants, 32/48 patients (66%) have previously used a computer. All patients and their relatives made a positive evaluation of the cognitive training tool. Only 2/48 patients (4%) were not interested in performing the exercises at home; 19/48 patients (39%) mentioned the need for further coaching from a relative or health care professional. The patients who mentioned difficulties in performing the exercises have not used the computer earlier.
  
  
  CONCLUSIONS
  This new Web-based system was very well accepted by patients and their relatives, who showed high levels of motivation to use it on a daily basis at home. The simplicity of its use and comfort were especially outlined. This tool will have an important effect on human resource management, in increasing the patient access to specialized health care and improving the quality and national health system costs of rehabilitation programs.
authors: Neurology Department, Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal. vitor.cruz@chedv.min-saude.pt.
authors: Vítor Tedim
authors: 0000-0002-5333-4771
authors: VT
authors: Cruz
authors: Joana
authors: 0000-0002-6591-3578
authors: J
authors: Pais
authors: Virgílio
authors: 0000-0001-6025-8511
authors: V
authors: Bento
authors: Cátia
authors: 0000-0003-2708-8826
authors: C
authors: Mateus
authors: Márcio
authors: 0000-0002-8332-8487
authors: M
authors: Colunas
authors: Ivânia
authors: 0000-0002-5622-4631
authors: I
authors: Alves
authors: Paula
authors: 0000-0002-3461-230X
authors: P
authors: Coutinho
authors: Nelson Pacheco
authors: NP
authors: Rocha
keywords: Web-based applications; cognitive deficits; cognitive training; eHealth systems; neurorehabilitation; usability test