Extensive summary of the lectures of the mandatory course Innovations in Clinical Neuropsychology. This summary includes all the figures, tables and images that were used to illustrate the content of the lectures.
Technology and the brain
There are many apps, games (e.g., Nintendo games) and websites that claim to enhance brain function.
However, many of these are not scientifically proven to be helpful.
Daily life solutions using technology
For example, an agenda in your phone with notifications instead of on paper, an app and keychain to
help you find your car keys and Google Maps to guide you to your destination.
Why should we innovate?
• Technical development is already going on. The technologies are available, so let’s use them.
• Scientific motivation: additional data can be collected, additional features can be added to
current tools.
• Innovative tools might be able to provide less limitations than older tools.
Categories
Diagnostic tools
Computer based assessment of cognition is quite old and was originally used in the military and in
sports (concussions). In the clinical practice, old tools were digitalized so that they could be done on a
computer. Digitalizing old tools has the advantage of providing more detailed measurements (e.g., time
and drawing pattern in the Trail Making Test). Scoring of certain tests is also easier. Other advantages:
• It can be tailored to specific needs
• It is easy to use
• It can reduce of human error (e.g., in coding, scoring and monitoring responses)
• It is possible to mimic everyday situations
• It allows for remote and portable testing
Disadvantages:
• Normdata of paper-and-pencil tests are not directly transferable to computer tests
• Validity and reliability need to be proven
• Technical requirements (when something is in need of specific software)
• It requires some training of clinicians on how to use it
• Cybersickness
• It is often a novel technique, adjustment time is needed. Elderly can get used to it with a few
practice runs.
• Privacy issues with data storage.
• Digital environment may rely on different cognitive processes
o Van der Ham et al., 2015: participants walked a route in real life with 10 turns and 6
objects along the way. This required locomotion. Participants had to walk the same
route virtually and this did not require locomotion. In a hybrid condition (walking
around in a real environment with a tablet with a virtual route), there was locomotion.
Landmark knowledge (how well you can remember landmarks along the route) was
unaffected. Locomotion benefits metric processing (where the objects were placed)
and memory of the order in which the objects were placed along the route.
Treatment tools
Treatment tools are less developed than diagnostic tools. Innovative
treatment tools are mostly in the physical therapy domain.
Ecological validity of a treatment is very important. New techniques are
better at addressing activities in the natural context.
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Some factors in the International
Classification of Functioning (ICF)
model can be improved by novel
techniques.
Compensation: when a function is
lost or reduced, another function or
strategy is used instead. In virtual
situations, these new functions or
strategies can be used by the patient.
When the patient is confident enough
about the function/strategy, he/she
can use it in the real world.
Restoration: when a function is lost or reduced, trying to improve that function (e.g., memory training).
Relevant situations (e.g., doing groceries) can be presented that stimulate the use of the function.
Ethical considerations:
• Real versus virtual situations. It should be made clear what the differences are between the
real and the virtual situation.
• Social interaction: there should be sufficient social interaction with the patient. Often the
virtual techniques are combined with other methods such as face to face sessions or calls.
• Level of understanding of the patient should be good enough.
eHealth
• Communication: contact between patient and caregiver in another form (e.g., online portal,
phone call). Additional information can be easily sent back and forth.
• Self-management: an addition to regular care. It provides the patient with more ways to
monitor own progress. There is a direct link to the clinician. An example: wearables and
smartwatches.
• Tracking and monitoring: serves as a data analysis tool. It is an additional tool. E.g., smartphone
and smartwatch.
• Recordkeeping: a way of keeping track of information, it is another way of archiving. It leads
to better communication. Privacy issues should be considered, very secure systems should be
used and it should be clear what information becomes available to whom, when, where.
Brain Computer Interface
The BCI principle: it shows us the loop involved in brain computer interfacing. One of the assigned
papers covers this principle in more detail.
Goals of BCI:
- Moving a wheelchair/robot arm/cursor on a screen
- Communicate through letters and words
- Control environmental factors.
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Lecture 2 – Visuospatial cognition, VR
and serious gaming
Spatial cognition
The spatial cognition domain is very broad and contains many factors. Spatial cognition is involved in
most of daily life: for example finding your way in a city, finding your car keys and grasping an object.
Neural correlates
Brain area Function
Frontal cortex Memory
Information processing
Visual cortex Perception
Posterior parietal cortex (left) Locations
Attention
Temporal cortex Identification
Recognition
Hippocampus (right) Navigation
Perspective taking
Small vs large scale space
A distinction that we can make in space is the distinction between small scale space and large scale
space. In testing, we generally use small scale space. By small scale space we mean everything that
fits on a table top and that you can interact with without having to move your body (e.g., a rubrics
cube). An example of a large scale space is when you have to walk through a real maze (so not
digitally).
There is a lot of distinction between small and large scale space. There is limited overlap in de
cognitions involved. Problems in large scale hold very little relations to whether they have a small
scale problem.
What is navigation?
There are 3 types of very basic spatial behavior:
1. Route following; finding the shortest route and keep using this. For example: ants find food
and leave trail pheromones to let other ants know the route to the food.
2. Piloting; exploring the environment. Experiment: Morris water maze. A circular pool. Below
the water surface there is a platform. It is an experiment for mice and rats. They will explore
the pool and try to find the platform.
3. Dead reckoning: when you take a left turn and walk a bit further, your body will memorize
your starting point. Your body will calculate the quickest way back to the starting point.
Stages of navigation
Human navigation is quite complex, for we find ourselves in complex situations and we have higher
order brain functioning that plays a role in navigation. Navigation starts with input (spatial cues),
then we process this input (computational mechanisms) and that results in spatial representations of
space.
Spatial cues can be environmental (e.g., landmarks, maps) and self-motion (e.g., vestibular cues,
optic/auditory/tactile flow and proprioceptive feedback). Computational mechanisms consist of
spatial computations that are being made (e.g., computing directions and distances and imagining
shifts in spatial perspective) and of executive processes (e.g., route planning or selection and
handling uncertainty or conflicts). Spatial representations can be online or offline. We use online
representations while in the environment. Offline representations are made up from memories of
your online representations.
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