Innovations in Clinical Neuropsychology (6464CN08Y)
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Extensive lecture summary Innovations in Clinical neuropsychology
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Course
Innovations in Clinical Neuropsychology (6464CN08Y)
Institution
Universiteit Leiden (UL)
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Innovations in Clinical Neuropsychology (6464CN08Y)
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Technology and the brain:
- Brain games such as sudoku or Nintendo games only train you to be better at that game and don’t
train your entire brain.
- These games are not scientifically based:
*“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
improves everyday cognitive performance.”
- If we train something, the outcome will only be positive for that area in the brain that is trained
Daily life solutions:
- Things that we used to do on paper are now digital (phones)
- Trackers (for your keys)
- More advanced solutions: refrigerator that makes your shopping list
*Brain structures are changing because of the amount of support we get externally nowadays.
Maybe we should reduce the amount of support to stimulate the brain.
Technology and learning:
- It can be very helpful, especially when this information is 3 dimensional → visual learning
*It can be a tool to reduce diversity in cognitive skills (het kan een ondersteuning zijn voor
mensen die slechter zijn in een bepaald cognitief domein om ze zo toch even goed te laten presteren
als de anderen die er geen moeite mee hebben)
- Some 3d technologies can reduce the gaps between male/female stereotypes (in the sense of
learning predispositions).
- You can visually present cases that you otherwise will not stumble upon on during theoretical
learning.
- Physical learning can also be stimulated/enhanced through technology
Neuropsychology:
- Digital diagnostic solutions
*Allows neuropsychologists to create their own diagnostical tools
*Provide data advantages
Why should we innovate?
- What’s wrong with the way we do things now?
*The world is changing, so lets see how it can help us
*It can help to create a lot more detailed conclusions
Different categories where we can use digital tools:
1. Diagnostics:
*It started with computer based assessment of cognition
- In the military (these were the first developments)
- In Sports
*To evaluate the course of concussion
- Clinical practice
*Digital version of existing standardized material
*Advantages:
1. More detailed measurements
, 2. Time (Initiation/inspection/time per item)
3. Drawing/writing (Staring point, detecting e.g. neglect, clustering)
- Initiation took 2.2s.
- It took 2.4s to go
from 1 to A\
- Etc.
4. Tailoring to specific needs
5. Ease of use
6. Reducing human error
7. Mimicking everyday situations (measuring every functioning)
8. Remote (online) and portable testing
*Disadvantages:
1. Normdata not directly transferable
2. Validity and reliability need to be proven
* Because the new setting may affect the normscores.
Therefor the old normdata may not be applicable.
*Design decisions also may affect cognitive outcomes
3. Technical requirements
4. Training of clinicians
5. Digital environment may rely on different processes
*Privacy things/Location?
6. Cybersickness: Nausea when using VR (Especially when older)
7. Novelty, adjustment time needed
*May also affect scores & People may assume that
technology is only for young people
8. Privacy issues with data storage
*Virtual input in the real world (study): Studying input in the real world
- Virtual mazes → I’m testing navigation skills, but is that really what you are doing?
- Findings on the different studies:
1. Learning condition affects performance (real world, hybrid or virtual)
- Depending on task
2. Landmark knowledge unaffected
3. Locomotion (so moving in environment) benefits metric processing
- Sense of direction and mental map
- Memory for route order
2. Treatment:
- Less developed than diagnostic tools
- Rapidly increasing
- Well studied tools focus mostly on physical therapy
- Ecological validity:
*Addressing activities in natural context
*Goal attainment: when giving tasks to a patient we should keep very personal goals of the
patient in mind
, - 2 things we can do:
1. Compensation:
*Function is lost/reduced → use other function
*Other function reduces impairment
- Changing cognitive strategies
*Situations can be presented in which the alternative strategy is stimulated
2. Restoration (alternative of compensation):
*Function is lost/reduced → improve that function
- Memory training
*Relevant situation can be presented that stimulate function use
Ethical considerations for digital treatment tools:
- Real vs virtual → This line is thinning
- Social interaction → We might mistake interactions through a digital form for real social
interactions
- Level of understanding of the patient
3. E-Health:
- Refers to 4 domains:
1. Communication (is changing through e-health):
- Personal contact in other form (instead of calling to the hospital)
- Providing additional information
- Smartphones, online portals
2. Self-management:
- Addition to regular care: Wearables, smartwatch
*Direct link to clinician (send this data to your clinician)
3. Tracking and monitoring:
- Additional information
- Smartphone/wearables
- Data analysis
4. Records:
- Other form of archiving
, - Easier communication (Between clinicians & to patients)
- Privacy issues to consider
4. Brain computer interface:
= Principles:
- Goals are highly varied:
*Wheelchair
*Robot arm
*Cursor an a screen
*Letters/words
*Environmental controls
Spatial cognition is the example used in this lecture to walk you through new developing
technologies. Question: how can VR help?
1. Spatial cognition:
- There are situations in which we really have to think hard about where to go → consciously
attending to spatial cognition:
*Navigating
*Finding objects
*Your own body in space
- How far away are objects from me?
- How far do I need to reach to grab it? Etc.
- There are tools designed when our spatial cognition fails
- Small vs large scale space:
*Performing diagnostics is only focused on small scale space
- Small scale is more action related/motor based
*Large scale space is what goes wrong more often
- So there is a mismatch between diagnostics and the daily life difficulties
- Large scale is much more memory based/cognitive based
*Rodent studies | water maze:
- Circle maze filled with milky water & underneath is a platform
- Rodents hate swimming so they purposely find the platform
- It only takes them 8 trials to find the platform
- This study taught us a lot about spatial cognition
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