A research team, coordinated by the Center for Research in Neuropsychology and Cognitive-Behavioral Intervention (CINEICC) of the Faculty of Psychology and Educational Sciences of the University of Coimbra (FPCEUC) and by the NeuroRehabLab of the University of Madeira, tested a cognitive training program computerized, consisting of cognitive and motor activities, in chronic psychiatric patients (with, for example, psychiatric clinical conditions of schizophrenia, depressive and bipolar disorder) residing in long-term hospitalization units.
This computerized cognitive training, called Full-Body Interaction Cognitive Training (FBI-CT), was revealed to have positive impacts on cognitive indicators, such as processing speed, sustained attention for short periods of time, and verbal memory, as well as on non-cognitive indicators, as a decrease in depressive symptoms.
With this study, the team sought to «evaluate the feasibility and acceptability of the program, as well as analyze its impact on cognitive indicators (for example, attention, memory, executive functions) and non-cognitive indicators (such as quality of life, functional capacity and state emotional)», contextualizes Joana Câmara, CINEICC researcher and first author of the study. «To date, there are still few scientific studies that evaluate the impact of interventions combined with a functional focus in the psychiatric population, which is an innovative theme in the process of therapeutic intervention in these clinical conditions», explains the researcher.
According to the National Epidemiological Study of Mental Health, «more than a fifth of Portuguese people (22.9%) have a psychiatric pathology, a number that has certainly been growing since the pandemic», contextualizes Joana Câmara. At the same time, «the scientific literature reveals that the psychiatric population has persistent cognitive deficits that compromise their adherence to therapy, quality of life and functional capacity, and, for this reason, this population tends to be more sedentary than the population in general, being more susceptible to developing cardiovascular and metabolic diseases that aggravate their clinical condition and affect their cognitive functioning», he adds. In this sense, the implementation of interventions with this population, especially those that combine cognitive and motor components, «can help to face the previously mentioned negative consequences and also has the advantage of being more viable in a context of psychiatric hospitalization, where human resources and time to intervene are limited», highlights the researcher.
There were 14 sessions of 30 minutes each, administered three times a week to 18 participants. A part of the group of patients attended the program in a combined intervention format (more dynamic), in which the content of the cognitive training was projected on a wall with the participants solving tasks by performing movements detected by Kinect (motion sensor). The remaining group attended the training program considered more passive, in which participants solved cognitive training tasks on a tablet.
The training was developed using the Musiquence platform, which allows the training to be customized according to the user’s characteristics. The program sessions were organized by different functional themes, with the aim of bringing cognitive training tasks closer to actions that people have to carry out in real life, with a view to training functional skills and promoting involvement and motivation. Topics addressed included functional communication, the use of public transport, cooking meals, going shopping, financial management, and the management of health-related issues.
After participating in the 14 sessions of the program, the participants were followed up after the intervention and also after three months. In the follow-up after the sessions, it was possible to attest to the «feasibility and acceptability of the program, as well as high levels of satisfaction following the intervention», explains Joana Câmara.
The group of patients who attended the combined intervention «showed slightly higher levels of satisfaction, possibly because it implies a more dynamic and multisensory interaction, showing significant improvements in cognitive indicators such as processing speed, sustained attention for short periods of time and verbal memory, and in non-cognitive indicators, such as a decrease in depressive symptoms», highlights the doctoral student at the Faculty of Psychology and Educational Sciences at the University of Coimbra. In the case of the group that attended sessions using a tablet, «they showed significant gains, but only in cognitive indicators, including sustained attention for long periods of time, verbal memory and executive functions», adds J
oana Chamber. In the follow-up that took place three months later, «the participants of both groups were reassessed and it was verified that the first group maintained the gains obtained in verbal memory, as well as the decrease in depressive symptoms», he highlights.
Regarding the impacts of this pilot study, the CINEICC researcher states that «in the future, it would be important to replicate it with a larger sample, which included participants of both sexes, in order to clarify which of these approaches/implementation formats is more effective. ». Regarding the benefits of combined interventions with a focus on the functional component, Joana Câmara adds that «scientific research in healthy groups suggests that interventions that include different approaches to action – including cognitive training, physical activity, nutrition and psychological support – are more effective in promoting cognitive, physical, functional and well-being indicators than all these interventions adopted alone. In this sense, it is urgent to develop and evaluate the effectiveness of this type of intervention in clinical populations with complex intervention needs, such as the psychiatric case, and to try to transfer them from the field of research to clinical practice».
The study also had the participation of Manuela Vilar, professor at the Faculty of Psychology and Educational Sciences at the University of Coimbra and researcher at the Research Center for Neuropsychology and Cognitive-Behavioral Intervention, and Luís Ferreira, Ana Lúcia Faria, and Sergi Bermúdez I Badia, from the NeuroRehabLab at the University of Madeira.
The results of this intervention can be consulted in the scientific article “Feasibility, Acceptability, and Preliminary Impact of Full-Body Interaction on Computerized Cognitive Training Based on Instrumental Activities of Daily Living: A Pilot Randomized Controlled Trial with Chronic Psychiatric Inpatients”, published in the scientific journal Games for Health Journal.
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