Special issue on technology and neuropsychological rehabilitation: Overview and reflections on ways to conduct future studies and support clinical practice.

In this editorial, we wish to highlight and reflect on research advances presented in the articles comprising this special issue on technology and neuropsychological rehabilitation, which happens to be published more than a decade after the first special issue on the subject. In 2004, the journal recognised the great potential of information technology for increasing the support provided to people with cognitive deficits, and published emerging state-of-the art practices in the field. Since that time, research and technology have made tremendous progress, and the influence of information technology on research methods has transformed the field of neurorehabilitation. The aim of this editorial is thus to shed light on methodological and conceptual issues requiring further attention from researchers and clinicians in the fields of neuropsychological rehabilitation and technology, and to stimulate debate on promising avenues in clinical research.

Use of a mobile device in mental health rehabilitation: A clinical and comprehensive analysis of 11 cases.

This study aimed to test the feasibility of using a mobile device (Apple technology: iPodTouch®, iPhone® or iPad®) among people with severe mental illness (SMI) in a rehabilitation and recovery process and to document the parameters to be taken into account and the issues involved in implementing this technology in living environments and mental health care settings. A qualitative multiple case study design and multiple data sources were used to understand each case in depth. A clinical and comprehensive analysis of 11 cases was conducted with exploratory and descriptive aims (and the beginnings of explanation building). The multiple-case analysis brought out four typical profiles to illustrate the extent of integration of a personal digital assistant (PDA) as a tool to support mental health rehabilitation and recovery. Each profile highlights four categories of variables identified as determining factors in this process: (1) state of health and related difficulties (cognitive or functional); (2) relationship between comfort level with technology, motivation and personal effort deployed; (3) relationship between support required and support received; and (4) the living environment and follow-up context. This study allowed us to consider the contexts and conditions to be put in place for the successful integration of mobile technology in a mental health rehabilitation and recovery process.

A randomized controlled trial with a Canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia.

OBJECTIVE: Medication adherence is extremely important in preventing relapse and lowering symptoms in schizophrenic patients. However, estimates show that nearly half of these patients have poor adherence. The Brief Adherence Rating Scale (BARS) seems to be the most reliable tool assessing adherence in schizophrenia and shows that the antipsychotic adherence ratio (AAR) is about 49.5% in schizophrenia. The aim of the study was to test if an electronic pill dispenser named DoPill(®) improved AAR of schizophrenic patients. Furthermore, we compared AAR obtained by the DoPill(®) and the BARS, in order to verify whether the DoPill(®) provides reliable assessment of medication adherence. METHODS: The DoPill(®) is a smart pill dispenser that beeps and flashes at the appropriate time of the day. Each of its 28 compartments is covered by a plastic lamina that, when taken off, sends a signal to the pharmacist. Patients were randomized to the DoPill(®) or treatment as usual groups for 6 weeks. The BARS was used as a reference measure. RESULTS: Forty-six percent of patients were deemed to be non-adherent with antipsychotic medication. The mean AAR was 67% after 6 weeks. DoPill(®) recorded better AAR than some of those found in the literature and were lower than the BARS estimate we found. CONCLUSION: These results suggest that DoPill(®) is a valid tool that provides more reliable and objective data for the clinician about their patient's adherence, than existing assessment tools like the BARS. Furthermore, the device may help patients successfully manage their medication regimen.

Ecological assessments of activities of daily living and personal experiences with Mobus, an assistive technology for cognition: a pilot study in schizophrenia.

Mobus is a cognitive orthotic designed for people with difficulties managing Activities of Daily Living (ADL), as encountered in schizophrenia. It provides a schedule manager as well as the possibility to report occurrences of symptomatic experiences. Receiving this information by Internet, caregivers can assist the patient rehabilitation process. Our aim was to explore the use and satisfaction of Mobus by people with schizophrenia. Nine outpatients tested Mobus for 6 weeks. Indicators of cognitive functioning and autonomy were measured with the CAmbridge Neuropsychological Tests Automated Battery (CANTAB) and the Independant Living Skills Scale (ILSS). On average, 42.6% of the planned ADL were validated and more than 1 symptom per week were reported. Mainly because of technical breakdown, more than 50% of the outpatients evaluated the Mobus satisfaction below 1.7/5, nevertheless 3 participants appreciated it greatly. Some enhancements were found on subscales of CANTAB and ILSS and some participants reported that they acquired planning skills by using Mobus. To ensure ease of use, refinements are needed from rehabilitation and technical approaches, especially to personalize the device. Discussions on ethical and methodological issues lead to an improved version of Mobus that will be tested with a larger sample size.

[Alzheimer's disease and geolocation: initial results of the Estima study]. / Maladie d'Alzheimer et géolocalisation: premiers résultats de l'etude Estima.

Geolocation devices for patients suffering from Alzheimer's disease constitute an improvement in their care. However, this system arouses debate. The Estima study offers a series of results and recommendations concerning the use of these devices. It consists of three complementary sections: a sociological study, an observational retrospective study and an ethical analysis.

Computerized assessment of cognition in schizophrenia: promises and pitfalls of CANTAB.

OBJECTIVE: Over the last decade, the Cambridge Neuropsychological Test Automated Battery (CANTAB), which comprises visuo-spatial tasks, has been utilized in cognitive studies of schizophrenia. A clear approach concerning the usage of CANTAB for the appraisal of neurocognitive dysfunction in schizophrenia is currently lacking. METHOD: In this paper, we have first reviewed the overall applications of CANTAB and then evaluated methodological strengths and weaknesses of CANTAB as a neurocognitive battery for schizophrenia. We carried out a systematic search and assessment of studies where CANTAB was utilized to measure cognitive function in schizophrenia. We have also attempted to quantify the available data and perform a meta-analysis, but this approach turned out to be still premature. RESULTS: CANTAB has enabled researchers to highlight significant deficits affecting broad cognitive domains in schizophrenia, such as working memory, decision-making, attention, executive functions and visual memory. So far, the most consistent deficit observed with CANTAB testing has been attentional set-shifting, suggestive of fronto-striatal dysfunctions. In addition, preliminary evidence points towards the potential use of CANTAB to identify cognitive predictors of psychosocial functioning, to describe the relationships between symptoms and cognition, and to measure the impact of pharmacological agents on cognitive functioning. CONCLUSION: CANTAB has been used successfully to highlight the range of visuo-spatial cognitive deficits in schizophrenia, producing similar results to those obtained with some traditional neuropsychological tests. Further studies validating the use of CANTAB following the standard set by Measurement And Treatment Research to Improve Cognition in Schizophrenia (MATRICS) are warranted.

[Kitchen and schizophrenia: a crossroad activity of an ecological, occupational and neuropsychological assessment]. / Cuisine et schizophrénie: activité carrefour d'une évaluation écologique, ergothérapique et neuropsychologique.

In this exploratory study, the authors examine the various occupational and neuropsychological assessments used to analyze deficits qualitatively and quantitatively in patients with schizophrenia. Considering that it is necessary to further explore their repercussion on the performance of activity of daily living (ADL) and domestic activities (DA), they thus attempt to verify if the distinction between two levels of functional autonomy could translate at the cognitive and clinical levels in (25) 23 patients included in a program destined to young adults (schizophrenia spectrum DSM-IV criteria) in Montréal. These patients had the opportunity, within the clinical program, to submit to neuropsychological evaluations as well as evaluations offered by the occupational therapy service thanks to a tool frequently used by occupational therapists entitled Assessment of Motor and Process Skills (AMPS). The objective of this article is to conjugate two possible perspectives, drawn from two different disciplines, on a very current human activity such as "preparing meals" in people suffering from schizophrenia and which functioning of daily life is disturbed.