Cognitive remediation therapy - implementation and translation into clinical practice in rural and metropolitan New South Wales mental health services.

OBJECTIVE: Cognitive Remediation Therapy (CRT) is an effective intervention in managing the significant cognitive deficits experienced by those living with psychosis. Given its strong evidence base CRT is recommended in Australian and international guidelines for rehabilitation of people with psychosis, however, access to CRT remains limited. In this commentary, we describe recent efforts to implement CRT programs within NSW mental health services. Development of CRT delivery has been successfully achieved in both rural and metropolitan settings, utilising both face-to-face and telehealth methods. CONCLUSIONS: The delivery of CRT in public mental health services is feasible and adaptable to diverse settings. We strongly advocate for sustainable implementation of CRT into routine clinical practice. This will require policy and practice change to enable resources for CRT training and delivery to become embedded in the roles of the clinical workforce.

Valoración de un programa de formación de cuidadores sobre la capacidad cognitiva de personas con demencia / Assessment of a caregiver training program on the cognitive capacity of people with dementia

Objetivos: El incremento de la población mayor ha hecho que se eleve el porcentaje de personas con demencia que requieren una atención especializada dirigida a mantener o retrasar su declive cognitivo y físico. El objetivo de esta investigación ha sido analizar si un grupo de personas con demencia mejoran cognitivamente al ser atendidos por cuidadores profesionales que han sido formados en un módulo de estimulación cognitiva del programa CUIDA-2 siguiendo los principios de la atención centrada en la persona. Metodología: La muestra estuvo formada por 47 personas con demencia (divididas en grupo tratamiento y grupo control) y 5 cuidadores formales de un centro de día de personas con demencia de Granada. El grupo tratamiento de personas mayores fue atendido durante 3 meses por cuidadores que recibieron el programa de formación. Todos los participantes fueron evaluados antes y después de la intervención con diversas pruebas de evaluación cognitiva. Resultados: Las personas con demencia que fueron atendidas por los cuidadores formados en el programa mantuvieron o mejoraron sus puntuaciones en todas las pruebas analizadas, si bien estas mejoras solo fueron significativas en diversas subescalas de los test empleados. Conclusiones: Se ha comprobado que el programa de formación de cuidadores aquí analizado produce un efecto positivo para las personas con demencia, ya que ayuda a mejorar y mantener sus funciones cognitivas. Esta investigación abre nuevas líneas de trabajo en el ámbito de la intervención cognitiva en personas con demencia que pueden ser de gran utilidad cuando se trabaje con esta población (AU)

Objectives: The increase in the elderly population has led to a rise in the percentage of people with dementia who require specialized attention aimed at maintaining or delaying their cognitive and physical decline. The aim of this research was to analyze whether a group of adults with dementia improve cognitively when being attended by professional caregivers who were trained in a cognitive stimulation module of the CUIDA-2 program following the principles of the person-centered-care model. Methodology: The sample consisted on 47 people with dementia (divided into treatment group and control group) and 5 professional caregivers of a day center for people with dementia in Granada. The older people treatment group was treated for three months by caregivers who received the training program. All participants were assessed before and after the intervention with various cognitive assessment tests. Results: People with dementia who were treated by caregivers trained in the program maintained or improved their scores in all the tests analyzed, although these improvements were only significant in various subtest. Conclusions: The caregiver training program produced a positive effect in the adults with dementia, as it helps to improve and maintain their cognitive functions. This research opens new lines of work in the field of cognitive intervention in people with dementia that can be very useful when working with this population (AU)

Effects of virtual reality-based cognitive training in older adults living without and with mild dementia: a pretest-posttest design pilot study.

OBJECTIVE: Modern technologies are increasingly used in the development of cognitive interventions for older adults. Research into possible applications of virtual reality in such interventions has begun only recently. The aim of present study was to evaluate the effects of 8 sessions of VR-based cognitive training using the GRADYS game in healthy older adults (n = 72; aged 60-88) and older adults living with mild dementia (n = 27; aged 60-89). RESULTS: Older adults with mild dementia demonstrated worse baseline cognitive performance than participants without dementia. Both groups showed progress in training, which was greater in healthy older adults. There were also significant differences in cognitive functioning before and after the training. However, positive changes were revealed almost exclusively in the group of older adults without dementia. Based on the findings, we can recommend the GRADYS game for cognitive enhancement and as a possible counter-measure for cognitive decline experienced in normal cognitive ageing. Our results provide also support for the usefulness of VR technology in cognitive interventions in older adults. The use of the GRADYS game in persons living with dementia, however, would require several of the hardware and software modifications. Trial registration ISRCTN17613444, date of registration: 10.09.2019. Retrospectively registered.

Implementing cognitive remediation and social cognitive interaction training into standard psychosis care.

BACKGROUND: To evaluate the planned implementation of group based Cognitive Remediation therapy (CR) and Social Cognitive Interaction Training (SCIT) into routine psychosis care in a mental health service in Australia. METHOD: The study was conducted over 3 years in a mental health service in a metropolitan city in Australia. Participants were 22 program facilitators and 128 patients attending the programs. Implementation outcomes were assessed using administrative data, staff surveys and program audits. RESULTS: There was fidelity to the particular therapies at a program level. Programs were assessed as being feasible within the study setting with each hospital district developing a capacity to run CR and SCIT. The establishment of new programs improved the reach, but waiting lists indicate a need to expand capacity. There was a relatively high dropout and several factors impacted on completion of the programs - notably, acute exacerbation of psychosis. Once initiated the therapies were acceptable with no-one ceasing SCIT due to loss of interest and only 10% of participants ceasing CR due to loss of interest. Annual audits of programs found programs established were maintained and facilitators were retained. CONCLUSION: SCIT and CR programs were successfully implemented in three hospital districts. Several factors impeded participants receiving the recommended "dose" of the programs. The maintenance of the programs in the short term is encouraging in regards to organisational fit. Dissemination of cognitive rehabilitation programs to a service population takes planning. An implementation plan is essential for guiding development and maintenance of programs. These therapies are best suited to people in a stable phase of illness. Service user co-production is recommended to improve recruitment in future studies.

La intervención en habilidades narrativas en alumnado con dificultades del lenguaje. Una oportunidad para el trabajo colaborativo entre logopedas, profesorado y familias / The intervention in narrative skills in students with language difficulties. An opportunity for collaborative work between speech therapists, teachers and families

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El papel de la formación cognitiva en la endourología: un ensayo controlado aleatorizado / The role of cognitive training in endourology: a randomised controlled trial

Introducción: La formación cognitiva es una modalidad de formación importante que permite al usuario ensayar un procedimiento sin realizarlo físicamente. Esto ha llevado a intereses recientes a incorporar la formación cognitiva en la educación quirúrgica, pero la investigación actualmente es limitada. El uso de la formación cognitiva en cirugía no es claro, por lo que este estudio tuvo como objetivo determinar si, en relación con una condición de control, el uso de la formación cognitiva mejora las habilidades quirúrgicas técnicas en un simulador de ureteroscopia y, si es así, si un método de formación cognitiva es superior. Métodos: Este estudio prospectivo y comparativo reclutó a 59 estudiantes de medicina y los asignó al azar a uno de los 3 grupos: formación de simulación de control solamente (n = 20), grupo de formación cognitiva de tarjetas educativas (n = 20) o grupo de formación cognitiva de imágenes mentales (n = 19). Todos los participantes completaron 3 tareas al inicio en el simulador URO Mentor, seguidas de la intervención cognitiva si se asignaron al azar para recibirla. Los participantes regresaron para realizar una tarea de evaluación en el simulador. Las medidas de resultado del informe de ejecución URO Mentor se usaron para el análisis y se realizó una encuesta cuantitativa a todos los participantes para evaluar la utilidad de la formación recibida. Resultados. Este estudio mostró que la formación cognitiva tiene efectos mínimos en las habilidades técnicas de los participantes. El grupo de imágenes mentales tuvo menos fallos de láser en la tarea de evaluación en comparación tanto con el grupo control como con el de tarjetas educativas (p = 0,017, p = 0,036, respectivamente). El grupo de tarjetas educativas calificó su preparación para ser más útil en comparación con el control (p = 0,0125). Otros parámetros analizados entre los grupos no alcanzaron significación estadística. Se descubrió que la formación cognitiva era factible y rentable cuando se llevaba a cabo además de la formación de simulación. Conclusión: Este estudio ha demostrado que el papel de la formación cognitiva en la adquisición de habilidades quirúrgicas es mínimo y que ninguna forma de entrenamiento cognitivo fue superior a otra. Se necesita investigar más para evaluar otras formas de realizar entrenamiento cognitivo

Introduction: Cognitive training is an important training modality which allows the user to rehearse a procedure without physically carrying it out. This has led to recent interests to incorporate cognitive training within surgical education but research is currently limited. The use of cognitive training in surgery is not clear-cut and so this study aimed to determine whether, relative to a control condition, the use of cognitive training improves technical surgical skills on a ureteroscopy simulator, and if so whether one cognitive training method is superior. Methods: This prospective, comparative study recruited 59 medical students and randomised them to one of three groups: control- simulation training only (n = 20), flashcards cognitive training group (n = 20) or mental imagery cognitive training group (n = 19). All participants completed three tasks at baseline on the URO Mentor simulator followed by the cognitive intervention if randomised to receive it. Participants then returned to perform an assessment task on the simulator. Outcome measures from the URO Mentor performance report was used for analysis and a quantitative survey was given to all participants to assess usefulness of training received. Results: This study showed cognitive training to have minimal effects on technical skills of participants. The mental imagery group had fewer laser misfires in the assessment task when compared to both control and flashcards group (P = .017, P = .036, respectively). The flashcards group rated their preparation to be most useful when compared to control (P = .0125). Other parameters analysed between the groups did not reach statistical significance. Cognitive training was found to be feasible and cost effective when carried out in addition to simulation training. Conclusion: This study has shown that the role of cognitive training within acquisition of surgical skills is minimal and that no form of cognitive training was superior to another. Further research needs to be done to evaluate other ways of performing cognitive training

[Cognitive remediation and nursing care]. / Remédiation cognitive et prise en charge infirmière.

Therapies based on cognitive remediation integrate psychiatric care. Cognitive remediation helps to ease cognitive disorders and enable patients to improve their day-to-day lives. It is essential to complete nurses' training in this field. This article presents the example of a patient with schizophrenia who followed the Cognitive Remediation Therapy programme, enabling him to access mainstream employment.

Implementing cognitive remediation therapy (CRT) in a mental health service: staff training.

OBJECTIVE: This paper describes the establishment of training in cognitive remediation for psychosis within a community mental health service. METHODS: Clinical staff working in the community of a mental health service were surveyed to ascertain their interest in cognitive aspects of psychosis and skills training in cognitive remediation (CR). Based on the results of the survey a tiered training programme was established with attendance figures reported for each level of training. Fidelity assessment was conducted on the five CR programmes operating. RESULTS: Of 106 clinical staff working in the community with people diagnosed with a psychotic illness 51 completed the survey (48% response rate). The training needs varied with all 106 staff receiving the fundamental (mandatory) training and 51 staff receiving CR facilitator training. Thirty three percent of staff trained as facilitators were delivering CR. CONCLUSIONS: Up skilling the mental health workforce to incorporate an understanding of the cognitive aspects of psychosis into care delivery can be facilitated by a tiered training structure. Fundamental training on the psychosocial aspects of psychosis can act as a platform for focussed CR skills based training. There is also a need for accessible therapy based supervision for staff wishing to develop competencies as CR therapists.