Implementation and Outcomes of a Collaborative Multi-Center Network Aimed at Web-Based Cognitive Training – COGWEB Network

Abstract

BackgroundCognitive care for the most prevalent neurologic and psychiatric conditions will only improve through the implementation of new sustainable approaches. Innovative cognitive training methodologies and collaborative professional networks are necessary evolutions in the mental health sector.ObjectiveThe objective of the study was to describe the implementation process and early outcomes of a nationwide multi-organizational network supported on a Web-based cognitive training system (COGWEB).MethodsThe setting for network implementation was the Portuguese mental health system and the hospital-, academic-, community-based institutions and professionals providing cognitive training. The network started in August 2012, with 16 centers, and was monitored until September 2013 (inclusions were open). After onsite training, all were allowed to use COGWEB in their clinical or research activities. For supervision and maintenance were implemented newsletters, questionnaires, visits and webinars. The following outcomes were prospectively measured: (1) number, (2) type, (3) time to start, and (4) activity state of centers; age, gender, level of education, and medical diagnosis of patients enrolled.ResultsThe network included 68 professionals from 41 centers, (33/41) 80% clinical, (8/41) 19% nonclinical. A total of 298 patients received cognitive training; 45.3% (n=135) female, mean age 54.4 years (SD 18.7), mean educational level 9.8 years (SD 4.8). The number enrolled each month increased significantly (r=0.6; P=.031). At 12 months, 205 remained on treatment. The major causes of cognitive impairment were: (1) neurodegenerative (115/298, 38.6%), (2) structural brain lesions (63/298, 21.1%), (3) autoimmune (40/298, 13.4%), (4) schizophrenia (30/298, 10.1%), and (5) others (50/298, 16.8%). The comparison of the patient profiles, promoter versus all other clinical centers, showed significant increases in the diversity of causes and spectrums of ages and education.ConclusionsOver its first year, there was a major increase in the number of new centers and professionals, as well as of the clinical diversity of patients treated. The consolidation of such a national collaborative network represents an innovative step in mental health care evolution. Furthermore, it may contribute to translational processes in the field of cognitive training and reduce disease burden.

CogniViTra, a Digital Solution to Support Dual-Task Rehabilitation Training

“…To respond to the challenges of cognitive rehabilitation, some of the authors of this article were involved in the development of several eHealth applications that, taken together, constitute a Cognitive Health Ecosystem [21,22]. This development started in 2005 in a memory clinic that organized and delivered care to a 400,000 inhabitant population and was anchored in a hospital with clinical and research obligations.…”

“…The key element of the Cognitive Health Ecosystem is a Platform of Services that supports different eHealth applications [21,22] and was based on two important requirements: (i) to increase the productivity and intervention capacity of the professionals and (ii) to move the clinical decision to the community, to ensure increased adherence and quality of the services.…”

“…In strategical terms, Cogweb [21] is the ultimate exponent of the available services, and approximately 10,000 patients had access to Cogweb-mediated remote cognitive rehabilitation.…”

Capturing Expert Knowledge for the Personalization of Cognitive Rehabilitation: Study Combining Computational Modeling and a Participatory Design Strategy

“…Although paper-and-pencil tasks are reliable tools to assess multiple domains of cognitive functioning (specific task scores can be used to evaluate the capacities of a patient in multiple cognitive domains) [15], there are few solutions to the inverse problem: a set of paper-and-pencil tasks that are specifically adapted to the results of different assessments of cognitive functioning of a patient [16,17]. Cognitive rehabilitation approaches have been relatively successful for focal cortical deficits (eg, neglect and aphasia) but less so for more generalized cognitive impairment (eg, slowed information processing and executive dysfunction) [5].…”

“…Over the past few years, several computer-based solutions have been proposed to increase the availability and quality of cognitive training, flooding the marketplace with commercial brain exercise programs that claim to improve cognition and have diagnostic abilities [31] such as the CogWeb [16,32,33] and the Guttmann Neuro Personal Trainer [34,35], for instance. There is also an increasing number of research projects focused in using a task modeling approach in poststroke rehabilitation, as the CogWatch, that developed intelligent common objects to help retraining Apraxia or action disorganization syndrome patients on how to carry out ADLs by providing persistent multimodal feedback to them [36].…”