| Access to specialized cognitive rehabilitation services is often challenging for clients with cognitive disabilities for many reasons. Therefore, the purpose of this study was to determine the efficacy of remote cognitive rehabilitation to provide services to a distant clinic using telerehabilitation (TR). A remote cognitive rehabilitation system was developed to deliver services remotely. The remote cognitive rehabilitation system consisted of two unique components, videoconferencing and a tablet PC equipped with a web-based learning management system (Moodle). The Ecologically Oriented Neurorehabilitation of Memory (EON-MEM) was selected as a manualized approach to delivering cognitive rehabilitation and to standardize administration. The EON-MEM consists of weekly meetings with a clinician, as well as paper based daily homework activities completed between sessions. Electronic versions of the homework were developed and transferred into Moodle. Clinical usability was assessed during development to further refine the system. Upon completion of development, the finalized system was deployed into a clinical trial evaluating the equivalency and efficacy of a 9-week memory intervention delivered face-to-face (FTF) and using TR. Thirty subjects participated in a quasi-experimental study. The findings based upon confidence intervals indicate the TR intervention was not statistically equivalent to the FTF intervention. Efficacy results indicated the overall treatment intervention (p=0.001 to 0.055), as well as the FTF group (p=0.003 to 0.415) and TR group (p=0.001 to 0.070), significantly improved some objective and self-report memory function, including the Wechsler Memory Scale –IV Logical Memory and the Self-Regulation Skills Interview. Participation in the 9-week EON-MEM resulted in statistically and clinically significant improvements in standardized and self-report measures of memory function. Summative usability was conducted on the electronic activities to ensure a high level of fidelity to the original, paper based activities. Additional clinical usability testing was conducted at the conclusion of clinical trial. Usability results indicate subjects were satisfied with completing cognitive rehabilitation sessions remotely, as well as completing homework activities through Moodle on the tablet PC. Results from these studies demonstrate that learning management systems are a novel approach to delivery of cognitive rehabilitation. Results from this preliminary study indicate TR is an acceptable modality for delivering cognitive rehabilitation services. |
