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Video Game Improve Cognition in Strokelbrain Injury Survivors? A NORTHERN ILLINOIS UNIVERSITY Can an "educational" video game improve cognition in strokelbrain injury survivors? A Thesis Submitted to the University Honors Program In Partial Fulfillment of the Requirements of the Baccalaureate Degree With Upper Division Honors Department Of Allied Health and Communicative Disorders/Speech Language Pathology By Stacey Behnke DeKalb, Illinois May, 2011 University Honors Program Capstone Approval Page Capstone Title (print or type) Can an "educational" video game improve cognition in stroke/brain injury survivors? Student Name (print or type) _Stacey 8ehnke _ Faculty Supervisor (print or ty e) _Jamie Ma~ r _ Faculty Approval Signature -----:~.....\I-Ih'-l.,,,J.:l-<:....--::::......--f>-~~-=----------~---_---_ Department of (print or ty~e) A\ hu:l t\tol+~b~ Communication Disorders Speech Language Pathology Date of Approval (print or type) \~---I.J"",-ci.L- _ HONORS THESIS ABSTRACT THESIS SUBMISSION FORM AUTHOR: Stacey Behnke THESIS TITLE: Can an "educational" video game improve cognition in stroke/brain injury survivors? ADVISOR: Jamie Mayer ADVISOR'S DEPARTMENT: Allied Health and Communicative Disorders DISCIPLINE: Speech Language Pathology YEAR: 2011 PAGE LENGTH: 79 BIBLIOGRAPHY: Page 15 and 16 ILLUSTRATED: No PUBLISHED: No LIST PUBLICATION: COPIES AVAILABLE (HARD COPY): ABSTRACT (100-200 WORDS): Can an "Educational Videogame" Improve the Cognition of Stroke/Brain Injury Survivors? ABSTRACT Current healthcare policies limit the time during which intensive rehabilitation is available for stroke and brain injury survivors (AAPM&R, 2009). Yet the timeline for recovery from such insults extends well beyond the typical window of rehabilitation provision, which makes independently administered cognitive stimulation an essential component of the recovery process. Unfortunately, little data exist as to the efficacy of such programs. Therefore, the purpose of this study was to determine whether a computerized, general cognitive stimulation program (Le., Nintendo OS' "Brain Age 2"), would successfully remediate specific cognitive skills in stroke or brain injury survivors compared to healthy controls. The benefits of this game include, (1) readily available for public use, (2) doesn't require training, (3) self- motivating which is important for successfully completing the program (Cherney et aI., 2008), and (4) automatically tracks the performance and reaction time. Participants in this study included stroke and brain injury survivors with mild cognitive-linguistic deficits and age- and education-matched healthy controls. All subjects were assessed for memory, attention, reaction time, executive function, and subjective perception of cognition; then played the "Brain-Age" game for 6 weeks, 30-60 min/day. Participants then repeated baseline testing; data analysis included comparing pre- and post- treatment test scores. Can an "Educational Videogame" Improve the Cognition of Stroke/Brain Injury Survivors? © eees . 2:O(J7Hint" •• ©;lQQ1 ""'K¢U CO •• U·d. (IGN Entertainment, 2011) Learning Objectives a. Discuss why an independently administered rehabilitation regimen is needed in the chronic phase post-stroke or brain injury. b. Describe the benefits and drawbacks of computerized cognitive stimulation in healthy controls and stroke/brain injury survivors. c. Describe the objective evidence for improvement (of lack thereof) of specific cognitive skills in healthy controls and stroke/brain injury survivors. Background/Purpose The leading cause of long term disability in the United States is currently a stroke (American Heart Association, 2009). A stroke is any disruption in blood flow to the brain and is sometimes referred to as a cerebrovascular accident or CVA (Murray, & Clark, 2006). CVA's can cause damage to the right and left hemispheres of the brain causing cognitive-communication disorders as well as physical motor issues. A Gallup survey was conducted by the NSA (National Stroke Association) in 1996 and showed that 40% of adults were unaware that a stroke occurs in the brain and also did not know what the symptoms of a stroke were (Murray, & Clark, 2006). This shows that not many people are aware ofthe dangers of a stroke which worsens the chances of getting immediate treatment. Risk factors of a stroke include hypertension (high blood pressure), heart disease, diabetes, smoking, obesity, substance abuse and high cholesterol. Signs of a stroke include dizziness, confusion, severe headache, one-sided numbness or weakness and slurred speech (Murray, & Clark, 2006). When a person has a stroke, the first thing that needs to happen is the recognition of symptoms and request help from a medical professional for acute care. For the next few weeks the stroke survivor will go through what is called spontaneous recovery. This is when the stroke survivor naturally regains cognitive, sensory and motor skills (AAPM&R, 2009). How severe the stroke will depend on how much the stroke survivor will spontaneously recover. After the stroke survivor is medically stable but still in acute care, the initiation of rehabilitative treatment can begin (US Agency for HealthCare Research and Quality, 1995). It is important to wait to begin research until at least 6 months post onset because it would be difficult to attribute it to the treatment or spontaneous recovery (Department of Citizen Services, 2010). Because rehabilitative therapy is quite expensive, most stroke survivors rely on insurance to pay for it. But, most current healthcare policies limit the time during which intensive rehabilitation is available for stroke and brain injury survivors to as little as 2-3 weeks as an inpatient therapy and 1-2 months of outpatient therapy (AAPM&R, 2009). This is a problem because the timeline for recovery from such insults extends well beyond this typical window of rehabilitation provision. It is proven that it is possible for stroke and brain injury survivors to progress even years after the occurrence ofthe stroke (Bhogal, 2003). Progress can be made because of the neuroplasticity of the adult brain. Neuroplasticity is the increase of gray matter in the brain created by changes in the function and organization of the brain. This means that afferent signals are sent to an undamaged part of the brain that are not normally used for a . specific task and reorganizes it so it can be used for a different task. Also, increased gray matter in the hippocampus is very important since this is the part of the brain associated with memory and learning which is changed during this process. The hippocampus also mediates the production of neuronal or glial stem cells that go to the damaged part of the brain and help with the repair process. Repetition is very important for this process because it takes time to train and reinforce the brain to do something new (Gauthier et aI., 2008). As a result, repetitive and independently administered cognitive stimulation becomes an essential component of the recovery process of a stroke survivor possessing cognitive problems. Because of the growing popularity of video games, it is of interest to explore usage of educational video game for an at home therapy program. Unfortunately, little data exist as to the efficacy of such programs which is why this study is of importance. This study (part one) supplemented a larger study (part two) currently in progress by Dr. Jamie Mayer. Part one of the study is to run the testing of healthy control subjects and analyze their data. Healthy control subjects are an important supplement to Dr. Mayer's study because Nintendo's claims of improved cognition have not to our knowledge been tested on healthy individuals with no history of neurological problems. Such data are crucial prior to exploring the validity of this game to improve cognition in stroke and brain injury survivors. Part two of the study is meant to explore the possibilities of using an "educational" video game to see if it can improve cognition in stroke/brain injury survivors. This topic is pertinent because "There is a growing interest in whether computer and video games may increase IQ. But despite suggestive advertisements, there is no empirical evidence that computer games enhance anything beyond task-specific performance and selective visuospatial attention." (Jaeggi et.a\. 2008). It is of interest to use Nintendo's "Brain Age 2" game because of its many benefits. (1) The game is readily available for public use. This means it is available for purchase at a local department store. (2) The game doesn't require training. It is geared towards the general public and anyone can learn how to utilize it. (3) Nintendo's "Brain Age 2" game is self- motivating and socially acceptable which is important for successfully completing the program (Cherney et al., 2008). Self motivation is important because it will keep the stroke survivor interested in the game and they will have a higher chance of completing the therapy program. Also, since it is socially acceptable, the stroke survivor will feel comfortable playing the game, again, increasing the chance they will finish the therapy program. (4) Lastly, the game automatically tracks the performance, reaction time and how often the stroke survivor plays which is beneficial for collecting data. This way, there is no extra paper work to fill out since the game already does it. Hypothesis Given the data to date, (e.g., Jaeggi et al., 2008) it is hypothesized that there will be minimal change from pre- to post-testing in the healthy control participants due to ceiling effects. The ceiling effect is where the participant reaches a certain point and can no longer improve. Also, age may have potential to affect the results. It is possible, however, that individuals with a history of stroke/brain injury do have the potential to benefit from this program with respect to specific cognitive functions. Methods Participants Part one of my supplemental study included nine healthy (did not have a stroke or brain injury) participants all over the age of 45 and all had at least a high school education. Participants of part two conducted by Dr.
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