Exploring the use of the CAREN to support cognitive recovery

Franki Collinson, Occupational Therapist, has more than 30 years of experience and is a self-confessed ‘digital dinosaur’ and is not a natural ‘digital adopter’. However, it is widely acknowledged that engaging patients post Acquired Brain Injury is often challenging and we are living in a world of technological innovation that invades every aspect of our daily living. Her role as a Cognitive Champion for SP Therapy Services allowed her to explore the potential use of the CAREN to support cognitive recovery and would now recommend CAREN as a treatment modality to appropriate clients.
The Computer Assisted Rehabilitation Environment (CAREN) is owned and run by the Brain and Spinal Injury Charity (BASIC). Fund raising secured £500,000 for the purchase, installation and training of staff in 2015. It is used as a versatile, multi-sensory virtual reality system in the treatment and rehabilitation of human locomotion, or walking, as well as pain, posture, balance, spinal stability and motor control integration.
At its location at BASIC in Salford, Manchester, it is accessed regularly by Physiotherapists and Technicians to improve the physical abilities of patients with ABI, Stroke, Parkinson’s and Dementia.
Occupational Therapists recognise that patients with complex neurological conditions often struggle to multi-task e.g. think and walk. Occupational Therapists often use paper-based exercises to challenge cognition prior to working in a real environment such as a shopping centre or leisure facility.
Currently, the CAREN is used under the supervision of an experienced Physiotherapist and the programs are set up by a trained CAREN technician. Franki Collinson, Occupational Therapist observed several clients in varying stages of their rehabilitation at BASIC with the CAREN being used primarily to work on physical deficits.
Whilst the Physiotherapist and the technicians recognised the benefit of the cognitive challenge that the CAREN can provide there was not, at the time, a method for specifically grading or selecting an appropriate cognitively challenging program. The aim of the sampling project was to identify if any programs could be chosen to challenge specific cognitive functions where these are suspected of being compromised.
There is a wide array of programs for the clinicians to choose from to improve cognitive functioning.
The Braintree Cognitive Hierarchy has been used to demonstrate where the CAREN may be used to support the development of several cognitive domains.

Ideally, the programs chosen can be used to grade from the foundation functions of attention and visual processing skills and will work upwards towards more complex executive functioning; planning and organisational skills.
Real life requires continuous automatic processing. After a brain injury everyday tasks are very conscious and effortful. The need to ensure vulnerable people are safe can mean that those delivering rehabilitation can be risk averse and there is limited capacity for spontaneous learning and error.

Franki Collinson is presenting the above information to BASIC in the form of a poster and it is hoped it will enhance their use of the CAREN for patients with a range of cognitive difficulties.