Cognitive stimulation session for people with cognitive impairment

Researcher Olalla Sáiz Vázquez talks about a cognitive stimulation session for people with mild cognitive impairment or without cognitive impairment, using the NeuronUP platform.

General goal

Restore impaired cognitive abilities in users and, once restored, preserve the abilities they have regained.

Specific goals

• Increase levels of selective attention,
• restore the ability to sustain attention,
• exercise short-term memory and semantic memory,
• improve processing speed,
• support color and detail discrimination,
• strengthen visual acuity,
• promote reality orientation and spatial orientation,
• train planning and concentration skills,
• strengthen number and word sequencing,
• support reasoning,
• improve hemineglect.

This cognitive stimulation intervention for people with mild or no cognitive impairment will be carried out using the Occupational Therapy Practice Framework (AOTA). (2).

The approaches that will be used to achieve the proposed goals are restoration, to restore the skills that are impaired in users, and maintenance, so that users preserve the abilities they have regained.

The activities will be related to the different areas of occupation:

• Instrumental activities of daily living (IADLs),
• education (environmental),
• play,
• social participation, since it is done in a group (2).

In addition, three types of activities will be carried out:

• Playful activities that users may enjoy, such as “Card Pyramid” and “Word Search,” which are explained below.
• Others to help users integrate new concepts into their lives, such as the activity “Pick Up your Baggage” and the exercise “Recycle your trash.”
• Others that are more theoretical, such as “Word Association” and “Emotion recognition.”

The cognitive stimulation exercises for people with mild or no cognitive impairment will be flexible and suited to users’ pace. They will also be short, so that users don’t lose focus or become tired and unmotivated. Finally, users will be encouraged and helped throughout each activity.

Cognitive stimulation activities for people with mild or no cognitive impairment

1. Moving Colors

What does it involve?

This activity involves finding, as quickly as possible, the colored squares that stay still among a set of moving squares of different colors.

The activity consists of 5 screens in total, whether the user fails or passes. The user has a maximum of 5 minutes to complete it. This time is tracked with a timer that appears on the screen and counts up. There is also an inactivity alert that notifies the user if they go two minutes without making any move in the activity.

The user has three lives, losing one every 3 mistakes, until all three are used up. The activity ends when the user finds and selects the squares that are still. The phase chosen to start this activity is phase 4; if the user completes the screen correctly, they will be prompted to move up a phase; otherwise, they will move back to a previous one.

What does this activity work on?

This activity works on:

• Sustained attention,
• visual gnosis,
• selective attention.

Play by levels

Moving Colors has three levels, easy, medium, and hard, with 3 phases each.

Languages

This game is available in Spanish, English, French, Portuguese, and Catalan.

2. Pick Up your Baggage

What does it involve?

In this activity, the user has to identify on the conveyor belt the luggage that is the same (with the same characteristics) as the model suitcases. Depending on the phase, more suitcases will appear to recognize. In this case, the user will start at phase 7, so two suitcases will appear. Users must pay close attention to the characteristics, since very similar suitcases may appear.

As in the previous activity, the user has three lives. Each time they use up a life, the model suitcases change, and so do the suitcases on the belt. The activity ends when the user has selected all the luggage on the belt that matches the model, with the same characteristics.

What does this activity work on?

• Selective attention,
• sustained attention,
• processing speed,
• working memory,
• leisure.

Play by levels

Pick Up your Baggage has three levels, easy, medium, and hard, with 4 phases each.

Languages

This game is available in Spanish, English, French, Portuguese, Catalan, German, and Italian.

3. Word Search

What does it involve?

In this activity, users have to find a series of words hidden in a grid of letters. The words can be placed vertically, horizontally, or diagonally, and they can run in any direction.

There are three modes to choose from: correction mode, in which, if the user makes a mistake and selects a word they weren’t supposed to find, it is marked as wrong; and free mode, which tells you at the end of the activity whether you got everything right or which words you missed.

The third mode is custom, in which you can change how the activity works for each user, choosing free or correction mode and also selecting the maximum number of errors.

You can also change the maximum time for the activity by choosing how many minutes the user spends on it. You can also add an inactivity alert: if, for example, the user goes one minute without finding a single word, it will remind them to continue with the game, since they may have become distracted. The alert is both visual and audible. You can even add a timer that counts down or up, so the user can see how much time is left in the activity.

Finally, you can give specific instructions to make the task easier for the user. Or, for example, if it is a custom word search with the names of their grandchildren, you can specify that they need to find their grandchildren’s names in the word search.

The parameters you can select are used to increase or decrease the difficulty: the grid size, where you can remove or add columns and rows; the direction of the words to find (horizontal, vertical, diagonal, or backward); the number of words the user has to find; and finally, which words the professional wants users to find, organized by word length or theme, or, as mentioned above, a custom word search, such as one with the names of their grandchildren.

What does this activity work on?

• Selective attention,
• sustained attention.

Format

This activity is available in both digital and paper format.

Languages

This game is available in Spanish, English, French, and Portuguese.

Children’s version

This Word Search generator has a children’s version called The Magic Word.

4. Emotion recognition

What does it involve?

The aim of the activity is to recognize the emotions shown and match them with the terms that define them. There are three levels of increasing difficulty. Once a level is selected, the task begins: the person sees an image of someone making a particular face that expresses a specific emotion. To select an answer, they have to click on the correct option, as shown in the image.

For this activity, the medium level will be selected, since, although it is the highest, its complexity is not very high. Within this level, you can select one of 11 sublevels.

If participants find they are able to increase the difficulty, they can select another, harder level with its corresponding sublevels. To start playing, click the “correction mode” option to check that the answers are correct and give the player positive feedback. There is only one life for each level.

What does this activity work on?

• Social cognition,
• reasoning,
• Vocabulary.

Play by levels

This worksheet has 3 levels: basic, easy, and medium.

Format

This activity is available in both digital and paper format.

Languages

This game is available in Spanish, English, French, Portuguese, and Catalan.

5. Word Association

What does it involve?

The following activity aims to strengthen a person’s executive functions. To do this, it is based on relating words arranged in three columns. It has three levels of increasing difficulty and many sublevels depending on the difficulty selected.

Players will select the medium level and correction mode to check that their answers are correct. The player has three lives that keep the game going if they make a mistake in the connections. If the player sees there is room for improvement in terms of difficulty, their level can be increased to make it more complex.

What does this activity work on?

• Reasoning.

Play by levels

This worksheet has 5 levels: basic, easy, medium, hard, and advanced.

Format

This activity is available in both digital and paper format.

Languages

This game is available in Spanish, English, Portuguese, and Catalan.

6. Recycling trash

What does it involve?

This activity involves putting different types of waste in the right bin.

It falls within the occupational areas of activities of daily living (ADLs), specifically instrumental activities of daily living (IADLs), since it covers topics related to cooking, cleaning, and environmental education.

The activity consists of four screens to complete. For each one, the user will have a maximum of 4 minutes, with an inactivity alert every 2 minutes. To help with time management, a timer that counts up will be shown at the top left of the screen. The activity will also be described as clearly as possible so that users understand it.

The activity becomes more complex as screens are completed. It starts with screens in which the setting is the house, with a total of 4 items to place and a high number of errors allowed. As help, users will have a label showing the names of the objects, a general label for the bins, and a list. As they complete screens, the setting changes: some screens will be set on the street so that the activity is more complete and doesn’t focus on a single setting.

The number of items will increase (from 4, as mentioned, to 6 or 8 items), and the maximum number of errors will decrease, along with the level of help. The bin label will stay on throughout the screens to help users find the bins, since bin colors vary from city to city (for example, in Burgos the organic waste bin is gray instead of green).

The time set for this activity is 8 minutes; depending on how quickly users work, they will complete more or fewer screens. They will also have three lives.

What does this activity work on?

• Reasoning,
• sustained attention,
• semantic memory,
• episodic memory.

Play by levels

This game has 3 levels, easy, medium, and hard, with 3 phases each.

Format

This activity is available in both digital and paper format.

Languages

This game is available in Spanish, French, and Italian.

7. Card Pyramid

What does it involve?

This activity involves placing the cards shown in consecutive order, either ascending or descending, regardless of suit. Since it uses the Spanish deck, the jack (sota) comes after the seven, and the ace comes after the king. This activity falls within the occupational area of play.

It will consist of 5 screens to complete. For each one, the user will have 5 minutes, with an inactivity alert every 2 minutes. To help the user manage their time, a timer that counts up will be shown at the top left of the screen.

Instructions will also be given clearly and precisely so that users understand them. As users progress, the complexity will increase by adding rows and columns, more decks, stricter correction criteria, and more errors, and the time allowed will gradually decrease.

What does this activity work on?

• Flexibility,
• planning,
• selective attention,
• hemineglect,
• alternating attention.

Play by levels

This game has 3 levels, easy, medium, and hard, with 2 phases each.

Languages

This game is available in Spanish, English, French, Portuguese, Catalan, and Italian.

References

• NeuronUP. NeuronUP [website]. La Rioja: NeuronUP; 2012 [accessed November 15, 2018]. Available at: https://neuronup.us/
• Ávila Álvarez A, Máximo Bocanegra M, Martínez Piédrola R, Matilla Mora R, Méndez Méndez B, Talavera Valverde MA et al. Marco de trabajo para la práctica de la Terapia Ocupacional: dominio y proceso. 2da Edición [Traducción]. www.terapia-ocupacional.com [portal en Internet]. 2010 [consultado el 20 de noviembre de 2017]; [85p.]. Disponible en: http://www.terapiaocupacional.com/aota2010esp.pdf. Traducido de: American Occupational Therapy Association (2008). Occupational therapy practice framework: Domain and process (2nd ed.).

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