COGMED WORKING MEMORY TRAINING: OVERVIEW
 Judith Aronson-Ramos, M.D.

For a quick introduction to why Dr. Aronson-Ramos is offering COGMED view the interview here.

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Cogmed Demonstration Video

You can DEMO the program here. Enter the user name: test and password: test44.

COGMED is an evidence based brain training program for children and adults.

COGMED has been demonstrated to improve Working Memory which may be impaired in AD/HD, learning disabilities, traumatic brain injury,  reading comprehension & math difficulties, autism spectrum disorders, and cognitive decline due to aging.

What is Working Memory?

Working memory is the active process of storing and processing information simultaneously. Working Memory is critical to carry out complex thinking tasks. In daily life we use working memory for things as diverse as remembering instructions, solving math problems, reading comprehension, controlling impulses, engaging in conversation, and numerous other tasks which require focused attention.

Many researchers feel WM is more predictive of academic performance and cognitive functioning than IQ. In school, working memory problems lead to poor academic progress, in the workplace under performance, and in daily life disorganization and chaos.

What is The Cogmed Story? (www.thecogmedstory.com)

The Cogmed Program was developed by Torkel Klingberg, a Swedish Neuroscientist at the prestigious Karolinska Institute, known for cutting-edge medical treatments, research, and the Nobel Prize in Medicine. Dr. Klingberg and his team discovered that working memory deficits underlie many difficulties children and adults experience with focused attention and learning. They also discovered that these WM deficits can be improved with computer based brain training.

This is the Cogmed Story - the unique and research supported data that  training working memory can help children and adults overcome problems with working memory function. The aim of Cogmed Working Memory Training is to increase the ability to stay focused, ignore distractions, plan and sequence, remember instructions, and start and finish tasks.  Those skills are crucial for both school and professional performance as well as for everyday living skills (e.g. cleaning one’s room).

Some specific examples of the difficulties faced by children and adults with Working Memory deficits include:

• Resisting tasks requiring mental effort
• Easily distracted, often impulsive
• Difficulty focusing on and completing a task
• Trouble remembering instructions or detailed information
• Problems getting information into memory and keeping it there
• Difficulty with tasks requiring organization, planning, and sequencing information
• Reading comprehension and mathematics difficulties
• Lack of a sense of time
• Poor judgment in social situations
• Weak conversational skills – turn taking, listening, commenting
• Organizational skills

These are some of the real world examples of Working Memory impairments that can debilitate the lives of children and adults. Obviously every individual is unique and may have some or all of these difficulties.

The actual treatment program involves at-home computer-based training for 30-45 minutes daily, 5 days a week, for 5 weeks.  The exercises are similar to computer games but the computer adjusts the level of difficulty (through Internet synchronization with a large data base) so the child or adult is always pushing him or herself.  While some children with a strong competitive spirit are motivated simply to “beat the game,” others may find the program frustrating so the coaching and training assistance are essential to maintain motivation. The parent, or other caregiver, will be taught the necessary techniques and strategies to be a “training aide” to their child to obtain the maximum benefits from the program. Additionally your Cogmed coach will be providing weekly telephone contact to assist you and will be tracking daily progress by continuously analyzing performance data. The program requires a commitment to adhering to a consistent training schedule in order to get the optimal results. Families should think about the program like they would an exercise and fitness regimen - it needs to be consistent and intense to produce results.

There is now a select group of professionals in the US and Canada certified to provide Cogmed Working Memory Training. The data collected thus far by the professionals in North America and worldwide have been gratifying, with 80% of those who complete the training showing good to outstanding results.  Some of the gains reported by parents include improvements in the following areas:

• Taking Initiative: including homework and chores.
• Remembering things: directions, routines, instructions, and information.
• Improved frustration tolerance: thinks before reacting; fewer “meltdowns”.
• Better able to focus, sustain attention, and can re-focus if attention starts to wander.
• Improved reading comprehension.
• Improved performance in math.
• Greater self-confidence and overall maturity, improved social interaction.
• Completing more tasks independently.
• Notebooks, materials, and planners more organized
• Reduced impulsivity and hyperactivity
• Better social skills, more connected to others
• Cognitive decline due to: stroke, aging, or traumatic brain injury

Improvement ranges from moderately good to excellent, in terms of “real world” functioning.  In some cases, results are apparent as early as the third or fourth week of training. In other cases, however, results emerge slowly and begin to become apparent only after training is completed.

There are three programs available: JM, RM and QM. Cogmed JM for younger children ages 4-9 is of shorter duration. Training sessions are fifteen minutes long, five days a week for five weeks. The program is designed with exercises of maximal intensity so the training can be condensed in a manner that is more developmentally appropriate for younger children.

Both of the programs for older children, teens and adults require the thirty minute training sessions a day, five days per week, for five weeks. The program for older children is called Cogmed RM. Children as young as seven years of age can train on this program. The appropriate choice at the younger ages will depend on individual characteristics of the child. Cogmed QM is the adult version, which may also be used with older teens if they prefer.

One of the most exciting aspects of the training is that results are long-lasting: over 80% of those who improve either maintain their gains or actually continue to improve over time at one-year follow-up. The program now includes a year long extension training program which is an abbreviated form of the training at your own pace-one hundred additional sessions over a one year period or roughly twice a week for a year. The extension training is optional but it is included as part of the training when you enroll.
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I have personally spent a considerable amount of time researching programs that offer a non-pharmacological addition to the treatment of ADHD and other problems with learning and development. This intervention has the evidence base and the research for me to be able to recommend it for my own patients.

COGMED Training in Practice

If you are not already an established patient, the process of enrolling will require a telephone screening; to be sure the program is appropriate for you or your child. This will be followed by an in office start-up visit to begin the program.

For my established patients who qualify for the intervention we will be able to begin the program immediately without further screening, once you have been properly trained on its use at an in office start-up session which will last approximately one hour.

The total cost of the program for RM, QM and JM includes: initial screening procedures, start-up session, five weekly telephone based coaching sessions, daily analysis of training data, and a wrap up session, with a 6 month follow up if desired. If you compare this fee to programs that are similar in intent you will see the fees are generally less because the duration of treatment is shorter and more intensive. Another thing to consider is that results are long term and demonstrated in actual imaging studies of the brain. Recently Cogmed launched the capability for you to monitor your or your child’s progress through the training web program. You can log on to the program at www.trainingweb.cogmed.com and enter the user name and password you have been assigned. Here you can see statistics and graphs of your daily performance as well as a list of FAQ’s and other information.

To demo cogmed go the DEMO SITE and enter user name: test and password: test44

I encourage you to review the extensive materials on the following websites: www.cogmed.com  www.sharpbrains.com and www.aboutworkingmemory.com  for more information about brain training programs and the research supporting them. Feel free to contact me with any questions you may have.
Judith Aronson-Ramos, M.D. Email: info@draronsonramos.com  Phone: 954-531-0847

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