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COGMED WORKING MEMORY
TRAINING: OVERVIEW
Judith Aronson-Ramos, M.D.
COGMED is an intensive computer-based treatment
intervention, for children and adults. There are three versions of the
program JM for 4-9 year olds, RM for 7 years old and up, and QM for teens
and adults. The program is completed on your home computer. The initial
phase of the training is five days a week, for 30-45 minutes a day for five
weeks. This is followed by an optional extension training program for 15
minutes a day for up to 100 sessions in a year. Throughout the program
trained staff members offer coaching and support to complete the program.
The Cogmed Program was developed in Stockholm at the prestigious Karolinska
Institute, known for cutting-edge medical treatments and research. The
research on Cogmed has already been published in leading
scientific and medical journals, and shows clinically significant
improvements in individuals who complete the training program. Research is
ongoing in Sweden and in
the United States
at Notre Dame, Harvard, Stanford, NYU, Case Western and other academic
institutions. Information about the research is available on the Cogmed
website at www.cogmed.com
COGMED is designed to improve Working Memory, now known to be a key
deficit in many individuals with AD/HD, learning disorders, reading
comprehension & math difficulties, auditory processing, and other
problems. Working Memory is a function of the brain that
helps us temporarily store and manage information required to carry out
complex thinking tasks. In daily life we use working memory for things as
diverse as remembering instructions, solving problems, controlling
impulses, social skills, focus and attention.
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
- Timed tests and
processing speed
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. For
the four to six years olds training is 10-15 minutes per day also 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 aide are essential to
maintain motivation. The “training aide” could be a parent,
sibling, teacher or anyone the family designates. This person will be
taught the necessary techniques and strategies to be the “training
aide” in order obtain the maximum benefits from the program.
Additionally your Cogmed coach will be providing weekly
telephone or email 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 are now approximately 75 professional practices 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 4-6 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. Now included in the training is an “Extension
Training” at no additional cost. This provides 100 extra cogmed training
session per year. Although the studies show training effects are lasting
this can only help reinforce the neural rewiring benefits of the program.
To see whether your computer would support the program, go to www.cogmed.com and run the test on your
computer. There is also detailed information about the program,
including information about who is most likely to benefit from working
memory training, and a demonstration of some of the actual training
exercises.
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. The fee for the initial screening and
start-up visit is $250, which will
be applied to the total
cost of the program once enrolled.
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 is $1,500 ($1,000 for JM) which includes:
initial screening procedures, start-up session, five weekly telephone
based coaching sessions, daily analysis of training data, a wrap up
session, a written final report, a 6 month follow up call and the 100 extra
training sessions per year. 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. Including the 100
extra training days the cost per training session is less than $20 per day.
You can compare other interventions by cost but you must also consider that
results are long term and demonstrated in actual imaging studies of the
brain as well as research published in reputable medical and scientific
journals. If additional family members begin a cogmed training program
within six months of the first training, we are able to offer a family
discount. This only applies to direct family members living in the same
household together. The price for each additional training is $1200 per
family member.
I encourage you to review the extensive materials on the website www.cogmed.com or visit www.sharpbrains.com and www.aboutworkingmemory.com
for general information about brain training programs and the research
supporting them. Feel free to contact me with any questions you may have.
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For appointments, please use
our convenient online Appointment Scheduler.
If you're having any difficulties, please call Dr. Aronson-Ramos direct at
561-901-3965
Email: info@draronsonramos.com
*Please note email is only for non-urgent matters. Though all
communications are confidential I cannot assure you of the privacy of
internet communications. Any information communicated over the internet is
at risk of public exposure. For guaranteed confidentiality please communicate
with me by voicemail 561-901-3965 or private fax 954-753-6280
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