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The Neuropsychological Educational Approach to Cognitive Remediation (NEAR) Model: Practice Principles and Outcome Studies

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NEAR is an evidence based approach to cognitive remediation which was specifically developed for use with psychiatric patients. NEAR emphasizes the fact that cognitive remediation is essentially a learning activity and therefore instructional techniques incorporate basic educational principles that have been shown to enhance learning. Rather than using a fixed software package, NEAR uses a variety of exercises, which are chosen based on whether they meet the criteria to both address neuropsychological deficits and be motivating and engaging. The theory behind the NEAR program, practice principles and outcome studies are reviewed.
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... Second, some concepts, such as the Neuropsychological Educational Approach to Rehabilitation (NEAR [145]), besides trying to relate tasks to everyday problem-solving or vocational challenges, explicitly use social interaction and peer support provided in group settings. Thus, approaches, such as NEAR, might also improve social cognition. ...
... In the NEAR approach [145], described above, regular group discussions are held on managing the problems encountered in everyday life and setting appropriate personal cognitive training goals. Other approaches, such as action-based CR [65,156], further extend this idea by adding practical activities, such as remembering messages or even role plays. ...
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Many people with psychiatric disorders experience impairments in cognition. These deficits have a significant impact on daily functioning and sometimes even on the further course of their disease. Cognitive remediation (CR) is used as an umbrella term for behavioral training interventions to ameliorate these deficits. In most but not all studies, CR has proven effective in improving cognition and enhancing everyday functional outcomes. In this paper, after quickly summarizing the empirical evidence, practical advice to optimize the effects of CR interventions is provided. We advocate that CR interventions should be as fun and motivating as possible, and therapists should at least consider using positively toned emotional stimuli instead of neutral stimuli. Participants should be screened for basic processing deficits, which should be trained before CR of higher-order cognitive domains. CR should stimulate metacognition and utilize natural settings to invoke social cognition. Wherever possible, CR tasks should link to tasks that participants face in their everyday life. Therapists should consider that participants might also benefit from positive side effects on symptomatology. Finally, the CR approach might even be utilized in settings where the treatment of cognitive impairments is not a primary target.
... The principles of Neuropsychological and Educational Approach to Remediation (NEAR) were used to develop the REAP program, with its emphasis on personalization, contextualization and transfer of learning to daily activities (24). The AR gamified training scenarios were developed using Unity 3D (25) and implemented on a RhinoX AR headset from Ximmerse (18). ...
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Objectives: The Augmented Reality Games to Enhance Vocational Ability of Patients (REAP) was an augmented reality vocational training program that provided skills training in the context of a psychiatric rehabilitation program. It was implemented over 10 weeks and consisted of gamified augmented reality café training scenarios and bridging group activities to facilitate transfer of learning to the work context. This pilot study aimed to explore the acceptability and effectiveness of the REAP program when carried out with adults with intellectual and developmental disabilities attending work therapy. Its objectives were: (1) to obtain feedback from participants and trainers on their experiences and acceptability of the REAP program and (2) to measure changes in vocational and cognitive skills of participants in the REAP program. Materials and methods: This was a pretest–posttest mixed methods study. 15 adults with intellectual and developmental disabilities attending work therapy in a non-profit organization participated in the REAP program and their vocational trainers were involved in assisting in this program. Feasibility Evaluation Checklist (FEC) and the Neurobehavioral Cognitive Status Exam (Cognistat) were administered at baseline, post-training and eight weeks after training. The participants and their trainers also provided user feedback via semi-structured interviews. Results: Majority of the participants and trainers found the REAP program to be useful and interesting. They also found that the augmented reality games were user-friendly and provided a unique opportunity to acquire new skills. Participants who engaged in this program showed a significant improvement in vocational skills and aspects of cognitive skills, which were maintained eight weeks after training. Conclusion: The gamified augmented reality vocational training was feasible and accepted by both adults with intellectual and developmental disabilities and their trainers. When integrated with bridging sessions to facilitate transfer of learning to existing work therapy, participants on the REAP program showed significant improvements in vocational skills and aspects of cognitive skills. Future experimental studies with larger sample size could provide stronger evidence on its effectiveness in improving vocational outcomes.
... These exercises are targeted at training certain domains of cognition that are typically hindered in schizophrenia (attention, working memory, verbal memory, verbal fluency, psychomotor speed, and executive function). NEAR takes on CR as a type of education (33), with stresses on short-and long-term goals that require patients to be insightful and motivated (34). There is also emphasis on patients to recognise the socio-emotional context of this approach and how it affects cognitive function (34). ...
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Objective: Early intervention in patients with first episode psychosis (FEP) can improve cognitive abilities, with both short- and long-term benefits. In this paper, we describe the implementation and review of cognitive remediation training (CRT) in an Asian FEP population. The outcomes of the training are also evaluated and discussed. Methods: This naturalistic paper describes in detail the real-life implementation and conduct of CRT in an early psychosis intervention service. One hundred and nine patients with FEP underwent a 24-session CRT programme, using Cogpack and Neuropsychological Educational Approach to Remediation. The program is evaluated with pre- and post-CRT assessment scores which included Montreal Cognitive Assessment and Brief Assessment of Cognition in Schizophrenia. The rates of improvement on these cognitive assessments were evaluated using paired t -tests, with statistical significance set at p ≤ 0.05. Results: Of the 109 patients who underwent CRT, a total of 92 (84.4%) completed all 24 sessions. Paired t -tests between pre- and post-CRT assessments scores revealed that participants significantly improved on majority of the measures, including verbal memory, digit sequencing, and symbol coding. Conclusion: As with other cognitive remediation programmes, CRT has shown to improve cognitive functioning in patients with FEP. The results support the use of CRT in an Asian context and may serve as guidance for the implementation of similar training programmes in other Asian early psychosis intervention services.
... On the other hand, Naismith et al. (2013) used Neuropsychological Education Approach to Remediation (NEAR) to implement an individually tailored CT regime. NEAR was originally developed to address cognitive impairment in psychiatric disorders, targeting learning as its core domain, and includes an extensive software library of activities (Medalia and Freilich, 2008). Naismith et al. (2013) assessed the efficacy of NEAR in a cohort of PD patients with and without cognitive impairment (n = 35 intervention, n = 15 wait-list control). ...
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Cognitive dysfunction, primarily involving impairments in executive function, visuospatial function and memory, is one of the most common non-motor symptoms of Parkinson’s disease (PD). Currently, the only pharmacological treatments available for the treatment of cognitive dysfunction in PD provide variable benefit, making the search for potential non-pharmacological therapies to improve cognitive function of significant interest. One such therapeutic strategy may be cognitive training (CT), which involves the repetition of standardized tasks with the aim of improving specific aspects of cognition. Several studies have examined the effects of CT in individuals with PD and have shown benefits in a variety of cognitive domains, but the widespread use of CT in these individuals may be limited by motor impairments and other concerns in study design. Here, we discuss the current state of the literature on the use of CT for PD and propose recommendations for future implementation. We also explore the potential use of more recent integrative, adaptive and assistive technologies, such as virtual reality, which may optimize the delivery of CT in PD.
... une fois par semaine pour un total de 20 semaines. La remédiation cognitive ciblait à la fois la neurocognition et la cognition sociale en utilisant les manuels de traitements basés sur des preuves ; l'approche éducative neuropsychologique de la remédiation cognitive (NEAR) 45 ...
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Nous proposons ici une traduction en langue française d'un article relatif à l'étude des difficultés cognitives subjectivement rapportées chez les individus à ultra haut risque (UHR) de psychose, et si ces difficultés cognitives auto-perçues peuvent être liées aux déficits cognitifs objectifs, la psychopathologie, le fonctionnement et l’adhésion à la remédiation cognitive (RC). Il s'agit de Glenthøj, L.B., Mariegaard, L., Kristensen, T.D. et al. Self-perceived cognitive impairments in psychosis ultra-high risk individuals: associations with objective cognitive deficits and functioning. npj Schizophr 6, 31 (2020). Mots clefs : Self-perceived cognitive impairments, psychosis ultra-high risk individuals, UHR, associations subjective versus objective deficits, functioning Altérations cognitives auto-perçues, individus à ultra haut risque de psychose, Associations des déficits objectifs versus subjectifs, fonctionnement
... The ICB-VIP modules consisted of all 11 defined cognitive and social cognitive domains as well as emotion regulation, which were grouped into 4 modules. The elements and strategy of the intervention capitalized on, and were influenced by, several cognitive rehabilitation programs, such as the Neuropsychological Educational Approach to Remediation (NEAR) [49], Compensatory Cognitive Training manual [50], and relevant strategies [51,52]. ...
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Skills training is a hallmark of the psychiatric rehabilitation model. However, many people with psychiatric illness cannot take advantage of learning opportunities in rehabilitation treatment settings because they have pervasive cognitive deficits in attention, memory and problem solving processes. These cognitive deficits must be addressed if learning is to be facilitated and clients are to achieve their stated goals. This paper describes a cognitive rehabilitation program that was implemented within an intensive psychiatric rehabilitation program. The reasons for choosing this particular model of cognitive remediation, the mechanisms of implementation, response of users and recipients, and reasons for continued use in other settings are described. Results of program evaluation monitoring surveys related to program utilization, psychosocial outcome and skill enhancement are presented.
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