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Unlike most products reviewed on this site, HAPPYneuron Pro may only be used through a therapist, rather than allowing direct purchase and access by a consumer. Therefore, this review contains information directed toward therapists and their patients.


Review by expert Dr. Alice Saperstein, Ph.D., Assistant Professor of Medical Psychology, Columbia University Medical Center

PROS

  • HAPPYneuron Pro’s Rehabilitation program platform supports a high intensity of cognitive training by offering both therapist-guided practice in face-to-face sessions as well as continued independent practice within a therapist designated training plan.
  • The Rehabilitation program is easily adaptable by offering 28 different exercises across 9 areas of cognition. Exercise parameters within each exercise can be customized to tailor cognitive practice to suit each individual’s cognitive and learning needs.
  • HAPPYneuron Pro’s Rehabilitation program is cost-effective – one subscription provides personal accounts for 10 users at one time.

CONS

  • Research data on the effectiveness of the Rehabilitation program for the proposed target populations (individuals with Traumatic Brain Injury, Stroke, Learning Disabilities, and ADHD) has not yet been published.
  • In research studies completed thus far, there is limited evidence for significant transfer of cognitive gains.

Description

The purpose of HAPPYneuron Pro is to provide a web-based platform for professionals to deliver cognitive remediation (CR) to clients with cognitive disabilities in a person-centered manner. The primary target populations for the HAPPYneuron Pro Rehabilitation program are people with Traumatic Brain Injury, Stroke, Learning Disabilities, and ADHD. The Rehabilitation program can also be used with psychiatric populations, such as people with depression or schizophrenia. The Rehabilitation program is intended to facilitate a cooperative working relationship for clients and CR therapists, as a personalized training plan of cognitive exercises may be created and adapted to suit the specific needs of each individual. Computer-based training with this program allows for both independent practice in accordance with a therapist-designed treatment program, and clinic or office-based use. The most unique aspect of this program is the high degree of control that the therapist has available in choosing not only the cognitive exercises for each individual, but also the parameters for each exercise which may be selected from a detailed control panel. This allows for tailoring of cognitive practice to suit each individual’s learning needs. The learning goal of the Rehabilitation program in SBT Pro is to improve cognition in a range of domains that are deemed pertinent for the client’s neurocognitive need.

Ease of Use and User Experience

User Interface

HAPPYneuron Pro provides a simple and user-friendly interface that is easily navigable, provided a basic level of computer literacy. It is strongly recommended that all clients are provided with an initial walk-through of program features to facilitate independent navigation to and between assigned exercises. Clients with more severe cognitive impairment will benefit from a greater level of therapist guidance with respect to use of program features and navigation.

Appropriateness of Content

Instructive language is simply presented and appropriate for the majority of users. Supplemental to verbal instructions, users can choose to view a dynamic demonstration for each exercise. By providing two modalities of instruction, HAPPYneuron Pro effectively supports independent use. Clients with more severe cognitive impairment and/or lower reading ability may require more therapist support with respect to understanding exercise instructions. Exercises vary in degree of verbal content; there is a good balance of verbal and non-verbal cognitive exercises. Language used in some verbal exercise stimuli (e.g. Restaurant, Secret Files) may be unfamiliar to many clients which may limit independent usability, particularly those with lower achieved education or lower reading ability. Therapists should therefore be cognizant of this so as to provide appropriate recommendations and in-person support.

Appropriateness of Feedback

HAPPYneuron Pro provides users with graphically and narratively presented feedback on exercise performance including level of accuracy, errors, response rate, and exercise progression. Feedback is provided at the end of each learning trial, as opposed to real-time progress updates. Opportunities to view solutions allow users to compare their responses to the correct solution. Supplemental therapist feedback is recommended to help clients understand performance feedback, utilize feedback to improve performance, and generate and apply strategies to aid learning in subsequent trials.

Cognitive Challenge

HAPPYneuron Pro exercises offer practice in a wide range of cognitive domains at a baseline level of challenge that is appropriate to the majority of clients for whom this program is recommended. The level of exercise difficulty automatically increases after the user achieves 100% accuracy on two consecutive trials, thereby allowing for both task mastery and continuous cognitive challenge. There are nine preset levels of challenge, thereby offering sufficient opportunity for continued practice and progressive cognitive improvement. If the Rehabilitation program is used for clients with serious mental illness, the step from one level of difficulty to the next may be too great. In all cases, the therapist is advised to gauge clients’ baseline abilities and progression through the initial levels of difficulty, and employ the Advanced Settings option to more finely control the exercise parameters as needed. For example, clients with more severely impaired cognition may benefit from more focused practice using one cognitive skill (e.g. abstract reasoning) prior to combining use of multiple cognitive skills (e.g. abstract reasoning plus processing speed) at one time. Using the Advanced Settings option, the therapist can control cognitive load and introduce additional task challenges, such as faster stimulus presentation and limited response times, on a case by case basis.

Ease of Account Management

HAPPYneuron Pro allows for therapists to manage up to 10 client accounts with one subscription. The user interface for therapists is easily navigable, allowing for the therapist to create and manage individualized training plans and view client progress in multiple domains including the exercises employed, dates and frequency of independent training sessions, the number of trials and rate of progression through levels of exercise difficulty. Clients can independently log in, choose which exercises in the training plan to use, and read personal messages from the therapist. The learning platform therefore supports a collaborative client-therapist relationship, opportunities for independent learning and continued practice between in-office visits.

Scientific Basis

The SBT Pro website offers an extensive list of research studies representing diverse international efforts focused on the development and study of web-based cognitive remediation. Completed research demonstrates treatment-related improvement in neurocognition in older healthy adults. Evidence for transfer effects from the trained exercises to untrained cognitive tasks is somewhat limited. Although there is evidence for improvement in cognitive abilities integral to performing real-world tasks, there is, as yet, no evidence for a direct relationship between cognitive improvement during training and improvement on functional outcome measures. Reports from adult participants indicate subjective improvement in cognitive ability, increased perceived competency, and improved well-being. Overall, the implications of research data are that computer-based cognitive training should employ many different exercises, high repetition of core cognitive exercises, and high intensity of cognitive practice in order to improve neurocognition. Published results specific to stroke patients and individuals with psychiatric disabilities are pending.

Qualitative Review of Program Efficacy

HAPPYneuron Pro offers a comprehensive program package that is flexible to meet the specific cognitive needs of each client which makes the Rehabilitation program suitable for a wide range of users. Exercise modules target a broad array of cognitive domains including executive functions, memory (verbal, visual, spatial), visual-spatial skills, auditory working memory, visual attention, and processing speed. There are between two and six exercises available within each module. Using the Basic Settings option in the Rehabilitation program, each exercise offers continuous preset levels of cognitive challenge such that the degree of difficulty increases in a stepwise manner as clients master each level. Levels modulate degree of difficulty with respect to the cognitive demands and the number of skills exercised at one time. The program also allows therapists to control progression to higher levels of challenge when the program is employed in face-to-face sessions. In addition, the Rehabilitation program uniquely allows for task parameters to be specified using an Advanced Settings option. The therapist can fine tune the level of difficulty by specifying attributes of each exercise such as time constraints, number and complexity of stimuli, number of trials, presence/absence of distractors, and availability of hints. These options allow for the same exercise to be employed flexibly, with more finely graded levels of complexity to target different cognitive skills within a single exercise context. The Rehabilitation program provides opportunities for repeated practice of cognitive skills in varied contexts which will reinforce and promote generalization of cognitive gains. To allow for high intensity of practice, this program is recommended for use along with a trained CR therapist, combining face-to-face sessions and independent between-session practice. It is not recommended for client use that is solely independent from a trained mental health professional.

Estimate of efficacy relative to similar products

The Rehabilitation program has many attributes that recommend its use in clinical practice for people with cognitive disabilities. HAPPYneuron Pro provides a platform for intensive therapist-guided and independent practice on a broad array of cognitive skills. Given the wide range of cognitive targets available in this program, the therapist is responsible for determining which modules are most relevant for the client’s presenting problem and which exercises will most likely lead to improvement in functionally relevant domains. With respect to learning context, some clients may prefer and benefit from this style of learning platform, which is two-dimensional and moderate in the degree of user-program interaction; stimulus presentation is simple, but colorful, engaging, and more modern than other commercially available software programs. The program offers an effective, streamlined approach to cognitive training. However, some clients may prefer other web-based programs that, relative to HAPPYneuron Pro, are more game-like and provide a more complex sensory experience. The therapist should be cognizant of the client’s learning style to determine if this platform is appropriate.

Cost

A 3-month subscription can be purchased for $150, providing for 10 individual accounts. Additional accounts can be purchased in increments of 10. Therefore a course of cognitive remediation can be offered at a rate of $15 per client. An advantage of this program’s subscription service is that user accounts can be activated and deactivated, such that a deactivated user’s account can be reactivated without incurring loss of personal data. One subscription therefore offers flexibility to the subscriber, and provides a personalizable and cost effective method of delivering cognitive remediation to people with cognitive disabilities.

Reviewed July 2014

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