Building Grey Matter at the Brain Gym

It’s not just fun and games; learn what vets and service members are doing at Walter Reed’s Brain Fitness Center.

To an outsider it might just look like fun and games, but at the Brain Fitness Center on the campus of Walter Reed Army Medical Center in Washington, DC, war veterans and service members are using high-tech programs to help their brains heal.

The Brain Fitness Center (BFC) at Walter Reed Army Medical Center (WRAMC) opened in 2009. The BFC’s goal is to give active duty and veteran service members with cognitive dysfunction — that is, difficulty with attention, memory, decision-making, etc. — the opportunity to explore brain-fitness products and perhaps find something new, challenging, and engaging to help in their rehabilitation. The cognitive workout patients receive in the BFC does not replace traditional rehabilitative therapies, but many feel it enhances their recovery.

Over the last decade or so, research has proven that — contrary to years of believing differently — the brain can continue to learn and become stronger at any age. In addition to eating right, staying social, reducing stress, getting sound sleep, and participating in physical exercise, exercising the brain is one of the top ingredients to a healthy body and mind.

Thanks to advances in our understanding of neuroplasticity — that is, the brain’s ability to change itself — as well as demand from the aging Baby Boomer generation, brain training programs have proliferated and become widely available. “Brain gyms” are popping up around the country with products to help you “think younger.” Fun and affordable online games and smartphone apps are also now widespread.

Although originally designed for people as they age, these brain-stimulating products can also help people who have sustained a traumatic brain injury (TBI).

“Think sharper”

There are a variety of ways to maintain brain health, including staying socially active and physically fit, and choosing “brain foods” (eat more berries and salmon!). Just as physical exercise is necessary for physical fitness, brain exercise is important for maintaining brain fitness. The most important aspect of brain exercise is doing something novel and challenging — something that offers a variety of stimuli. At any age, taking up knitting, a foreign language, or a musical instrument will challenge your brain. Once you’ve mastered one skill, you should find a new one to try so that your brain is challenged with new stimuli. The benefit of computer-based products is that computers can generate thousands of different stimuli in a short time-frame and in an entertaining, game-like format.

Most brain training programs assess a person’s level of cognitive function and provide exercises at an appropriately challenging level. Brain exercises should not be frustrating; however, they should be challenging. Like physical exercise, if you push yourself a little more each time you work out, you receive increasing benefits.

As most people know from exercising, finding a sport or routine that you like is important. If you don’t like swimming laps, playing tennis, or lifting weights, you probably won’t stick with it. By the same token, it’s important to find a brain-fitness product that fits your lifestyle demands and personal needs. There are brain games, more clinically focused brain exercises, and then there is focused brain training for a specific cognitive function or group of functions. Some products are designed to cross-train multiple areas and others target one specific area. For example, some programs may provide exercises for your memory, attention, and language skills while others to target a specific area like visual processing. The research on the effectiveness of these products varies, but currently, the jury is still out on how useful these products are for recovery from TBI. However, new research is addressing the direct and indirect benefits of some of these programs for patients with TBI and post-traumatic stress disorder (PTSD).

With the variety of brain training products on the market, it can be daunting for someone with a brain injury to sort through and evaluate each product to find what works best. It’s great to have choices, but you need to do your homework. Many of these products are expensive and may require a subscription with additional payments. The Brain Fitness Center at WRAMC offers a library of products for test driving and for regular use. The goal is to make tools for good brain health easily accessible. The BFC offers computer programs that can be used in the center by appointment, software that can be taken home, web-based technology, and brain games for hand-held devices. This way, you get to try them out and find the ones that best fit your needs and preferences.

Brain training products can vary from free iPhone apps to $400 software programs. The BFC works closely with the American Red Cross chapter at Walter Reed to provide software to service members through donations. If you are an active-duty service member or veteran and you want to purchase a product but the cost is too high, contact your local VA or Military Treatment Facility (MTF) to see if there is a Red Cross or other charitable organization able to provide these items. Many groups raise money for items such as smartphones, laptops, and assistive devices, and these groups may be able to include brain training software as part of their donations. These groups may be especially helpful for people who live in rural areas or for those who cannot get to the BFC.

What’s out there?

The products and resources listed below are used in the Brain Fitness Center at WRAMC, although there are other excellent programs on the market. Please note that Walter Reed, the Department of the Army, and the Department of Defense do not endorse these or any other specific products.

• Brain Fitness Classic by Posit Science: This product aims to sharpen auditory processing skills. Increasing the speed and accuracy of information you hear has been shown to make you “think quicker” and improve certain aspects of memory. PositScience recommends that you use this product daily for 60 minutes over an eight-week period. Brain Fitness Classic is available on CD for your home computer (Mac or PC).
  http://www.positscience.com/our-products/brain-fitness-program
• Dakim BrainFitness: Dakim uses a cross-training model, with exercises in memory, visual processing, critical thinking, language, and calculation. The stimuli are varied and include video clips of movies, famous songs as well as trivia. This program is designed to be used over the long term and to provide continuously novel content. Dakim recommends using the program 20 minutes a day at least two to three times a week. Dakim BrainFitness is available on CD for your home computer (Mac or PC).
  http://www.dakim.com/
• Insight by Posit Science: This program is designed to increase the accuracy and efficiency of visual information processing. Reacting more quickly to visual stimuli and expanding the visual field are two goals of the program. Many of the exercises in the program are part of their driving-safety software, designed to reduce the risk of accidents. Posit Science recommends that you use this product daily for 60 minutes over an eight-week period. Insight is available on CD for your home computer (Mac or PC).
  http://www.positscience.com/our-products/insight
• Lumosity: Lumos Lab’s website provides exercises targeting memory, attention, speed, flexibility, and problem solving. Users can design their own personalized training, including “courses” with TBI- and/or PTSD-specific content. Users have some control over what exercise they select on given day, and the content adapts to the appropriate challenge level. Lumosity is available on the web and as an iPhone app.
  http://www.lumosity.com/
• Nintendo Brain Age I and II: These two products are specifically designed for the Nintendo DS, a hand-held game device. The initial assessment tests your “brain age,” which could be “70 years old” even if you are only 27. From there, you work to decrease your brain age with exercises. The program has familiar games such as Sudoku, and the difficulty adjusts for the user. Two different Nintendo DS owners can compete in games. Brain Age is only available for the Nintendo DS.
  http://www.brainage.com/

Sharpbrains.com provides a useful checklist to use when evaluating if a brain-fitness product is right for you.
http://www.sharpbrains.com/resources/10-question-evaluation-checklist/

Brain games don’t replace traditional rehab

The staff at the BFC is part of WRAMC’s traumatic brain injury rehabilitation team and works to accommodate each person’s unique needs. The BFC does not replace traditional cognitive therapy. If a person is currently in, or has been recently discharged from, speech or occupational therapy, BFC staff works with that person’s therapist to best help him with his rehabilitation goals.

If you suspect an undiagnosed cognitive dysfunction and have not been evaluated by a neuropsychologist, speech or occupational therapist, you should first seek out an appropriate evaluation. If you do not have a specific diagnosis of TBI or have already been through TBI rehabilitation and are looking for ways to improve your overall brain health, a commercially available product may be worth exploring. Take some time to peruse the websites of the companies that have developed these brain products. Look for free demos and promotions. Try to get a good grasp on the time commitment recommended and the targeted areas of improvement. Just like working out at the gym, maintenance is important. If you use a program intensely for a few months, it is likely you will notice some benefits, and conversely, if you stop using the program, your benefit will decrease over time. Continuing with a program — for brain and body — provides long-term benefits. So consider whether the program will become boring or too time-consuming. Pick something that fits your needs and is something that will be engaging in the long term.

Studies not only show that maintaining a healthy brain can help reduce the risk for dementia,¹ but some brain training products also show evidence of improving overall quality of life.² However, since most studies for these products have been conducted with the aging population, the Brain Fitness Center at Walter Reed hopes to help provide outcomes for its unique population. The center is committed to investigating the effectiveness of these products by collecting data that may shed light on subjective and objective changes after the use of these products. We have seen more than 130 patients in the last year-and-a-half. A retrospective analysis of those first 100 patients is underway, and staff is currently recruiting for a randomized-controlled prospective research study comparing two of the products. The BFC was recently awarded a government grant for a multi-site randomized study to examine the effectiveness of a new product.

Sound mind in sound body

Cognitive exercise is only one factor in brain health. Our brains benefit from overall physical and mental health. So eat well, sleep and exercise more, find ways to reduce the stress in your life, and maintain your social relationships.