Rehabilitation of frontal/executive impairments in schizophrenia

Objective: A relatively high prevalence of deficits in cognitive flexibility, working memory and planning ability has been reported in schizophrenia patients. The objective was to develop a rehabilitation training program in an attempt to improve these specific cognitive functions. Method: The deficits in cognitive flexibility, working memory and planning ability were interpreted as reflecting executive cognitive processing impairments secondary to prefrontal neural system dysfunction. Following the 'process specific' approach, it was considered important to develop tasks that hypothesised the exercise of these cognitive abilities and the more molecular information processes thought to be fundamental to these abilities. Care was taken to ensure that all tasks involved the practice of processes thought to activate frontal/prefrontal neural systems. Attentional, visual, verbal, conceptual, motor and fine motor tasks were considered important for each process area in order to involve as many functional modalities as possible. Results: A program comprising cognitive shift, working memory and planning modules was developed. Conducted over 11 weeks, four modules were of 2 weeks' duration, and the fifth of 3 weeks' duration. Four individual 1 hour training sessions were conducted each week. Core elements of the modules are described. Conclusion: Consisting predominantly of pencil and paper information processing exercises, all of the training exercises are presented in the volumes of the Frontal/Executive Program. The program appears to be user-friendly with therapists now successfully delivering the program, in its entirety, to schizophrenia patients. Should future studies replicate preliminary findings of improved neurocognitive performance following training with the program, such findings would have important implications for the treatment of schizophrenia.