Michael J Boivin1, Noeline Nakasujja2, Alla Sikorskii3, Horacio Ruiseñor-Escudero4, Itziar Familiar-Lopez5, Kimberley Walhof6, Esther M van der Lugt7, Robert O Opoka8, Bruno Giordani9. 1. Department of Psychiatry, Michigan State University, East Lansing, MI, USA; Department of Neurology & Ophthalmology, Michigan State University, East Lansing, MI, USA. Electronic address: boivin@msu.edu. 2. Department of Psychiatry, Makerere University School of Medicine, Kampala, Uganda. Electronic address: drnoeline@yahoo.com. 3. Departments of Psychiatry and Statistics & Probability, Michigan State University, East Lansing, MI, USA. Electronic address: sikorska@msu.edu. 4. Department of Psychiatry, Michigan State University, East Lansing, MI, USA. Electronic address: ruisenore@gmail.com. 5. Department of Psychiatry, Michigan State University, East Lansing, MI, USA. Electronic address: ifamiliar@gmail.com. 6. Department of Obstetrics and Gynecology, University of Utah Medical School, Provo, UT, USA. Electronic address: kimwalhof@gmail.com. 7. Leiden University Medical Center, Leiden, The Netherlands. Electronic address: esthervanderlugt@gmail.com. 8. Department of Paediatrics and Child Health, Makerere University School of Medicine, Kampala, Uganda. Electronic address: opokabob@yahoo.com. 9. Departments of Psychiatry, Neurology, Psychology, and School of Nursing, University of Michigan, Ann Arbor, MI, USA. Electronic address: giordani@umich.edu.
Abstract
BACKGROUND:Computerized cognitive rehabilitation training (CCRT) may be beneficial for alleviating persisting neurocognitive deficits in Ugandan severe malaria survivors. We completed a randomized controlled trial of CCRT for both severe malaria and non-malaria cohorts of children. METHODS: 150 school-age severe malaria and 150 non-malaria children were randomized to three treatment arms: 24 sessions of Captain's Log CCRT for attention, working memory and nonverbal reasoning, in which training on each of 9 tasks difficulty increased with proficiency; a limited CCRT arm that did not titrate to proficiency but randomly cycled across the simplest to moderate level of training; and a passive control arm. Before and after 2 months of CCRT intervention and one year following, children were tested with the Kaufman Assessment Battery for Children, 2nd edition (KABC-II), computerized CogState cognitive tests, the Behavior Rating Inventory for Executive Function (BRIEF), and the Achenbach Child Behavior Checklist (CBCL). RESULTS:Malaria children assigned to the limited-CCRT intervention arm were significantly better than passive controls on KABC-II Mental Processing Index (P = 0.04), Sequential Processing (working memory) (P = 0.02) and the Conceptual Thinking subtest (planning/reasoning) (P = 0.02). At one year post-training, the limited CCRTmalaria children had more rapid CogState card detection (attention) (P = 0.02), and improved BRIEF Global Executive Index (P = 0.01) as compared to passive controls. Non-malaria children receiving CCRT significantly benefited only on KABC-II Conceptual Thinking (both full- and limited-CCRT; P < 0.01), CogState Groton maze chase and learning (P < 0.01), and CogState card identification (P = 0.05, full CCRT only). Improvements in KABC-II Conceptual Thinking planning subtest for the non-malaria children persisted to one-year follow-up only for the full-CCRT intervention arm. CONCLUSION: For severe malaria survivors, limited CCRT improved attention and memory outcomes more than full CCRT, perhaps because of the greater repetition and practice on relevant training tasks in the absence of the performance titration for full CCRT. There were fewer significant cognitive and behavior benefits for the non-malaria children, with the exception of the planning/reasoning subtest of Conceptual Thinking, with stronger full- compared to limited-CCRT improvements persisting to one-year follow-up.
RCT Entities:
BACKGROUND: Computerized cognitive rehabilitation training (CCRT) may be beneficial for alleviating persisting neurocognitive deficits in Ugandan severe malaria survivors. We completed a randomized controlled trial of CCRT for both severe malaria and non-malaria cohorts of children. METHODS: 150 school-age severe malaria and 150 non-malariachildren were randomized to three treatment arms: 24 sessions of Captain's Log CCRT for attention, working memory and nonverbal reasoning, in which training on each of 9 tasks difficulty increased with proficiency; a limited CCRT arm that did not titrate to proficiency but randomly cycled across the simplest to moderate level of training; and a passive control arm. Before and after 2 months of CCRT intervention and one year following, children were tested with the Kaufman Assessment Battery for Children, 2nd edition (KABC-II), computerized CogState cognitive tests, the Behavior Rating Inventory for Executive Function (BRIEF), and the Achenbach Child Behavior Checklist (CBCL). RESULTS:Malariachildren assigned to the limited-CCRT intervention arm were significantly better than passive controls on KABC-II Mental Processing Index (P = 0.04), Sequential Processing (working memory) (P = 0.02) and the Conceptual Thinking subtest (planning/reasoning) (P = 0.02). At one year post-training, the limited CCRT malariachildren had more rapid CogState card detection (attention) (P = 0.02), and improved BRIEF Global Executive Index (P = 0.01) as compared to passive controls. Non-malariachildren receiving CCRT significantly benefited only on KABC-II Conceptual Thinking (both full- and limited-CCRT; P < 0.01), CogState Groton maze chase and learning (P < 0.01), and CogState card identification (P = 0.05, full CCRT only). Improvements in KABC-II Conceptual Thinking planning subtest for the non-malariachildren persisted to one-year follow-up only for the full-CCRT intervention arm. CONCLUSION: For severe malaria survivors, limited CCRT improved attention and memory outcomes more than full CCRT, perhaps because of the greater repetition and practice on relevant training tasks in the absence of the performance titration for full CCRT. There were fewer significant cognitive and behavior benefits for the non-malariachildren, with the exception of the planning/reasoning subtest of Conceptual Thinking, with stronger full- compared to limited-CCRT improvements persisting to one-year follow-up.
Authors: Michael J Boivin; Paul Bangirana; Justus Byarugaba; Robert O Opoka; Richard Idro; Anne M Jurek; Chandy C John Journal: Pediatrics Date: 2007-01-15 Impact factor: 7.124
Authors: Paul Bangirana; Noeline Nakasujja; Bruno Giordani; Robert O Opoka; Chandy C John; Michael J Boivin Journal: Child Adolesc Psychiatry Ment Health Date: 2009-12-08 Impact factor: 3.033