Electrophysiological Brain Changes Associated With Cognitive Improvement in a Pediatric Attention Deficit Hyperactivity Disorder Digital Artificial Intelligence-Driven Intervention: Randomized Controlled Trial

Abstract

Background Cognitive stimulation therapy appears to show promising results in the rehabilitation of impaired cognitive processes in attention deficit hyperactivity disorder. Objective Encouraged by this evidence and the ever-increasing use of technology and artificial intelligence for therapeutic purposes, we examined whether cognitive stimulation therapy implemented on a mobile device and controlled by an artificial intelligence engine can be effective in the neurocognitive rehabilitation of these patients. Methods In this randomized study, 29 child participants (25 males) underwent training with a smart, digital, cognitive stimulation program (KAD_SCL_01) or with 3 commercial video games for 12 weeks, 3 days a week, 15 minutes a day. Participants completed a neuropsychological assessment and a preintervention and postintervention magnetoencephalography study in a resting state with their eyes closed. In addition, information on clinical symptoms was collected from the child´s legal guardians. Results In line with our main hypothesis, we found evidence that smart, digital, cognitive treatment results in improvements in inhibitory control performance. Improvements were also found in visuospatial working memory performance and in the cognitive flexibility, working memory, and behavior and general executive functioning behavioral clinical indexes in this group of participants. Finally, the improvements found in inhibitory control were related to increases in alpha-band power in all participants in the posterior regions, including 2 default mode network regions of the interest: the bilateral precuneus and the bilateral posterior cingulate cortex. However, only the participants who underwent cognitive stimulation intervention (KAD_SCL_01) showed a significant increase in this relationship. Conclusions The results seem to indicate that smart, digital treatment can be effective in the inhibitory control and visuospatial working memory rehabilitation in patients with attention deficit hyperactivity disorder. Furthermore, the relation of the inhibitory control with alpha-band power changes could mean that these changes are a product of plasticity mechanisms or changes in the neuromodulatory dynamics. Trial Registration ISRCTN Registry ISRCTN71041318; https://www.isrctn.com/ISRCTN71041318

Visualization and Interaction Technologies in Serious and Exergames for Cognitive Assessment and Training: A Survey on Available Solutions and Their Validation

“…In the first case, the user is required to handle a device and apply a physical pressure to a surface to trigger events. Whereas, in the second case, [2], [4], [5], [7], [10], [11], [18], [22], [24], [25], [28], [30], [34], [45], [51], [53], [60]- [121] 79 Mobile devices [13], [16], [19], [26], [31], [36], [37], [39], [41], [43], [44], [59],…”

“…Immediate feedback after actions can also be useful, as it could help the users knowing when they succeeded or failed and why, recognizing their errors, recovering strategies, reducing their frustration and increasing their motivation. To this purpose, multimodal feedback are often provided, through congratulation messages, hints or events, like objects disappearing if correctly selected or sounds of clapping hands to highlight the correctness of a given answer [4]- [6], [13], [20], [41], [43], [50], [57], [59], [106], [112], [125], [133], [162], [208], [210]- [212]. Finally, since the benefits of cognitive training might only be noticed in the long term, healthy competition is greatly appreciated as it can positively affect patients psychological well-being and promote social networking.…”

“…Touchscreen surface [3]- [5], [7], [13], [16], [19], [21], [26], [31]- [33], [36], [37], [39], [41], [43], [44], [48], [50], [58], [59], [85], [118], [121]- [127], [129]- [145], [160]- [168], [199], [225], [232] 60…”

“…Access to a higher level is often bound to the achievement of a certain score, accuracy or number of consecutive correct trials or to the acquirement of certain motor and cognitive abilities [2]- [24] and, sometimes, inadequate performance can lead to a negative level adjustment [25]- [42]. Alternative solutions include the use of AI techniques, as case-based algorithms [43], ontology based models [44], or open learner models [45], or giving the therapists [46]- [48] and the patients [17], [49], [50] the permission to intervene in the difficulty level selection. Otherwise, difficulty adjustments can be done real-time, during gameplay, by modifying game parameters according to players performance [51]- [53].…”

Alpha-band power increases in posterior brain regions in attention deficit hyperactivity disorder after digital cognitive stimulation treatment: randomized controlled study

“…Indeed, this type of algorithm has already been shown to be effective in improving cognitive processes affected in ADHD patients. 34 …”