Home-based cognitive training in pediatric patients with acquired brain injury: preliminary results on efficacy of a randomized clinical trial

Abstract

Cognitive rehabilitation may compensate for cognitive deficits of children with acquired brain injury (ABI), capitalizing on the use-dependent plasticity of a developing brain. Remote computerized cognitive training (CCT) may be delivered to patients in ecological settings, ensuring rehabilitation continuity. This work evaluated cognitive and psychological adjustment outcomes of an 8-week multidomain, home-based CCT (Lumosity Cognitive Training) in a sample of patients with ABI aged 11-16 years. Two groups of patients were engaged in five CCT sessions per week for eight weeks (40 sessions). According to a stepped-wedge research design, one group (Training-first Group) started the CCT immediately, whereas the other group (Waiting-first Group) started the CCT after a comparable time of waiting list. Changes after the training and after the waiting period were compared in the two groups. Both groups improved in visual-spatial working memory more after the training than after the waitinglist period. The Training-first group improved also in arithmetic calculation speed. Findings indicate that a multi-domain CCT can produce benefits in visual-spatial working memory, probably because, in accordance with previous research, computer games heavily tax visuo-spatial abilities. This suggests that the prolonged stimulation of the same cognitive ability may generate the greatest benefits in children with ABI.Pediatric acquired brain injuries (ABI) are among the main causes of lifelong disabilities in school age children and are often accompanied by cognitive, behavioral and affective problems 1-4 . From a cognitive point of view, impairments in global intelligence or core cognitive domains, such as attention, memory, executive functions, processing speed and visual abilities, have been reported 2,3 . These impairments may be associated with negative academic outcomes and short-and long-term functional problems at home and in general life in community 5-7 . Even those children having an intellectual quotient within the normal range often experience difficulties at school after the injury 8,9 . Tailored rehabilitation on cognitive functions has been recognized to be a key component of medical care following an ABI, as it may lead to improved functioning in everyday life [10][11][12][13][14][15][16] . Indeed, early stimulation of cognitive functions may promote use-dependent brain plasticity 17,18 and enhance the potential for the inherent brain plasticity after damage 19 . However, after hospitalization, a high number of children with ABI do not receive any help or support, experiencing a problematic return to ecological settings 20,21 .Recently, technological devices have been introduced in rehabilitation to provide treatments deliverable in ecological settings with the aim to overcome the limitations of a traditional rehabilitative approach, such as elevated costs, accessibility problems and heterogeneity in treatment practice, and to reach larger numbers of patients [22][23][24] . The majority of these programs have been dev...

Feasibility and Acceptability of a Real-Time Telerehabilitation Intervention for Children and Young Adults with Acquired Brain Injury During the COVID-19 Pandemic: An Experience Report

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