Rehabilitation of Executive function in Paediatric Traumatic brain injury (REPeaT): protocol for a randomized controlled trial for treating working memory and decision-making

Abstract

BackgroundWorking memory allows us to hold information in an active state for short periods of time, and is essential in facilitating goal directed cognitive functioning. Difficulties in working memory and decision-making are common post childhood Traumatic Brain Injury (TBI). Despite this, there is a paucity of research pertaining to implementation and effectiveness of interventions to reduce these common difficulties which impact significantly on one’s ability to function independently. One such intervention, Cogmed Working Memory Training Program, has shown success in improving working memory in other childhood clinical populations, but has received little evaluation in the TBI area. This study aims to evaluate whether Cogmed improves working memory and decision-making post childhood TBI and whether these benefits generalize to functional areas.MethodsThe study is a randomized controlled trial (RCT) of the Cogmed (RM version) intervention for children post-TBI. Children aged 7–15 years are initially screened for working memory impairments. Eligible participants are then randomized into either the treatment group (Cogmed) or the active-control group (Lexia Reading). Each group trains online for 50 min each day, 5 days per week, for 5 consecutive weeks. The online training is supported by online clinician meetings each week. Outcome neuropsychological and functional assessments are carried out immediately at the completion of the intervention and at 6 months follow-up.DiscussionThis study follows gold standard methodology in intervention research; uses a novel measure of decision-making; measures the effects of intervention on functional outcomes immediately and longer-term post intervention; uses online clinician support in order to allow more families easy access to the program; and promotes the use of technology to improve health services. If efficacious in improving working memory, decision-making, and functional outcomes, our team will then take a key role in implementing Cogmed into clinical care.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12617000085370. Trial Registration Date: 16/01/2017. Protocol Version/Date: HREC 35181G/18.08.2017. Study Status: Ongoing.

Rehabilitation of Executive Function in Pediatric Traumatic Brain Injury (REPeaT): Outcomes of a pilot randomized controlled trial.

“…Following screening for eligibility, participants were randomly assigned to (a) the treatment group (Cogmed) or (b) an active-control group (Lexia Reading Core5). Both groups completed their respective computerized training programs from their homes with the supervision of a parent and weekly clinician support via online video platform (see Sood et al, 2018, for detailed methodology and see Figure 2).…”

“…Parents/guardians were sent a tracing letter followed by a phone-call to provide them with more information. Eligibility criteria included: (a) an evidence of at least 6 months post mild-to-severe TBI; (b) school-age (7–15 years) at the time of intervention; and (c) reduced WM or EF (1 SD below mean, see Table 1) on screening measures (Sood et al, 2018); (d) fluent in English; (e) no severe sensory, physical or neurological impairment, or learning difficulty diagnosis; (f) general intellectual ability above 70; and (g) primary caregiver/family available to supervise the training program. At screening written parental and child (if above 12 years) consent was obtained.…”

“…WM is the ability to hold, retain, manipulate, and retrieve information in an active mental state for a short period of time (Baddeley, 2007; Baddeley & Hitch, 1974). WM is fundamental for higher order cognitive processes and activities such as mathematics (Peng et al, 2016; Pennington & Ozonoff, 1996; Raghubar et al, 2010), adaptive behavior, social skills, and quality of life (Catroppa & Anderson, 2011; Sood et al, 2018). Models of WM describe a multicomponent ability that consists of two information storage systems that maintain and manipulate verbal (phonological loop) and visuospatial (visuospatial sketchpad) information, a central executive system that processes verbal and visuospatial information simultaneously, and an episodic buffer that integrates information from different components into multimodal representations (Baddeley, 2007; Baddeley & Hitch, 1974; Repovs & Baddeley, 2006).…”

“…Consequently, deficits in WM postchildhood TBI may also derail the development of DM. Pediatric studies using gambling tasks as a measure of DM post-TBI have shown severity-related compromise in DM (Hanten et al, 2006; Schmidt et al, 2012); however, these studies are limited, with no study investigating the relationship between WM and DM in this clinical population (Sood et al, 2018). Therefore, WM may be regarded as an important target for intervention in children post-TBI.…”

“…Therefore, WM may be regarded as an important target for intervention in children post-TBI. With extensive evidence demonstrating cognitive interventions have effective results (Simons et al, 2016), the utility of an intervention that targets WM may also further influence improvements in DM and subsequent longer term functional skills (Sood et al, 2018). Despite this, there are few evidence-based interventions in this area (Catroppa & Anderson, 2006; Sood et al, 2018).…”