Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial

Abstract

Background Impaired executive functions (EFs, i.e., purposeful, goal-directed behaviour) cause significant disability after paediatric acquired brain injury (pABI) warranting efficient interventions. Goal Management Training (GMT) is a metacognitive protocol proven effective for executive dysfunction in adults. This pre-registered, blinded, parallel-randomized controlled trial evaluated efficacy of a paediatric adaptation (pGMT) compared to a psychoeducative control (paediatric Brain Health Workshop, pBHW) to improve EF. Methods Children aged 10 to 17 years with pABI (e.g., traumatic brain injury, brain tumour), ≥ 1 year post-onset or ended treatment, with parent-reported EF complaints were eligible. Participants were randomized (computer-algorithm) to either group-based pGMT (n = 38) or pBHW (n = 38). The active control was tailored to keep non-specific factors constant. Thus, both treatments comprised of 7 sessions at hospitals over 3 consecutive weeks, followed by 4 weeks of telephone counselling of participants, parents, and teachers. Parent-reported daily life EF, assessed by the questionnaire Behavior Rating Inventory of Executive Function (BRIEF; Behavioral Regulation Index (BRI) and Metacognition Index (MI)), were co-primary outcomes 6 months post-intervention. Secondary outcomes included neuropsychological tests and a complex naturalistic task (Children’s Cooking Task). Results Seventy-three participants (96%) completed allocated interventions and 71 (93%) attended the 6-month follow-up. The results demonstrated no significant difference in effectiveness for the two interventions on parent-reported EF: For BRIEFBRI, mean (SD) raw score for pGMT was 42.7 (8.8) and 38.3 (9.3) for pBHW. Estimated difference was − 2.3 (95% CI − 5.1 to 0.6). For BRIEFMI, the corresponding results were 80.9 (20.4) for GMT and 75.5 (19.3) for pBHW. Estimated difference was − 1.4 (95% CI −8.5 to 5.8). In performance-based tests, pGMT was associated with improved inhibition and executive attention, while pBHW was associated with fewer errors in the naturalistic task. Conclusions In pABI, metacognitive training (pGMT) did not demonstrate additional effectiveness on parent-reported daily life EF at 6-month follow-up, when compared to a psychoeducative control. Both interventions were well-tolerated and demonstrated distinct improvements at different EF assessment levels. To conclude on pGMT efficacy, larger studies are needed, including further investigation of appropriate assessment levels and possible differences in effect related to treatment duration, developmental factors, and injury characteristics. Trial registration ClinicalTrials.gov, NCT0321534211, 11 July 2017

Assessment of Executive Function in Everyday Life—Psychometric Properties of the Norwegian Adaptation of the Children’s Cooking Task

“…Seventy-seven participants with pABI who met inclusion and exclusion criteria and completed baseline assessment in the RCT study were included in this study. For a full description of recruitment procedures, see Hypher et al (2019Hypher et al ( , 2021 and Brandt et al (2021). In addition, further two participants with severe motor and language dysfunction but who were able to attend regular school, were unable to complete the CCT without adult interference and were thus excluded.…”

“…The HCs were assessed by the same test administrator at each site. However, the HCs were only assessed with the WISC-V subscales Vocabulary, Similarities, Block Design, Matrix Reasoning (Brandt et al, 2021); the CCT, and the BADS-C (including parent report from the DEX-C). The order of test presentation varied across participants.…”

Predictors of Functional School Outcome in Children With Pediatric Acquired Brain Injury

“…This cross-sectional study presents baseline data derived from a dual site, evaluator-blinded, parallel group randomized controlled trial (RCT) on the efficacy of cognitive rehabilitation for children and adolescents with pABI ( 55 , 56 ). The original RCT was preregistered at clinical.trials.gov (NCT03215342), approved by the Regional Committee for Medical and Health Research Ethics (2017/772), Norway, and conducted in accordance with principles of Good Clinical Practice, the Helsinki Declaration and the standards for Ethical Research Involving Children (ChildWatch International and UNICEF).…”

“…Seventy-six participants (mean age 13.4 years, SD = 2.3, 57% girls), with pABI resulting from non-traumatic (brain tumor, stroke, hypoxia/anoxia, and brain infections/inflammations; n = 58) and traumatic (TBI; n = 18) injuries, and who were between the age of 10 to 17 years at time of invitation, were recruited from trauma referral centers from the north, mid- and south-east regions of Norway (see Table 1 for demographic and medical characteristics). Information related to the inclusion and exclusion criteria was collected by a semi-structured interview [for more details about the semi-structured interview see ( 56 )]. Inclusion required executive complaints in daily life as determined by a free description of the child‘s function in daily-life and specific EF questions (e.g., “ Does the child handle doing more than one thing at the same time?…”

“…in the semi-structured interview, in addition to minimum 12 months since injury/illness or completion of cancer therapy. The exclusion criteria consisted of: (i) pABI before 2 years of age; (ii) cognitive, sensory, physical or language impairment affecting the capacity to attend regular school (i.e., follow educational goals of peers and regular teaching) and/or complete the intervention; (iii) preinjury neurological disease, severe psychiatric disorder and/or stimulant medication; (iv) recently detected brain tumor relapse [see also ( 56 )].…”