Neuropsychological benefits of computerized cognitive rehabilitation training in Ugandan children surviving severe malaria: A randomized controlled trial

Authors

Michael J. Boivin, Michigan State University, USA
Noeline Nakasujja, Makerere University School of Medicine, Uganda
Alla Sikorskii, Michigan State University, USA
Horacio Ruiseñor- Escudero, Michigan State University, USA
Itziar Familiar- Lopez, Michigan State University, USA
Kimberley Walhof, University of Utah Medical School, USA
Esther M. van der Lugt, Leiden University Medical Center, The Netherlands
Robert Opoka, Aga Khan UniversityFollow
Bruno Giordani, University of Michigan, USA

Document Type

Article

Department

Paediatrics and Child Health (East Africa)

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 CCRT malaria 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.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

Brain Research Bulletin

DOI

10.1016/j.brainresbull.2018.03.002

Recommended Citation

Boivin, M. J., Nakasujja, N., Sikorskii, A., Escudero, H. R., Lopez, I. F., Walhof, K., van der Lugt, E. M., Opoka, R., Giordani, B. (2019). Neuropsychological benefits of computerized cognitive rehabilitation training in Ugandan children surviving severe malaria: A randomized controlled trial. Brain Research Bulletin, 145(2019), 117-128.
Available at: https://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/455