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A Randomized Controlled Trial to Evaluate if Computerized Cognitive Rehabilitation Improves Neurocognition in Ugandan
Michael J Boivin1, Noeline Nakasujja2, Alla Sikorskii3
11 Departments of Psychiatry and Neurology & Ophthalmology, Michigan State University , East Lansing, Michigan.
Insights
Computerized cognitive rehabilitation training (CCRT) improved cognitive functions in Ugandan children with HIV. This intervention shows promise for neurocognitive rehabilitation in low-resource settings.
Area of Science:
- Neuroscience
- Pediatrics
- Global Health
Background:
- Children with HIV often experience cognitive impairments affecting neuromotor, attention, memory, and executive functions.
- These deficits can persist even in clinically stable children receiving antiretroviral therapy.
- Addressing cognitive challenges is crucial for the overall well-being and development of children with HIV.
Purpose of the Study:
- To evaluate the neuropsychological and behavioral benefits of computerized cognitive rehabilitation training (CCRT) in Ugandan children living with HIV.
- To determine if CCRT can improve cognitive functions in a low-resource setting.
- To assess the long-term effects of CCRT on cognitive performance and behavior.
Main Methods:
- 159 rural Ugandan children (6-12 years) with WHO Stage I or II HIV disease were randomized into three groups: full CCRT, limited CCRT, or a passive control group.
- The CCRT involved 24 one-hour sessions over 2 months using "Captain's Log" software targeting working memory, attention, and visual-spatial skills.
- Assessments were conducted at baseline, immediately after the 2-month intervention, and 3 months post-intervention.
Main Results:
- The full CCRT group showed significantly greater improvements in the Kaufman Assessment Battery for Children-second edition (KABC-II) mental processing index, planning, and knowledge compared to controls.
- The limited CCRT group demonstrated significant improvements in learning.
- Both CCRT groups exhibited significant gains in CogState Groton maze learning, though not in attention/memory or behavioral ratings.
Conclusions:
- Computerized cognitive rehabilitation training (CCRT) is an effective intervention for neurocognitive rehabilitation in clinically stable children with HIV in low-resource settings.
- CCRT can lead to measurable improvements in specific cognitive domains, including processing, planning, and learning.
- Further research may explore optimizing CCRT protocols for broader cognitive and behavioral benefits in this population.
Objectives:
Clinically stable children with HIV can have neuromotor, attention, memory, visual-spatial, and executive function impairments. We evaluated neuropsychological and behavioral benefits of computerized cognitive rehabilitation training (CCRT) in Ugandan HIV children.
Design:
One hundred fifty-nine rural Ugandan children with WHO Stage I or II HIV disease (6 to 12 years; 77 boys, 82 girls; M = 8.9, SD = 1.86 years) were randomized to one of three treatment arms over a 2-month period.
Methods:
The CCRT arm received 24 one-hour sessions over 2 months, using Captain's Log (BrainTrain Corporation) programmed for games targeting working memory, attention, and visual-spatial analysis. These games progressed in difficulty as the child's performance improved. The second arm was a "limited CCRT" with the same games rotated randomly from simple to moderate levels of training. The third arm was a passive control group receiving no training. All children were assessed at enrollment, 2 months (immediately following CCRT), and 3 months after CCRT completion.
Results:
The CCRT group had significantly greater gains through 3 months of follow-up compared to passive controls on overall Kaufman Assessment Battery for Children-second edition (KABC-II) mental processing index (p < .01), planning (p = .04), and knowledge (p = .03). The limited CCRT group performed better than controls on learning (p = .05). Both CCRT arms had significant improvements on CogState Groton maze learning (p < .01); although not on CogState attention/memory, TOVA/impulsivity, or behavior rating inventory for executive function and child behavior checklist (psychiatric behavior/symptom problems) ratings by caregiver.
Conclusions:
CCRT intervention can be effective for neurocognitive rehabilitation in children with HIV in low-resource settings, especially in children who are clinically stable on ARV treatment.
