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Randomized clinical trial on the effects of early cognitive interventions for children with acquired brain injury
Claudia Corti1, Susanna Frigerio2, Monica Recla2
1Department of Severe Acquired Brain Lesions, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy. claudia.corti@lanostrafamiglia.it.
Insights
Early cognitive rehabilitation for pediatric acquired brain injuries (ABIs) showed significant improvements in attention and executive functions. Both personalized and standardized interventions were effective, suggesting early standardized approaches may benefit children with ABIs.
Area of Science:
- Neuroscience
- Pediatrics
- Rehabilitation Medicine
Background:
- Pediatric acquired brain injuries (ABIs) can lead to substantial cognitive deficits.
- Early intervention is crucial for recovery, yet optimal rehabilitation formats lack robust evidence.
Purpose of the Study:
- To compare the efficacy of personalized versus fixed-dose cognitive stimulation interventions in children with ABIs.
- To evaluate the impact of multidomain cognitive interventions on various cognitive functions.
Main Methods:
- A randomized clinical trial involving 40 children (aged 5:0-17:11) with ABIs.
- Two groups received 12-week multidomain cognitive rehabilitation (3 daily sessions, 5 days/week).
- Cognitive outcomes, including visual sustained attention, were assessed at baseline and post-intervention.
Main Results:
- Significant improvements were observed in primary (visual sustained attention) and most secondary cognitive outcomes.
- Effect sizes ranged from medium to very large, indicating substantial gains.
- No significant differences were found between the personalized and fixed-dose intervention groups.
Conclusions:
- Both personalized and standardized multidomain cognitive interventions appear effective in the early recovery phase for pediatric ABIs.
- The prolonged, intensive nature of both interventions likely contributed to widespread cognitive improvements.
- While personalized approaches are recommended for chronic phases, standardized interventions may be suitable for early rehabilitation.
Abstract:
Pediatric acquired brain injuries (ABIs) may cause significant cognitive deficits. Early rehabilitation is recommended, but there is no solid evidence on the best intervention formats. This randomized clinical trial investigated the efficacy of two multidomain cognitive interventions for children aged 5:0-17:11. A personalized intervention was compared with an intervention providing a fixed-dose cognitive stimulation. 40 children were randomized into the 2 study arms and received 12-week rehabilitation (3 45-minute daily sessions for 5 days per week). 34 children completed the intervention and were assessed at baseline (T0) and post-intervention (T1). Visual sustained attention and other cognitive measures of attention, memory, visual-spatial/visual-constructional abilities and executive functions were primary and secondary outcomes, respectively. Primary and 14 of the 16 secondary outcomes showed an improvement at T1 with a medium-to-very-large effect, but training effects could not be disentangled from spontaneous recovery. No differences were found between interventions, likely because of the prolonged multidomain stimulation provided by both of them, which might have been helpful in improving the widespread cognitive deficits of children in both groups. Therefore, while for the chronic phase the guidelines recommend a personalized approach, in the early phase of recovery a standardized intervention may also be effective.
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