Immediate Neuropsychological and Behavioral Benefits of Computerized Cognitive Rehabilitation in Ugandan Pediatric Cerebral Malaria Survivors

Abstract

Objective-Our earlier studies on Ugandan children surviving cerebral malaria showed cognitive deficits mainly in attention and memory. We now present the first study in sub-Saharan Africa to investigate the feasibility and potential benefits of computerized cognitive rehabilitation training on neuropsychological and behavioural functioning of children surviving cerebral malaria.Methods-A randomized trial in which 65 children admitted 45 months earlier with cerebral malaria were recruited at Mulago Hospital, Kampala, Uganda. For eight weeks, 32 of the children received weekly training sessions using Captain's Log cognitive training software and the other 33 were assigned to a non treatment condition. Pre-and post-intervention assessments were completed using CogState, a computerized neuropsychological battery, measuring Visuomotor Processing Speed, Working Memory, Learning, Attention and Psychomotor Speed and the Child Behavior Checklist measuring Internalising Problems, Externalising Problems and Total Problems.Results-Pre-intervention scores were similar between both groups. Treatment effects were observed on Visual Spatial Processing Speed (group effect (standard error) 0.14 (0.03); p< 0.001); on a Working Memory and Learning task (0.08 (0.02); p< 0.001), Psychomotor Speed (0.14 (0.07); p= 0.04) and on Internalising Problems (−3.80 (1.56); p= 0.02) after controlling for age, sex, school grade, quality of the home environment and weight for age z scores. Similar treatment effects were observed when no adjustments for the above covariates were made.Conclusions-Computerized cognitive training long after the cerebral malaria episode has immediate benefit on some neuropsychological and behavioral functions in African children. The long-term benefit of this intervention needs to be investigated.

A Randomized Controlled Trial to Evaluate if Computerized Cognitive Rehabilitation Improves Neurocognition in Ugandan Children with HIV

“…10,12,13,44 This study, however, is the first to do so within a more rigorous RCT study utilizing full and limited CCRT and passive control arms. The Astle et al study lacked a passive control arm for performance and connectivity reference.…”

“…This computerized neurocognitive assessment was used in our prior CCRT studies. 13,[25][26][27] A 30-min session is presented, which includes playing cards in a game-like manner to assess memory, attention, discrimination learning, and executive function that is nonlanguage dependent. It does so with card detection (simple reaction time), identification (choice reaction time), one-back WM, and one-card learning.…”

“…11 Similar improvements were noted for Captain's Log CCRT with children surviving severe malaria. 12,13 Although CCRT had an immediate effect on cognitive outcomes pertaining to attention and some aspects of learning, the evidence was inconclusive in terms of neuropsychological or psychosocial behavioral benefit at school or in the home.…”

Pediatric Cerebral Malaria: A Scourge of Africa

“…In a subsequent computerized cognitive rehabilitation training study with this same cohort of children approximately 3 years after their illness [103], TNF-a levels during the acute illness was significantly negatively correlated with neuropsychological memory and learning performance prior to cognitive rehabilitation training intervention. Statistically significant negative Spearman correlation coefficients were obtained between CSF TNF-a during illness and computerized maze learning (p = 0.03), card detection (attention; p = 0.025), card identification (two-step attention; p = 0.009) and card one-back working memory task (p = 0.02) immediately prior to cognitive rehabilitation training intervention.…”

“…Neurocognitive rehabilitative treatment programs are usually unavailable in the low-resource settings where most affected children live. A computerized cognitive rehabilitation therapy has recently been successfully piloted in CM survivors [103]. A randomized controlled trial of this therapy targeting pediatric severe malaria survivors is in process with end points targeting abnormalities in working memory, executive functioning and psychosocial adjustment.…”