Remote Technology-Based Training Programs for Children with Acquired Brain Injury: A Systematic Review and a Meta-Analytic Exploration

Abstract

Introduction. Multidisciplinary rehabilitation interventions are considered to be a need for children with acquired brain injury (ABI), in order to remediate the important sequelae and promote adjustment. Technology-based treatments represent a promising field inside the rehabilitation area, as they allow delivering interventions in ecological settings and creating amusing exercises that may favor engagement. In this work, we present an overview of remote technology-based training programs (TP) addressing cognitive and behavioral issues delivered to children with ABI and complement it with the results of a meta-analytic exploration. Evidence Acquisition. We performed the review process between January and February 2019. 32 studies were included in the review, of which 14 were further selected to be included in the meta-analysis on TP efficacy. Evidence Synthesis. Based on the review process, the majority of TP addressing cognitive issues and all TP focusing on behavioral issues were found to be effective. Two meta-analytic models examining the means of either cognitive TP outcomes or behavioral TP outcomes as input outcome yielded a nonsignificant effect size for cognitive TP and a low-moderate effect size for behavioral TP. Additional models on outcomes reflecting the greatest beneficial effects of TP yielded significant moderate effect sizes for both types of TP. Nevertheless, consistent methodological heterogeneity was observed, pointing to cautious interpretation of findings. A subgroup analysis on visuospatial skill outcomes showed a smaller yet significant effect size of cognitive TP, with low heterogeneity, providing a more reliable estimation of overall cognitive TP effects. Conclusions. Promising results on remote cognitive and behavioral TP efficacy emerged both at the review process and at the meta-analytic investigation. Nevertheless, the high heterogeneity that emerged across studies prevents us from drawing definite conclusions. Further research is needed to identify whether specific training characteristics and population subgroups are more likely to be associated with greater training efficacy.

Tele-Neuro-Rehabilitation in Italy: State of the Art and Future Perspectives

“…Technology-based treatments represent a promising field for multidisciplinary rehabilitation of children with acquired brain injury (ABI). Corti et al ( 22 ) underlined in a recent review that telerehabilitation is promising to enhance cognitive and behavioral domains remotely. Traditional cognitive rehabilitation is known to have some limitations related to the time, costs, and accessibility of patients to these services ( 61 – 63 ).…”

“…Literature data shows that telerehabilitation can be a promising intervention for elderly ( 20 ), adults ( 21 ), children with neurological diseases ( 22 ), as well as for the treatment of motor ( 23 , 24 ), cognitive ( 25 ) and language disorders ( 26 – 30 ). In Italy, the healthcare system could be supported by telemedicine interventions, due to the aging population, the increase in chronicity and morbidity of diseases, and the presence of rural areas, islands, and mountains.…”

Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury: A European Prospective and Multicenter Study

“…One key initiative is to give patients with TBI the opportunity to undergo rehabilitation even if they are discharged home after acute care, and rehabilitation programs may be conducted in day hospital or home settings. 45 Some of these programs may incorporate tele-rehabilitation, which has recently been developed in both pediatric and adult TBI populations, 46,47 and this may help overcome the problem of access to specialized rehabilitation services. As neurobehavioral changes are frequent after TBI, and as patients may show poor self-awareness, 48 initiating early multidisciplinary rehabilitation may help patients better understand their needs and the potential interest of physical or occupational therapy.…”

Home-based cognitive training in pediatric patients with acquired brain injury: preliminary results on efficacy of a randomized clinical trial

“…the feasibility and accessibility of remote computerized cognitive training (CCT) for children with ABI have been documented 24,25 . Preliminary results on the efficacy of CCT in these children [14][15][16]26 or in children with neurodevelopmental disorders 27,28 have also been provided. A recent meta-analysis indicated that remote CCT programs based on the repetition of cognitive exercises (drill-based exercises) have an effect on the visual-spatial abilities of children with ABI, but no effects were documented for other cognitive abilities 26 .…”

“…Preliminary results on the efficacy of CCT in these children [14][15][16]26 or in children with neurodevelopmental disorders 27,28 have also been provided. A recent meta-analysis indicated that remote CCT programs based on the repetition of cognitive exercises (drill-based exercises) have an effect on the visual-spatial abilities of children with ABI, but no effects were documented for other cognitive abilities 26 . Nevertheless, evidence of the effects on far transfer measures of CCT programs for children with ABI has been questioned 29,30 .…”