ABSTRACT

Children in Uganda are at risk for significant cognitive sequelae from severe malaria. Computerized cognitive rehabilitation training (CCRT) represents a potential method to improve working memory, behavior, and executive functioning, cognitive domains most at risk following severe malaria. The primary aim of this study was to complete a secondary analysis of data from a concluded CCRT randomized control trial in order to compare the training efficiency of a commonly used CCRT program under conditions of titrated (adaptive) or non-titrated (non-adaptive) training and with children with increasing malaria severity to determine how various factors may affect potential CCRT improvement. A total of 201 school-aged children (66.2% boys) who were either healthy (n = 102) or previously diagnosed with severe or cerebral malaria (n = 99) were randomized into two active treatment arms (titrated and non-titrated learning). Each child received 24 one-hour sessions of training over 8 weeks using Captain’s Log® CCRT by BrainTrain, which includes a comprehensive set of CCRT tasks. Children generally benefited from CCRT over the 24 training sessions, but titrated CCRT showed a clear advantage over non-titrated. Severity of illness or factors such as BMI, did not moderate CCRT performance indicators. These findings support our hypothesis that titrated CCRT would result in steeper improvement in learning, but do not support our hypothesis that history of recent significant illness would affect learning proficiency. Findings were evident across all CCRT performance scores, even given that children were from generally rural, low-resource settings and were generally unfamiliar with computers.

ABBREVIATIONS:

Computerized Cognitive Rehabilitation Training (CCRT); Mental Processing Index (MPI); Home Observation for the Measurement of the Environment (HOME); Socioeconomic Status (SES); least square means (LSM)

摘要

乌干达的儿童面临严重疟疾导致严重认知后遗症的风险。计算机化认知康复训练 (CCRT) 代表了一种改善工作记忆、行为和执行功能的潜在方法，这些认知领域在严重疟疾后最危险。本研究的主要目的是对已结束的 CCRT 随机对照试验的数据进行二次分析，以比较常用 CCRT 计划在滴定（自适应）或非滴定（非自适应）条件下的训练效率培训并与疟疾严重程度增加的儿童一起确定各种因素如何影响潜在的 CCRT 改善。共有201名学龄儿童（66. 健康 (n = 102) 或先前被诊断患有严重或脑型疟疾 (n = 99) 的 2% 男孩被随机分为两个积极治疗组（滴定和非滴定学习）。每个孩子在 8 周内使用 BrainTrain 的 Captain's Log® CCRT 接受了 24 次一小时的培训，其中包括一套全面的 CCRT 任务。在 24 次培训课程中，儿童普遍受益于 CCRT，但滴定的 CCRT 显示出明显优于未滴定的优势。疾病的严重程度或 BMI 等因素并没有缓和 CCRT 性能指标。这些发现支持我们的假设，即滴定的 CCRT 会导致学习的更大幅度改善，但不支持我们的假设，即近期重大疾病史会影响学习能力。调查结果在所有 CCRT 绩效得分中都很明显，

缩写：

计算机化认知康复训练（CCRT）；心理加工指数（MPI）；家庭环境测量观测（HOME）；社会经济地位（SES）；最小二乘均值 (LSM)