Amsterdam 2015
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| Abstract #3431 - Late Breaker | ||||
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Session: 47.4: Late Breaker (Parallel) on Friday @ 09.00-10.30 in C001 Chaired by Ophelia Haanyama, Chen Zhang Authors: Presenting Author: Prof Michael Boivin - Michigan State University, United States |
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| Additional Authors: | ||||
| Aim: Millions of children worldwide with HIV are at risk for neurocognitive disorders due to HIV encephalopathy. Even clinically stable children can have neuromotor, attention, memory, visual-spatial, and other executive function impairments. This study is a randomized controlled trial to evaluate the neuropsychological and behavioral benefits of computerized cognitive rehabilitation training (CCRT) training in African children with HIV, who have had little prior exposure to computers. | ||||
| Method / Issue: 159 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 yrs) were randomly assigned to one of three treatment arms over a two-month period. The CCRT arm received 24 one-hour sessions (3 days per week) using Captain’s Log (BrainTrain Corporation) programmed for nine different games selected through prior screening to be appropriate for children in this cultural context. The games targeted working memory, attention, and visual-spatial analysis, with each game becoming increasing more difficult as the child gained mastery. The 2nd arm was a “limited CCRT” with the same nine games rotated randomly through the simplest levels of training. The third arm was a passive control group receiving no computer training. All children were assessed at enrollment prior to training, 2 months later (post-CCRT), and 3 months following the end of the training. Every training session was supervised by a research assistant and occurred in a quiet room in or near the child’s home. In addition to Captain’s Log program-based measures of performance improvement to ensure fidelity of training, assessment outcomes included the Kaufman Assessment Battery for Children, 2nd ed. (KABC-II), the CogState computerized cognitive performance test, Tests of Variables of Attention (TOVA), Behavior Rating Inventory of Executive Function (BRIEF, parent version), and the Achenbach Child Behavior Checklist (CBCL, parent version). | ||||
| Results / Comments: At post-training and 3-mo follow-up, the CCRT group had significantly greater gains compared to passive controls on overall KABC-II performance (P<0.01), Planning/Reasoning (P=0.04), and Knowledge (P=0.03). The limited CCRT group performed better than controls on Learning (P=0.05). Both CCRT arms had significantly greater gains on CogState Groton maze learning (P<0.01), but not any of the other CogState memory or attention measures, TOVA attention/impulsivity, or BRIEF and CBCL behavior/symptom ratings. Compared to controls, global performance gains on KABC-II and CogState were significant for both the CCRT and CCRT-limited children who were on HAART (P<0.02). CCRT gains in KABC-II, CogState, and TOVA performance during training were significantly associated with Captain’s Log performance improvements of training fidelity across the 24 training sessions (P<0.01). | ||||
| Discussion: CCRT intervention can be an effective and viable means of neurocognitive rehabilitation in children with HIV in low resource settings. We are evaluating whether neurocognitive gains correspond to gains in academic achievement, or improvements in behavioral adjustment in the home or community. These are important considerations as more evidence emerges regarding the behavioral and psychosocial risk to children with HIV in low-resource settings as they survive into adolescence. Future studies are planned evaluating cognitive games for tablets and smart phones that can make cognitive evaluation and CCRT accessible on a mobile network. | ||||
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