Computerized Cognitive Rehabilitation in Children after Severe Malaria

描述（由申请人提供）：研究主题：我们在乌干达的先前工作中记录了1/4的脑型疟疾（CM）学龄幸存者在患病后两年内持续存在注意力，记忆力或学习障碍。目前没有可行的治疗方法来预防这些残疾，撒哈拉以南非洲每年有数十万儿童受到影响。150名严重疟疾幸存者（5至12岁）和150名健康的社区对照（CC）儿童将从他们的家庭中招募成为我们的研究参与者。其中50名儿童将被随机选择接受24个计算机认知康复治疗（CCRT）项目的培训课程，该项目名为“船长日志”，主要针对有注意力和/或学习问题的美国儿童。将对主动控制组实施不以渐进方式指导儿童训练的锁定版船长日志，对被动控制组不进行干预。儿童将在家中或附近的诊所接受培训，由现场培训师监督。研究目的1：评估CCRT在改善乌干达重症疟疾幸存儿童的神经心理表现和精神预后方面的有效性。研究目的2：评估疟疾疾病的严重程度（例如，免疫性脑炎症、EEG异常）是CCRT神经心理学益处的预测因素。结局评估：在8周培训期前后和1年随访时，将进行儿童考夫曼成套评估（第2版）（KABC-2）、注意力变量视觉和听觉测试（TOVA）、CogState计算机神经心理学筛查测试、Bruininks-Oseretsky运动能力测试（第2版）和Achenbach儿童行为量表（CBCL）。学习成绩的提高也将得到评估。我们以前使用所有这些评估与乌干达儿童生存CM或艾滋病毒，以有效地评估神经心理和精神问题，并记录CCRT的有效性。船长的日志有一个内部评估功能，这将有助于我们监测具体的训练任务，孩子们最好的反应。根据我们先前对CM幸存者和HIV感染儿童进行CCRT干预的研究，我们预计CCRT可有效改善注意力、记忆力和学习能力;我们的评估将足够敏感，以记录神经心理学和精神病学方面的益处。分析：我们将比较重症疟疾干预组和对照组儿童在8周CCRT和1年随访时的神经心理学和精神病学增益（3 × 2 ANCOVA控制家庭环境质量）。CCRT干预儿童的这些收益将显著更大（研究目标1）。疟疾疾病期间更严重的免疫学和EEG指标将显示更需要CCRT的改善（研究目的2）。结论：CCRT治疗重症疟疾是有效的，可持续的。CCRT和计算机化认知测试将被证明是治疗资源匮乏环境中儿童的可行方法。

DESCRIPTION (provided by applicant): Research Topic: We have documented in our prior work in Uganda that 1 out of 4 school-age survivors of cerebral malaria (CM) has persisting attention, memory, or learning impairment two years after illness. No viable treatment presently exists to prevent these disabilities, and hundreds of thousands of children are affected each year in sub-Sahara Africa. One hundred and fifty severe malaria survivors (5 to 12 yrs of age), and 150 healthy community control (CC) children recruited from their households will be our study participants. Fifty of these children will be randomly selected to receive 24 training sessions of a computerized cognitive rehabilitation therapy (CCRT) program called Captain's Log, marketed mostly for American children with attention and/or learning problems. A locked version of Captain's Log which does not direct the child's training in a progressive manner will be administered to an active control group, and no intervention for the passive control group. Children will undergo training in their homes or in a nearby clinic supervised by a field trainer. Study Aim 1: To evaluate the effectiveness of CCRT in improving neuropsychological performance and psychiatric outcomes in Ugandan children who survive severe malaria. Study Aim 2: To evaluate whether severity of malaria illness (e.g., immunological brain inflammation, EEG abnormalities) is predictive of neuropsychological benefit from CCRT. Outcome Assessments: The Kaufman Assessment Battery for Children, 2nd ed. (KABC-2), visual and auditory Tests of Variables of Attention (TOVA), CogState computerized neuropsychological screening test, Bruininks-Oseretsky Test of Motor Proficiency (2nd edition), and Achenbach Child Behavior Checklist (CBCL) will be administered before and after the 8-week training period and at 1-yr follow-up. Improvements in academic performance will also be evaluated. We have previously used all these assessments with Ugandan children surviving CM or with HIV to effectively evaluate neuropsychological and psychiatric problems, and to document the effectiveness of CCRT. Captain's Log has an internal evaluator feature which will help us monitor the specific training tasks to which the children best respond. Based on our prior research with CCRT intervention with CM survivors and in children with HIV, we expect CCRT to be effective in improving attention, memory, and learning; and that our assessments will be sensitive enough to document neuropsychological and psychiatric benefit. Analyses: We will compare neuropsychological and psychiatric gains over the 8-weeks of CCRT and at 1-yr follow-up for our intervention groups across the severe malaria and control children (3 by 2 ANCOVA controlling for quality of home environment). These gains will be significantly greater for the CCRT intervention children (Study Aim 1). More severe immunological and EEG indicators during malaria illness will show greater need for an improvement from CCRT (Study Aim 2). Conclusion: CCRT will prove effective and sustainable in rehabilitation for severe malaria. CCRT and computerized cognitive tests will prove viable for treating children in resource-poor settings.