Culture–specific neurodevelopmental assessment of HIV-affected children

在NIH的资助下，我们开发了BPG(脑力游戏)，CCRT(计算机化认知游戏 康复治疗)为撒哈拉以南地区艾滋病毒携带者学童提供的数字游戏包。当一个孩子玩耍时， BPG将为神经认知评估收集游戏数据。BPG已经在HIV+儿童中进行了试点测试。 在研究目标1中，我们将评估同时效度和预测性效度。在这里，我们将评估BPG静态 (基线)评估将很好地符合我们的黄金标准静态衡量标准(KABC-II、TOVA、CogState)。 与这些相比，我们假设动态的BPG评估将提供更敏感的 评估大脑/行为功能受更接近的艾滋病毒暴露、疾病和 治疗。我们还假设，动态评估对远端发育风险更敏感。 因素(例如，社会经济地位、营养/生长、母亲照料质量)。 在研究目标2中，我们将比较BPG静态评估和动态评估的有效性。在这里，我们将验证 BPG静态和动态评估，采用以前使用的神经心理测试的黄金标准 我们的两个研究地点(乌干达坎帕拉和马拉维布兰太尔)的5-12岁儿童。孩子们将在3岁 队列：1)HIV阳性；2)HIV暴露和未感染(HEU)；3)HIV未暴露和未感染(HUU)。 由于参与了我们之前由美国国立卫生研究院赞助的艾滋病毒临床试验，队列将具有良好的特征。我们 假设基于BGP的静态和动态评估将对队列的先前纵向敏感 受导致发育迟缓和认知障碍的近端和远端风险因素影响的轨迹 问题，正如我们之前对这些队列进行的临床试验研究中所衡量的那样。 在研究目标3中，我们将在训练结束后测试动态评估对学习损失的敏感性。一个 动态评估的优点应该是它对随时间推移的学习损失的敏感性，以此作为衡量力量的标准。 大脑/行为功能的神经可塑性阳性。在这里，我们将通过评估所有3个队列来测试敏感性 在孩子完成12岁后6个月进行BPG和黄金标准测试(KABC-II、TOVA、CogState) BPG培训课程。我们假设BPG在6个月后动态评估学习损失。 CCRT后UP对儿童HIV脑/行为功能的完整性尤其敏感。 总体影响：BPG将成为第一个针对静态和动态双重认知评估进行验证的CCRT。 我们希望BPG的动态评估能力将为HIV疾病如何 和治疗影响大脑发育，使敏感和可获得的认知测量工具 临床试验。在资源受限的情况下，BPG也可以是一种可访问且成本低廉的评估工具 使社区卫生工作者能够监测患有其他疾病的儿童的大脑发育情况 疾病和伤害。它可以作为一款基于移动设备的平板电脑或智能手机设备来实现这一点，从而使Easy 无语言认知测试的可扩展性，这可以作为认知康复干预的一部分。

With NIH funding we have developed BPG (Brain Powered Games), a CCRT (Computerized Cognitive Rehabilitation Therapy) digital games package for HIV+ school children in the sub-Sahara. As a child plays, BPG will gather game data for neurocognitive assessment. BPG has been pilot-tested in HIV+ children. In Study Aim 1 we will evaluate concurrent and predictive validity. Here we will evaluate whether BPG static (baseline) assessment will correspond well to our gold standard static measures (KABC-II, TOVA, CogState). Compared to these, we hypothesize that dynamic BPG assessments will provide for a more sensitive evaluation of brain/behavior function as affected by more proximal factors of HIV exposure, disease and treatment. We also hypothesize that dynamic assessments will be more sensitive to distal developmental risk factors (e.g., SES, nutrition/growth, maternal caregiving quality). In Study Aim 2 we will compare the validity of BPG static and dynamic assessments. Here we will validate BPG static and dynamic assessments with a gold standard of neuropsychological tests previously used with children 5 -12 years old at our two study sites (Kampala, Uganda and Blantyre, Malawi). Children will be in 3 cohorts: 1) HIV-positive; 2) HIV exposed and uninfected (HEU); 3) HIV unexposed and uninfected (HUU). Cohorts will be well characterized due to participating in our previous NIH-sponsored HIV clinical trials. We hypothesize that BGP-based static and dynamic assessments will be sensitive to cohorts’ prior longitudinal trajectories as affected by proximal and distal risk factors that cause developmental delay and cognitive problems, as measured in our previous clinical trial studies with these cohorts. In Study Aim 3 we will test the sensitivity of dynamic assessment to learning loss after training ends. An advantage of dynamic assessment should be its sensitivity to learning loss over time as a measure of strength of positive neuroplasticity in brain/behavior functions. Here we will test sensitivity by evaluating all 3 cohorts with BPG and gold standard tests (KABC-II, TOVA, CogState) 6 months after the children complete their 12 sessions of BPG training. We hypothesize that BPG dynamic assessment of learning loss at 6-month follow- up post-CCRT will be especially sensitive to integrity of brain/behavior function in pediatric HIV. Overall Impact: BPG will be the first CCRT validated for dual cognitive assessment, both static and dynamic. We expect BPG’s dynamic assessment capability will provide fundamental new insights into how HIV disease and treatment affects brain development, enabling sensitive and accessible cognitive measurement tools for clinical trials. BPG can also be an accessible and inexpensive assessment tool in resource-constrained settings to enable community health workers to monitor brain development in children burdened by other diseases and injuries. It can do so as a mobile-based tablet or smart phone device lending itself to easy scalability of language-free cognitive testing, which can be done as part of cognitive rehabilitation intervention.