Computerized Cognitive Rehabilitation in Children after Severe Malaria

描述(申请人提供)：研究主题：我们在乌干达以前的工作中证明，脑型疟疾(CM)的学龄儿童幸存者中有1人在患病两年后出现持续性注意力、记忆或学习障碍。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)和从其家庭招募的150名健康社区控制(CC)儿童将成为我们的研究参与者。这些儿童中的50名将被随机选择接受名为船长日志的计算机化认知康复治疗(CCRT)项目的24个培训课程，该项目主要针对有注意力和/或学习问题的美国儿童。不以循序渐进的方式指导儿童训练的锁定版本的船长日志将被管理给主动控制组，被动控制组不进行干预。孩子们将在自己的家中或附近的诊所接受培训，由现场训练员监督。研究目的1：评价CCRT在改善在严重疟疾中存活的乌干达儿童的神经心理表现和精神结局方面的有效性。研究目的2：评估疟疾疾病的严重程度(如免疫性脑炎、脑电异常)是否可以预测CCRT对神经心理的益处。结果评估：考夫曼儿童评估组合，第二版。在8周的训练前后和1年的随访中，进行KABC-2、注意变量视觉和听觉测试(TOVA)、CogState计算机化神经心理筛查测试、Bruininks-Oseretsky运动能力测试(第二版)和Achenbach儿童行为检查表(CBCL)。学习成绩的提高也将被评估。我们以前曾使用所有这些评估评估存活的乌干达CM儿童或感染艾滋病毒的儿童，以有效地评估神经心理和精神问题，并证明CCRT的有效性。船长日志有一个内部评估器功能，它将帮助我们监控儿童最好地响应的具体培训任务。基于我们之前对CM幸存者和感染艾滋病毒的儿童进行的CCRT干预研究，我们预计CCRT在改善注意力、记忆力和学习方面是有效的；我们的评估将足够敏感，足以证明神经心理和精神方面的好处。分析：我们将比较严重疟疾和对照组儿童在CCRT治疗8周和1年随访期间的神经心理学和精神病学进展(3×2 ANCOVA控制家庭环境质量)。对于CCRT干预的儿童来说，这些收益将显著更大(研究目标1)。疟疾期间更严重的免疫学和脑电指标将表明，更有必要在CCRT(研究目标2)的基础上加以改进。结论：CCRT在重症疟疾的康复治疗中是有效的、可持续的。CCRT和计算机化的认知测试将证明在资源匮乏的环境中治疗儿童是可行的。

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.