1. Computerized cognitive rehabilitation training can improve neuropsychological outcomes in rural school-age Ugandan children with HIV.
Michael J. Boivin1,2, Bruno Giordani2, Paul Bangirana3, Alla Sikorskii4, Noeline Nakasujja3, Brian Winn5, Bryan Novak5, Robert O. Opoka6
1Dept. Of Psychiatry, Michigan State University; 2Dept. of Psychiatry, University of Michigan; 3Dept. of Psychiatry, Makerere University, Kampala, Uganda; 4Dept. of Statistics, Michigan State University;
5Dept. of Telecommunications, Michigan State University; 6Dept. of Paediatrics, Makerere University, Kampala, Uganda
STUDY POPULATION
Children 5 to 12 yrs with HIV, Kayunga District, Uganda
ANALYSIS MODEL
BACKGROUND
For HIV African children, enhanced access and effectiveness to ARV medications has changed the prognosis from a uniformly deadly disease early in childhood, to one in which survival well into adolescence is not uncommon (Armstrong F., 2003) (O'Hare, Venables, & Southall, 2005).
As such, pediatric HIV illness is increasingly becoming a sub-acute, chronic disease marked by developmental lag and progressive encephalopathy (PE) (Van Rie, Mupuala, & Dow, 2008).
The primary purpose of this study was to compare the neuropsychological benefit of 24 training sessions of Captain's Log computerized cognitive rehabilitation therapy (CCRT) to active and passive control groups over a 8-week period.
CCRT programs are currently used for children with developmental disabilities (e.g., ADHD) in high-income countries. Our group is the first to use CCRT with children with HIV in Africa (Boivin et al., 2010).
Neurocognitive rehabilitation treatment programs may be successful in improving cognitive performance outcomes in Ugandan HIV children.
RESEARCH QUESTION
Can Computerized Cognitive Rehabilitation Therapy improve short and long-term neuropsychological and psychiatric outcomes in Ugandan children with HIV?
REFERENCES
CONCLUSIONS
Ugandan children with HIV from resource-limited settings are adapting well to the computerized cognitive games training . They improved on some cognitive performance and learning tasks as a result of training.
CCRT may be a viable means of neurocognitive enrichment and rehabilitation in African children with poor access to other behavioral services.
NEXT PHASE: BRAIN POWERED GAMES
We are now in the process of field testing an African village version of CCRT (Brain Powered Games; BPG) developed at Michigan State University.
BPG is being implemented with our passive control group and we are seeing significant CogState working memory and TOVA attention benefits.
BPG has the advantage in that it has been coded for scaling to a mobile network platform, found throughout the developing world. BPG will be used for both cognitive assessment and rehabilitative training in resource-poor global settings.
ACKNOWLEDGEMENTS
Funding support from R34 MH (PI: Boivin). The authors have no financial disclosures or conflicts of interest to report.This study approved by Michigan State University, the University of Michigan, and Makerere University School of Medicine IRBs. The authors thank the Makerere University Walter Reed Project (MU-WRP) for their laboratory and medical treatment support of the children. We wish to thank the children and families of Kayunga who supported this work through their participation.
METHODS
ASSESSMENTS
Kaufman Assessment Battery for Children, 2nd edition (KABC-II): Sequential Processing (Memory), Simultaneous Processing (Visual-Spatial analysis), Learning, and Planning (Reasoning) global scales.
Test of Variables of Attention (TOVA): Visual Test
CogState Computerized Cognitive Assessment Battery: Groton Maze Task and Card Detection, Identification, One-Back Memory, and One-Card Learning Tasks.
Achenbach Child Behavior Checklist (CBCL): Internalizing Symptoms, Externalizing Symptoms
Behavior Inventory of Executive Function - BRIEF
Bruininks-Oseretsky Test of Motor Proficiency.
*All assessments had been previously adapted and have been shown to be culturally sensitive and reliable.
RESULTS
Both CCRT and active controls show comparable improvements throughout the 8 weeks of training in terms of the Captain’s Log performance measures on the training exercises.
Both groups also had greater gains over the passive control groups on KABC-II global performance (MPI), CogState Groton maze learning, Groton maze chase tests, card detection, and care identification tasks.
There were no significant differences in performance improvement among the three groups on TOVA attention test performance, BOT-2 motor proficiency test, or on the number of emotional or behavioral symptoms reported by the caregiver for the child on the Achenbach CBCL or BRIEF.
Figure 1: Methods—Children with HIV are randomly assigned to Treatment with Captain’s Log CCRT, Active Control (limited Captain’s Log), and Passive Control. (no intervention).
Armstrong F., W. E., Surgen K. (2003). HIV/AIDS in Children and Adolescents In M. Roberts (Ed.), Handbook of Pediatric Psychology (3rd ed., pp ). New York: Guilford Press.
O'Hare, B. A., Venables, J., & Southall, D. (2005). Child health in Africa: 2005 a year of hope? Arch Dis Child, 90(8),
Van Rie, A., Mupuala, A., & Dow, A. (2008). Impact of the HIV/AIDS epidemic on the neurodevelopment of preschool-aged children in Kinshasa, Democratic Republic of the Congo. Pediatrics, 122(1), e
Okamoto, S.-i., Kang, Y.-J., Brechtel, C. W., Siviglia, E., Russo, R., Clemente, A., et al. (2007). HIV/gp120 decreases adult neural progenitor cell proliferation via checkpoint kinase-mediated cell-cycle withdrawal and G1 arrest. Cell Stem Cell, 1(2),
Boivin, Busman, Parikh, Bangirana, Page, Opoka, Giordani (2010). A Pilot Study of the Neuropsychological Benefits of Computerized Cognitive Rehabilitation in Ugandan Children With HIV. Neuropsychology, 24(5),