Computer training and strategy instruction for children and adolescents with acquired brain injury.

Children and adolescents with acquired brain injury (ABI) frequently report problems with cognitive functioning and consequently problems with psychosocial functioning. While these problems are usually targeted with cognitive rehabilitation, evidence from well-designed studies into effectiveness of cognitive rehabilitation is lacking in this population. Computer-based cognitive retraining (CBCR) is a promising cognitive rehabilitation method, but has been insufficiently investigated in children and adolescents with ABI. The aim of the current study is to target cognitive functioning (i.e., attention, working memory, and executive functioning,) and consequentially psychosocial functioning (i.e., participation, family functioning and quality of life) of children and adolescents (age 8–18) with ABI by use of a CBCR combined with explicit strategy instruction. The study has a multicentre pretest-posttest trial design. There will be three time points of measurement: baseline (T0) before the start of the intervention period, post intervention (T1), and follow-up three months after the intervention (T2). Children and adolescents with ABI (n=50) who are at least 6 months post-injury and are experiencing cognitive problems will be recruited from rehabilitation centres and specialized schools during approximately 4 years (January 2016– December 2020).
All participating children and adolescents will be offered a 6–week CBCR program targeting a wide range of cognitive functions (i.e., attention, working memory, and executive functioning) combined with explicit strategy instruction. Participants train 5 times a week for approximately 30 minutes and attend 45 minutes of explicit strategy instruction per week. Three cognitive tests have been selected as primary outcome measures to assess change in attention (score on d2), working memory (score on Corsi Block-Tapping Test), and executive functioning (score on Concept Shifting Task). The main study parameters are the change in performance from baseline measurement (T0) to post intervention measurement (T1, i.e., 6 to 8 weeks after T0) on each of these three tests. For a broad overview of cognitive functioning after the intervention period, additional cognitive tests have been selected as secondary outcomes. Furthermore, subjective cognitive functioning (as measured with questionnaires) and psychosocial functioning (i.e., participation, family functioning and quality of life) of children and adolescent with ABI are considered secondary study parameters.

Children and adolescents with acquired brain injury who receive the computer-based cognitive retraining combined with the explicit strategy instruction will show significantly more improvement of cognitive functioning (i.e., attention, working memory, and executive functioning) and psychosocial functioning (i.e., participation, family functioning and quality of life) compared to children who only receive care as usual.

Baseline before the start of the intervention period (T0);

Post intervention (T1);

Follow-up three months after the intervention (T2).

All participating children and adolescents will receive care as usual. In addition, participants in the intervention group will be offered a 6–week CBCR program targeting a wide range of cognitive functions (i.e., attention, working memory, and executive functioning) combined with explicit strategy instruction. Participants train 5 times a week for approximately 30 minutes and attend 45 minutes of explicit strategy instruction per week.