COgnitive REhabilitation in pediatric Acquired Brain Injury (CORE pABI). A randomized controlled study

Acquired brain injury (ABI), often caused by trauma or brain tumors, affect several hundred children and adolescents in Norway every year. ABI may substantially reduce cognitive functions like attention, memory, learning, language and executive functions. Executive functions are needed for all aspects of our lives, including everyday tasks like getting dressed or making a meal, academic achievement, social relationships and future employment. ABI in children and adolescents not only impact cognitive functions at the time of injury or onset of disease, but also cognitive functions that are yet to develop. Previously we considered rehabilitation of cognitive functions following ABI a difficult task. Recent knowledge about brain function may prove us wrong. There is currently increasing interest in novel methods to restore brain function after injury. This study "Cognitive Rehabilitation in pediatric acquired brain injury" aimed to increase the knowledge base by employing two different group-based psychologist-led brain training methods in children and adolescents aged 10 to 18 years. The parents and teachers also took part in the training. The methods had different approaches to promote awareness about everyday tasks and thus improve health and everyday life of children and adolescents with ABI. Specifically, we examined whether metacognitive group-based cognitive training was able to improve cognitive function (and in particular executive functions) following ABI in 80 children and adolescents. This was compared to the effect of group-based psychoeducation, that is to learn and understand effects of brain injury. In addition to being assessed immediately following intervention, the participants were also assessed 6 months after the training. We found that both group-based training programmes improved congitive function, and also fatigue - a common disability following acquired brain injury. We found no difference in effect between the two methods. Furthermore, we examined health-related quality of life and prevalence of fatigue in children and adolescents with acquired brain injury, and which factors that potentially influenced quality of life, school function and fatigue. Finally, we assessed new methods to examine executive function in children and adolescents with acquired brain injury. Why is this study important? Both patients, their family, health care providers and the health authorities want better rehabilitation methods for children and adolescents with acquired brain injury. This study shows that cognitive rehabilitation improves health and wellbeing for this patient group, and provides new knowledge about cognitive function in children and adolescents with acquired brain injury.

Studiens hovedmål var å undersøke to ulike typer kognitiv rehabilitering etter ervervet hjerneskade hos barn og ungdom. Studien at det ikke var forskjell mellom de to ulike typene kognitiv rehabilitering etter 6 måneder. Begge rehabiliteringsmetoder var imidlertid godt tolerert og hadde klar positiv effekt på eksekutivfunksjoner. Kognitiv rehabilitering har derfor effekt, men i vår studie var det ingen forskjell på effekt om man valgte en metakognitiv trening (GMT) eller en psykoedukativ trening (BHW). Studien hadde også en rekke sekundære resultatmål som hadde til hensikt å finne ny kunnskap om pasientgruppen og utvikle nye metoder for å måle eksekutivfunksjon i denne pasientgruppen. Det ble gjort flere analyser i forhold til utmattelse (fatigue) som er et vanlig symptom i denne pasientgruppen. Kognitiv rehabilitering syntes å redusere utmattelse, men igjen var det ingen forskjell mellom de to rehabiliteringsmetodene. Faktorer som potensielt påvirker effekt av rehabilitering på utmattelse ble identifisert. Fatigue etter ervervet hjerneskade hos barn og ungdom kan også ha sammenheng med alder, eksekutivfunksjon og livskvalitet. Metoder for å måle eksekutivfunksjon i denne pasientgruppen ble også studert. Konkret ble en økologisk test (Children’s Cooking Task) for måling av eksekutivfunksjon vurdert, og det ble funnet at testen var velegnet for slik måling, og at testen målte dimensjoner av eksekutivfunksjon som andre tester ikke i samme grad måler. En annen test, Behavioural Assessment of the Dysexecutive Syndrome for Children BADS-C, ble også validert på dette deltakermaterialet og funnet valid.

Acquired brain injury (ABI) is one of the leading causes of death and disability in children and adolescents. Unlike adult injury, pediatric ABI does not only impact cognitive functions at the time of injury or onset of disease, but also cognitive functions yet to develop. Change in cognitive function is associated with negative impact on everyday function, academic achievement, social relationships, independence and future employment. Hence, improvements by cognitive rehabilitation interventions may potentially have important life-long effects. Patient organizations and governmental reports describe severe deficiencies in rehabilitation services for children. Important knowledge gaps and methodological shortcomings have been identified in pediatric cognitive rehabilitation research, including the need to evaluate long-term effects, larger sample size, and investigate if variables such as age, etiology or medical treatment influence intervention outcomes. The present study has been designed in close proximity between a multidisciplinary team and relevant user groups to address methodological weaknesses of prior studies. The study presents a long-awaited act directed towards a vulnerable patient group, hopefully closing knowledge gaps and seeks to give rise to new and evidence-based interventions that can be implemented in clinical practice. The research group has conducted a pilot on the study intervention and outcome assessment and has included patients and families from this pilot in the development of the current proposal. The study will be conducted as a multidisciplinary and a multicenter study with two sites that have extensive clinical experience with the patient group. Cooperation with key international actors, including developers of the most central methods employed in the study, has also been established. This project will further strengthen national and international collaboration, and ensure frontline knowledge within pediatric cognitive rehabilitation