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How to effectively evaluate the outcome of neurocognitive rehabilitation in children with neurological disorders?
Last modified: 2014-04-03
Abstract
Introduction
Attention impairment is commonly accompanying traumatic brain injury (TBI) and partial epilepsy (PE). Still, few systematically controlled neurocognitive rehabilitation techniques for children exist. Furthermore, evaluation of training effectiveness is insufficient. The aim of the study is to compare objective and subjective outcome assessments of computer-based attention dysfunction rehabilitation.
Methods
8 children (mean age 11.14 yrs; SD=0.90) with PE or mild TBI received individual supervised computer-based attention functions training using FORAMENRehab software (Sarajuuri et al., 2000), adapted for children by authors. Trainings occurred twice a week during 5-week-period following strict protocol. Intervention addressed four aspects of attention – sustaining, focusing, complex attention and tracking. For objective outcome evaluation children performed baseline tasks before and after the intervention. Subjective outcome was evaluated by parents’ ratings.
Results
Objective effect of rehabilitation was remarkable. Wilcoxon signed-rank test confirmed improvement in sustained attention (faster solving, Z=-2.366, Mr1=4.00, Mr2=0.00, p=0.018) and complex attention (increased correct responses, Z=-2.201, Mr1=0.00, Mr2=3.5, p=0.028 and decreased mistakes, Z=-1.992, Mr1=4.00, Mr2=1.00, p=0.046). Subjective evaluation of training effect showed positive behavioral change: children were more tranquil, diligent and less distracted. Reading, writing, mathematics, socialization and visuomotor skills improved. Besides, parents recommended the intervention to other patients.
Conclusions
Our multifaceted neurorehabilitation design with FORAMENRehab is effective for children with PE or mTBI. Intervention effectiveness is best confirmed in combination of objective testing and subjective evaluations. Intervention combines principles of holistic rehabilitation, modern computer-assisted neurocognitive rehabilitation and individual approach. Baseline assessment tasks could also be used as a diagnostic tool for describing attention dysfunctions.
Attention impairment is commonly accompanying traumatic brain injury (TBI) and partial epilepsy (PE). Still, few systematically controlled neurocognitive rehabilitation techniques for children exist. Furthermore, evaluation of training effectiveness is insufficient. The aim of the study is to compare objective and subjective outcome assessments of computer-based attention dysfunction rehabilitation.
Methods
8 children (mean age 11.14 yrs; SD=0.90) with PE or mild TBI received individual supervised computer-based attention functions training using FORAMENRehab software (Sarajuuri et al., 2000), adapted for children by authors. Trainings occurred twice a week during 5-week-period following strict protocol. Intervention addressed four aspects of attention – sustaining, focusing, complex attention and tracking. For objective outcome evaluation children performed baseline tasks before and after the intervention. Subjective outcome was evaluated by parents’ ratings.
Results
Objective effect of rehabilitation was remarkable. Wilcoxon signed-rank test confirmed improvement in sustained attention (faster solving, Z=-2.366, Mr1=4.00, Mr2=0.00, p=0.018) and complex attention (increased correct responses, Z=-2.201, Mr1=0.00, Mr2=3.5, p=0.028 and decreased mistakes, Z=-1.992, Mr1=4.00, Mr2=1.00, p=0.046). Subjective evaluation of training effect showed positive behavioral change: children were more tranquil, diligent and less distracted. Reading, writing, mathematics, socialization and visuomotor skills improved. Besides, parents recommended the intervention to other patients.
Conclusions
Our multifaceted neurorehabilitation design with FORAMENRehab is effective for children with PE or mTBI. Intervention effectiveness is best confirmed in combination of objective testing and subjective evaluations. Intervention combines principles of holistic rehabilitation, modern computer-assisted neurocognitive rehabilitation and individual approach. Baseline assessment tasks could also be used as a diagnostic tool for describing attention dysfunctions.
Keywords
pediatric rehabilitation, computer-assisted cognitive rehabilitation, attention deficit, epilepsy, mild traumatic brain injury, FORAMENRehab
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