Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial.
Cognition
Cognitive rehabilitation
Executive function
Goal management training
Paediatric acquired brain injury
Journal
BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723
Informations de publication
Date de publication:
02 11 2021
02 11 2021
Historique:
received:
19
03
2021
accepted:
14
09
2021
entrez:
2
11
2021
pubmed:
3
11
2021
medline:
24
11
2021
Statut:
epublish
Résumé
Impaired executive functions (EFs, i.e., purposeful, goal-directed behaviour) cause significant disability after paediatric acquired brain injury (pABI) warranting efficient interventions. Goal Management Training (GMT) is a metacognitive protocol proven effective for executive dysfunction in adults. This pre-registered, blinded, parallel-randomized controlled trial evaluated efficacy of a paediatric adaptation (pGMT) compared to a psychoeducative control (paediatric Brain Health Workshop, pBHW) to improve EF. Children aged 10 to 17 years with pABI (e.g., traumatic brain injury, brain tumour), ≥ 1 year post-onset or ended treatment, with parent-reported EF complaints were eligible. Participants were randomized (computer-algorithm) to either group-based pGMT (n = 38) or pBHW (n = 38). The active control was tailored to keep non-specific factors constant. Thus, both treatments comprised of 7 sessions at hospitals over 3 consecutive weeks, followed by 4 weeks of telephone counselling of participants, parents, and teachers. Parent-reported daily life EF, assessed by the questionnaire Behavior Rating Inventory of Executive Function (BRIEF; Behavioral Regulation Index (BRI) and Metacognition Index (MI)), were co-primary outcomes 6 months post-intervention. Secondary outcomes included neuropsychological tests and a complex naturalistic task (Children's Cooking Task). Seventy-three participants (96%) completed allocated interventions and 71 (93%) attended the 6-month follow-up. The results demonstrated no significant difference in effectiveness for the two interventions on parent-reported EF: For BRIEF In pABI, metacognitive training (pGMT) did not demonstrate additional effectiveness on parent-reported daily life EF at 6-month follow-up, when compared to a psychoeducative control. Both interventions were well-tolerated and demonstrated distinct improvements at different EF assessment levels. To conclude on pGMT efficacy, larger studies are needed, including further investigation of appropriate assessment levels and possible differences in effect related to treatment duration, developmental factors, and injury characteristics. ClinicalTrials.gov , NCT0321534211, 11 July 2017.
Sections du résumé
BACKGROUND
Impaired executive functions (EFs, i.e., purposeful, goal-directed behaviour) cause significant disability after paediatric acquired brain injury (pABI) warranting efficient interventions. Goal Management Training (GMT) is a metacognitive protocol proven effective for executive dysfunction in adults. This pre-registered, blinded, parallel-randomized controlled trial evaluated efficacy of a paediatric adaptation (pGMT) compared to a psychoeducative control (paediatric Brain Health Workshop, pBHW) to improve EF.
METHODS
Children aged 10 to 17 years with pABI (e.g., traumatic brain injury, brain tumour), ≥ 1 year post-onset or ended treatment, with parent-reported EF complaints were eligible. Participants were randomized (computer-algorithm) to either group-based pGMT (n = 38) or pBHW (n = 38). The active control was tailored to keep non-specific factors constant. Thus, both treatments comprised of 7 sessions at hospitals over 3 consecutive weeks, followed by 4 weeks of telephone counselling of participants, parents, and teachers. Parent-reported daily life EF, assessed by the questionnaire Behavior Rating Inventory of Executive Function (BRIEF; Behavioral Regulation Index (BRI) and Metacognition Index (MI)), were co-primary outcomes 6 months post-intervention. Secondary outcomes included neuropsychological tests and a complex naturalistic task (Children's Cooking Task).
RESULTS
Seventy-three participants (96%) completed allocated interventions and 71 (93%) attended the 6-month follow-up. The results demonstrated no significant difference in effectiveness for the two interventions on parent-reported EF: For BRIEF
CONCLUSIONS
In pABI, metacognitive training (pGMT) did not demonstrate additional effectiveness on parent-reported daily life EF at 6-month follow-up, when compared to a psychoeducative control. Both interventions were well-tolerated and demonstrated distinct improvements at different EF assessment levels. To conclude on pGMT efficacy, larger studies are needed, including further investigation of appropriate assessment levels and possible differences in effect related to treatment duration, developmental factors, and injury characteristics.
TRIAL REGISTRATION
ClinicalTrials.gov , NCT0321534211, 11 July 2017.
Identifiants
pubmed: 34724955
doi: 10.1186/s12916-021-02129-8
pii: 10.1186/s12916-021-02129-8
pmc: PMC8561897
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
253Informations de copyright
© 2021. The Author(s).
Références
Dev Neurorehabil. 2009 Apr;12(2):76-91
pubmed: 19340660
Clin Neuropsychol. 2016;30(1):95-106
pubmed: 26789092
Brain Inj. 2019;33(12):1522-1528
pubmed: 31446793
Br J Psychiatry. 1994 Jan;164(1):104-6
pubmed: 8137088
Brain Inj. 2018;32(6):679-692
pubmed: 29621405
J Int Neuropsychol Soc. 2000 Mar;6(3):299-312
pubmed: 10824502
J Head Trauma Rehabil. 2014 May-Jun;29(3):198-207
pubmed: 23640543
J Int Neuropsychol Soc. 2019 Nov;25(10):1082-1087
pubmed: 31232252
Brain Inj. 2005 Jun;19(6):459-70
pubmed: 16101268
Neuropsychology. 2011 Mar;25(2):176-84
pubmed: 21219074
Front Psychol. 2015 Mar 26;6:328
pubmed: 25859234
Patient Relat Outcome Meas. 2019 Apr 16;10:129-140
pubmed: 31114411
J Child Neurol. 2016 Jan;31(1):20-7
pubmed: 25123531
J Child Psychol Psychiatry. 2013 Feb;54(2):131-43
pubmed: 23057693
Dev Disabil Res Rev. 2009;15(2):133-43
pubmed: 19489085
Brain Cogn. 2004 Jun;55(1):104-15
pubmed: 15134846
J Neurotrauma. 2014 Apr 1;31(7):649-57
pubmed: 24147615
NeuroRehabilitation. 2014;34(1):87-100
pubmed: 24284466
Pediatrics. 2013 Jul;132(1):e158-66
pubmed: 23753094
BMC Med. 2010 Mar 24;8:18
pubmed: 20334633
PLoS One. 2015 Apr 29;10(4):e0124679
pubmed: 25923534
J Neuropsychol. 2010 Sep;4(Pt 2):197-209
pubmed: 19930791
Perspect Psychol Sci. 2013 Jul;8(4):445-54
pubmed: 26173122
Annu Rev Psychol. 2013;64:135-68
pubmed: 23020641
Neuropsychol Rehabil. 2009 Oct;19(5):716-32
pubmed: 19306233
Cogn Psychol. 2000 Aug;41(1):49-100
pubmed: 10945922
J Child Psychol Psychiatry. 2005 Apr;46(4):339-52
pubmed: 15819643
Child Neuropsychol. 2002 Jun;8(2):71-82
pubmed: 12638061
Dev Neurosci. 2006;28(4-5):364-79
pubmed: 16943660
J Int Neuropsychol Soc. 2011 Sep;17(5):759-65
pubmed: 21729406
Pediatrics. 2014 Mar;133(3):e546-52
pubmed: 24534397
Disabil Rehabil. 2014;36(2):105-16
pubmed: 23597002
Brain Inj. 2005 Sep;19(10):819-31
pubmed: 16175842
J Int Neuropsychol Soc. 2013 Jul;19(6):672-85
pubmed: 23575309
Cortex. 2000 Dec;36(5):649-69
pubmed: 11195912
Front Behav Neurosci. 2013 Feb 15;7:10
pubmed: 23422934
Neuropsychologia. 2007 Mar 25;45(6):1318-30
pubmed: 17084422
Am J Geriatr Psychiatry. 2011 Mar;19(3):240-8
pubmed: 20808114
Phys Med Rehabil Clin N Am. 2007 Feb;18(1):133-44, vii
pubmed: 17292816
BMJ Open. 2019 Aug 1;9(8):e029273
pubmed: 31375619
J Head Trauma Rehabil. 2005 Jan-Feb;20(1):95-109
pubmed: 15668573
J Int Neuropsychol Soc. 2010 Jan;16(1):118-29
pubmed: 19900348
Annu Rev Neurosci. 1990;13:25-42
pubmed: 2183676
Front Hum Neurosci. 2011 Feb 17;5:9
pubmed: 21369362
NeuroRehabilitation. 2003;18(3):239-50
pubmed: 14530589
NeuroRehabilitation. 2012;30(3):205-12
pubmed: 22635125
Arch Clin Neuropsychol. 2008 Mar;23(2):201-16
pubmed: 18096360
Brain Inj. 2012;26(9):1033-57
pubmed: 22715895
Br J Clin Pharmacol. 1994 May;37(5):401-4
pubmed: 8054244
Neuropsychol Rehabil. 2011 Apr;21(2):145-63
pubmed: 21229458
Pediatr Clin North Am. 2009 Aug;56(4):843-63
pubmed: 19660631
Clin Psychol Rev. 2008 Jun;28(5):801-23
pubmed: 18061324
Neuropsychol Rehabil. 2019 Dec;29(10):1569-1599
pubmed: 29540124
J Int Neuropsychol Soc. 2016 Apr;22(4):436-52
pubmed: 26812574
Dev Neuropsychol. 2008;33(5):623-36
pubmed: 18788014
Curr Dir Psychol Sci. 2012 Feb;21(1):8-14
pubmed: 22773897
Neuropsychologia. 2002;40(3):271-81
pubmed: 11684160
Neuropsychol Rehabil. 2020 Jan;30(1):130-161
pubmed: 31671014
Pediatrics. 2005 Dec;116(6):1374-82
pubmed: 16322161
Arch Phys Med Rehabil. 2019 Aug;100(8):1515-1533
pubmed: 30926291
J Pediatr Psychol. 2015 Apr;40(3):272-84
pubmed: 25080604
PM R. 2014 Sep;6(9):814-24
pubmed: 24755513
Pediatr Rehabil. 1999 Oct-Dec;3(4):167-75
pubmed: 10819429
Cortex. 2017 Jan;86:186-204
pubmed: 27251123
J Clin Epidemiol. 2010 Aug;63(8):e1-37
pubmed: 20346624
Neuropsychol Rehabil. 2021 May;31(4):601-620
pubmed: 32065032
Arch Phys Med Rehabil. 2016 Nov;97(11):1841-1852.e3
pubmed: 27424292
J Int Neuropsychol Soc. 1996 Jul;2(4):274-81
pubmed: 9375175