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COGNITIVE REHABILITATION IN CHILDREN WITH ACQUIRED BRAIN INJURIES. Ingrid van ´t Hooft PhD Department of Women and Child Health Astrid Lindgren Children´s Hospital Karolinska University Hospital Karolinska Institutet NBCNS MÖTE SOLBACKA 2008.
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IN CHILDREN WITH ACQUIRED BRAIN INJURIES
Ingrid van ´t Hooft PhDDepartment of Women and Child HealthAstrid Lindgren Children´s HospitalKarolinska University HospitalKarolinskaInstitutetNBCNS MÖTE SOLBACKA 2008
Acquired Brain Injury
Injury to the brain occurring after the post neonatal period
50% of children with severe to moderate TBI
(Brown 1981, Klonoff 1995, Catroppa & Anderson 1999, Anderson et al. 2004)
46% of children who suffered a stroke
(Chapman 2003, Max et al. 2004)
50% of children treated for brain malignancies
(Fletcher & Copeland 1988, Armstrong & Horn 1995, Parker et al 1997, Mulhern et al 1998, Mulhern 2005)
Slow processing speed
Neuropsychological tests, observations
Cognitive training is a theoretically based, specific and repeated training of impaired cognitive processes, with the aim to reduce behavioural changes due to CNS pathology
Reviews of a large number of studies in adults with TBI provide support for the effectiveness of cognitive rehabilitation
(Cappa 2003, Carney 2000 , Cicerone 2000, Cicerone et al. 2005)
PROCESS SPECIFIC TRAINING
Brett & Laatsch 1998, Franzen et al. 2005,
Thomson & Kerns 2000
:Butler & Copeland 1998
Light 1987, Ponsford 2001, Braga 2005
Hendriks 1996, Butler 2002
Reviews : Limond &Leek 2005, Anderson & Catroppa 2006, Laatsch et al. 2007
AMAT-C (Hendriks 96) SMART –C (van´tHooft et al. 2003, 2005, 2007)
Pilotprojectvan´t Hooft I, Andersson K, Sejersen T, Bartfai A, von Wendt L. Acta Paediatrica, 2003, 92; 935-940.3 children (9-16 years of age) with TBI trained 30 min per day during 20 weeks.
Test 6 months follow up
17weeks of training
2 children relapsed into malignancy.
Auditory Reaction Time Tests
Visual Reaction Time Test
Gordon Diagnostic System
Stroop Colour and Word Test
Binary Choice Test
Trail Making Test A, B
Coding ( WISC III)
Rey Auditory Verbal Learning
Rey-Osterrieth Complex Figure
Rivermead Behavioural Memory Test
TEST RESULTS TREATMENT GROUP CONTROL GROUP P VALUE
BINARY CHOICE RT
BINARY CHOICE CORRECT
15 WORDS RECALL
15 WORDS DELAYED
SIGNIFICANT IMPROVEMENTS WAS SHOWN ON MORE COMPLEX NEUROPSYCHOLOGICAL TESTS
NO SIGNIFICANT DIFFERENCES WERE OBSERVED ON SIMPLE REACTION TIME TESTS
Beneficial effect from a cognitive training programme on children with acquired brain injuries demonstrated in a controlled studyvan´t Hooft I, Andersson K, Bergman B, Sejersen T, von Wendt L, Bartfai A.Brain Injury, 2003, 19(7), 511-518.
in children with acquired brain injuriesvan’t Hooft I, Andersson K, Bergman B, Sejersen, von Wendt L, Bartfai A.vol 22.2 NeuroRehabilitation 2007
15 WORDS RECALL
REY COMPLEX FIGURE
Measuring effects on behaviour after cognitive training in children with acquired brain injuriesvan’tHooft I, Brodin U, Sejersen T, von Wendt L, Bartfai A.Submitted 2008
Aims: Evaluating the effects of cognitive training on school performance, attention, executive functions and social behaviour
Method: Ansula Behavioural Rating Scales (Levin 1992) as rated by parents, teachers and children before, immediately after completed training and at the 6 months follow up.
Teachers observed a significant change (p<.008) of school performance in the training group as compared to the controls direct after training
Parents showed the same trend
Smart training ……
Pilotstudie on 3 children with medulloblastomas
Reducing the time to 10 weeks
Combining the training with a parental programme of 5x1hour sessions
Transfer of exercises to daily life at home and at school
Support of the emotional and social aspects
Thanks for your attention
GOOD AND BAD BRAIN DRAWN BY KLARA 10 YEARS OF AGE