Technological aids for the rehabilitation of memory and executive functioning in children and adolescents with acquired brain injury

摘要: Background The use of technology in healthcare settings is on the increase and may represent a cost-effective means delivering rehabilitation. Reductions treatment time, delivery home, are also thought to be benefits this approach. Children adolescents with brain injury often experience deficits memory executive functioning that can negatively affect their school work, social lives, future occupations. Effective interventions delivered at without need for high-cost clinical involvement, could provide address current lack provision. We have systematically reviewed studies examining effects technology-based rehabilitation children acquired injury. Objectives To assess compared placebo intervention, no treatment, or other types injury. Search methods We ran search 30 September 2015. We searched Cochrane Injuries Group Specialised Register, Central Register Controlled Trials (CENTRAL), Ovid MEDLINE(R), MEDLINE(R) In-Process & Other Non-Indexed Citations, Daily OLDMEDLINE(R), EMBASE Classic + (OvidSP), ISI Web Science (SCI-EXPANDED, SSCI, CPCI-S, CPSI-SSH), CINAHL Plus (EBSCO), two databases, trials registers. internet, screened reference lists, contacted authors included studies. Selection criteria Randomised controlled comparing technological aid executive-functioning placebo, another intervention. Data collection analysis Two review independently titles abstracts identified by strategy. Following retrieval full-text manuscripts, performed data extraction assessed risk bias. Main results Four (involving 206 participants) met inclusion criteria review. Three studies, involving 194 participants, online target (that monitoring changing behaviour, problem solving, planning, etc.). These which were all conducted same research team, against 'placebo' (participants given internet resources injury). The family home additional support training, both, from psychologist doctoral student. fourth study investigated computer program addition components attention, organisation, solving). No information setting was provided, however speech-language pathologist, teacher, occupational therapist accompanied participants. Two young adults mild severe traumatic (TBI), while remaining moderate TBI. Risk bias We selection bias as low three unclear one study. Allocation high study, Only (n = 120) able conceal allocation therefore overall high. One took steps assessors (low detection bias), did not do so (high bias). Primary outcome 1: Executive functioning: Technology-based intervention versus placebo Results meta-analysis 194) TBI, favoured immediately post-treatment (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.66 -0.09; P 0.62; I2 0%). (As there 'gold standard' measure field, we translated SMD back any particular scale.) This result only small medium effect size (using Cohen’s rule thumb, where 0.2 effect, 0.5 one, 0.8 above large effect); unlikely clinically important participant. The 12) reported differences between control groups solving (an component functioning). standard deviations presented outcome, an calculated. The quality evidence according GRADE very low. highly likely change estimate effect. Primary 2: Memory One statistically significant improvement sentence recall group following eight-week remediation programme. calculated. Secondary outcomes Two 158) anxiety/depression measured Child Behavior Checklist (CBCL) meta-analysis. found (mean -5.59, CI -11.46 0.28; 53%). low, meaning effect. A single sought record adverse events none. Two (range 0 13 1 24 sessions). One functioning/social competence effect. secondary outcomes life academic achievement). Authors' conclusions This provides low-quality functions TBI. As contained relatively numbers participants (12 120), our findings should interpreted caution. involvement clinician therapist, rather than technology, led success these interventions. Future seek replicate larger samples, regions, using ecologically valid measures, reduced involvement.