Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial

Abstract 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 d...

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Autores principales:	Anne E. Brandt, Torun G. Finnanger, Ruth E. Hypher, Torstein B. Rø, Eva Skovlund, Stein Andersson, Kari Risnes, Jan Stubberud
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Executive function Cognition Paediatric acquired brain injury Goal management training Cognitive rehabilitation Medicine R
Acceso en línea:	https://doaj.org/article/de1ce15380964372aa8ac455d1e99d18
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spelling	oai:doaj.org-article:de1ce15380964372aa8ac455d1e99d182021-11-08T10:45:50ZRehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial10.1186/s12916-021-02129-81741-7015https://doaj.org/article/de1ce15380964372aa8ac455d1e99d182021-11-01T00:00:00Zhttps://doi.org/10.1186/s12916-021-02129-8https://doaj.org/toc/1741-7015Abstract 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 BRIEFBRI, mean (SD) raw score for pGMT was 42.7 (8.8) and 38.3 (9.3) for pBHW. Estimated difference was − 2.3 (95% CI − 5.1 to 0.6). For BRIEFMI, the corresponding results were 80.9 (20.4) for GMT and 75.5 (19.3) for pBHW. Estimated difference was − 1.4 (95% CI −8.5 to 5.8). In performance-based tests, pGMT was associated with improved inhibition and executive attention, while pBHW was associated with fewer errors in the naturalistic task. 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 2017Anne E. BrandtTorun G. FinnangerRuth E. HypherTorstein B. RøEva SkovlundStein AnderssonKari RisnesJan StubberudBMCarticleExecutive functionCognitionPaediatric acquired brain injuryGoal management trainingCognitive rehabilitationMedicineRENBMC Medicine, Vol 19, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Executive function Cognition Paediatric acquired brain injury Goal management training Cognitive rehabilitation Medicine R
spellingShingle	Executive function Cognition Paediatric acquired brain injury Goal management training Cognitive rehabilitation Medicine R Anne E. Brandt Torun G. Finnanger Ruth E. Hypher Torstein B. Rø Eva Skovlund Stein Andersson Kari Risnes Jan Stubberud Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial
description	Abstract 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 BRIEFBRI, mean (SD) raw score for pGMT was 42.7 (8.8) and 38.3 (9.3) for pBHW. Estimated difference was − 2.3 (95% CI − 5.1 to 0.6). For BRIEFMI, the corresponding results were 80.9 (20.4) for GMT and 75.5 (19.3) for pBHW. Estimated difference was − 1.4 (95% CI −8.5 to 5.8). In performance-based tests, pGMT was associated with improved inhibition and executive attention, while pBHW was associated with fewer errors in the naturalistic task. 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
format	article
author	Anne E. Brandt Torun G. Finnanger Ruth E. Hypher Torstein B. Rø Eva Skovlund Stein Andersson Kari Risnes Jan Stubberud
author_facet	Anne E. Brandt Torun G. Finnanger Ruth E. Hypher Torstein B. Rø Eva Skovlund Stein Andersson Kari Risnes Jan Stubberud
author_sort	Anne E. Brandt
title	Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial
title_short	Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial
title_full	Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial
title_fullStr	Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial
title_full_unstemmed	Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial
title_sort	rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial
publisher	BMC
publishDate	2021
url	https://doaj.org/article/de1ce15380964372aa8ac455d1e99d18
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Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial

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