The Effect of the 'Touch Screen-Based Cognitive Training' for Children with Severe Cognitive Impairment in Special Education.

Traditional education in special schools have some limitations. We aimed to investigate if the 'touch screen-based cognitive training' is feasible and effective for children with severe cognitive impairment (developmental age 18-36 months) in special education. In this case, 29 children were randomly allocated to intervention (n = 17, 'touch screen-based cognitive training', 30 min/session, 3 times/week, 12 weeks) and control (n = 12, traditional education) groups. Psychoeducational Profile-Revised (PEP-R), Early Childhood Behavior Questionnaire (ECBQ), Sequenced Language Scale for Infants (SELSI), Pediatric Evaluation of Disability Inventory (PEDI), and Goal Attainment Scale (GAS) were measured before and after 12 weeks of education. The 'touch screen-based cognitive training' was applicable in special education. When repeated measures analysis of variance (ANOVA) was used, significant groupⅹtime effect was found for GAS, and significant group effect was found for ECBQ (attentional shifting) and GAS. When adjusting for pre-education measurements, the intervention had a significant effect on the post-education measurements of ECBQ (attentional shifting) and GAS (p < 0.05). No relationship existed between the degree of improvements and the severeness of developmental delay in the measurements. 'Touch screen-based cognitive training' in special school was feasible and it improved cognition in children with severe cognitive impairment (developmental age 18-36 months), irrespective of the severeness of the developmental delay.

Effect of Anodal Transcranial Direct Current Stimulation Combined With Cognitive Training for Improving Cognition and Language Among Children With Cerebral Palsy With Cognitive Impairment: A Pilot, Randomized, Controlled, Double-Blind, and Clinical Trial.

About 30-45% of cerebral palsy (CP) patients have cognitive impairment. Previous studies showed the evidence that transcranial direct current stimulation (tDCS) may have some benefits in attention-deficit/hyperactivity disorder, autism spectrum disorder, and motor development in CP. The aim of this study is to evaluate the effect of tDCS on cognition, language, and activities of daily living (ADL) among children with CP with cognitive impairment. It was a pilot, randomized, controlled, double-blind, clinical trial in a tertiary pediatric hospital, and 13 children with CP and a cognitive age under 42 months were enrolled. tDCS group (n = 8) had active tDCS and cognitive training (20 min/session, total 20 sessions, for 12 weeks) and sham group (n = 5) had sham tDCS and cognitive training. Primary outcome was the Bayley Scales of Infant Development II (BSID II). Secondary outcomes were the Pediatric Evaluation of Disability Inventory (PEDI), the Laboratory Temperament Assessment Battery (Lab-TAB), the Early Childhood Behavior Questionnaire (ECBQ), the Korean version of MacArthur-Bates Communicative Development Inventories (M-B CDI-K), the Sequenced Language Scale for Infants (SELSI) and the Preschool Receptive-Expressive Language Scale (PRES). After intervention, the tDCS group showed significant improvements in all measurements (p < 0.05) except the M-B CDI-K (grammar), whereas the sham group only showed significant improvements in the Lab-TAB (manipulation domain), the ECBQ (attentional shifting), and the M-B CDI-K (comprehension). The between-group differences in the degree of post-intervention improvement were not statistically significant. The degree of improvement was associated with better baseline cognitive function and younger age (p < 0.05). There were no major adverse events after tDCS. The combined application of tDCS and cognitive training was feasible and associated with improvements in cognitive function, ADL, and language among children with CP with cognitive impairment. However, considering that it is a pilot study, further larger-scale systematic investigation is needed. Clinical Trial Registration: The trial was registered in the Clinical Research Information Service database, identifier: KCT0003023.

A tablet computer-based cognitive training program for young children with cognitive impairment: A randomized controlled trial.

BACKGROUND: Evidences suggest that cognitive training facilitates cognitive function, and most studies have targeted adults and children older than 4 years of age. This study investigated the applicability and efficacy of a tablet computer-based cognitive training program for young children with cognitive impairment of cognitive age between 18 and 36 months. METHODS: Thirty-eight children were randomly assigned to the intervention (n = 20, administered a tablet computer-based cognitive training program, for 30 minutes per session and twice a week over a period of 12 weeks) and control (n = 18, received the traditional rehabilitation program) groups. Mental scale of Bayley Scales of Infant Development II (BSID II), Pediatric Evaluation of Disability Inventory (PEDI), interest/persistence domain of the Laboratory Temperament Assessment Battery (LAP-TAB), Early Childhood Behavior Questionnaire (ECBQ), and Goal Attainment Scale (GAS) were evaluated before and after 12 weeks of therapeutic intervention. RESULTS: The tablet computer-based cognitive training program was applicable to all children in the intervention group without any problems including irritable behavior or obsession about a tablet computer. After 12 weeks, Mental scale of BSID II, PEDI (social function), LAB-TAB (observation), LAB-TAB (manipulation), and GAS showed statistically significant improvements in the intervention group, compared with the values in the control group (P < .05). After adjusting for the pre-treatment measurements and cognitive age, the tablet computer-based cognitive training program had significant effect on the post-treatment measurements of Mental scale of BSID II, PEDI (social function), LAB-TAB (observation), LAB-TAB (manipulation), and GAS (P < .05). There was no association between the change in the scores and the severity of cognitive delay in the most of the measurements, however, the self-care domain of PEDI showed a negative association with the severity of the cognitive delay (r = -0.462, P = .04). CONCLUSIONS: Application of a tablet computer-based cognitive training program was feasible and showed improvements in cognitive function in young children with cognitive impairment of cognitive age between 18 and 36 months, regardless of the severity of the cognitive delay. But severe cognitive delay can be related with less improvement in the self-care domain of PEDI. TRIAL REGISTRATION NUMBER: https://cris.nih.go.kr (KCT0002889).

Does well-functioning hand constraint induce stress in forced-use therapy for children with unilateral cerebral palsy?

This study investigated the stress induced by well-functioning hand constraint in forced-use therapy (FUT) for children with unilateral spastic cerebral palsy (CP).Seventeen children with unilateral spastic CP (mean age 5.8 years) received FUT: 4-week unaffected upper limb immobilization with a short-arm Scotchcast and were encouraged to incorporate it to their daily routines and plays. They were evaluated at pretreatment, immediate post-treatment, and 6 months post-treatment. The Korea-Child Behavior Checklist (K-CBCL) was used to assess the stress degree; box and block test (BBT), Erhardt Developmental Prehension Assessment (EDPA), Quality of Upper Extremity Skill Test (QUEST), and Pediatric Motor Activity Log (PMAL), upper limb function; and Pediatric Evaluation of Disability Inventory (PEDI), daily living activities.In the preschoolers, most scores of K-CBCL tended to increase after FUT; however, there was no significant change in all scale findings after FUT. In the school-aged children, most scores of K-CBCL tended to decrease after FUT; however, there was no significant change in all scale findings after FUT. The findings of the BBT, QUEST, PMAL how often and well subscales significantly improved post-treatment (P < .05).The 4-week FUT with well-functioning hand constraint significantly improved the UL function and did not induce emotional and behavioral problems in children with unilateral spastic CP.

Development of tablet personal computer-based cognitive training programs for children with developmental disabilities whose cognitive age is less than 4 years.

This study was to develop tablet personal computer-based cognitive training programs for children with developmental disabilities whose cognitive age is less than 4 years. Twelve cognitive training programs (named Injini) were designed comprising cognitive domains that included attention, visual and auditory perception, memory, executive function, language, and reasoning. In addition, programs related to learning experiences, such as self-regulation, role play, learning of number, and letter/shape concepts, comparison, classification, and pattern matching, were included. Six of 12 programs comprised approximately 10 levels for each program, with different difficulty levels. Other programs consisted of universal tasks that did not have a difficulty level. To ensure that the difficulty level was appropriate, we pre-tested the pilot version of Injini among 80 children with typical development aged 18 to 41 months. After modifying the pilot version, we developed the final version and tested it among 80 children with cognitive impairment whose cognitive age was 18 to 41 months. All children were assessed using the Bayley Scales of Infant and Toddler Development to determine their development and cognitive age. The difficulty level analyses in children with typical development revealed several inappropriate results wherein the success rate did not decrease with increase in level in some programs. After adjusting the difficulty level, the analyses in children with cognitive impairment demonstrated that the success rate gradually decreased with increasing level in all programs. Cognitive training programs for children with developmental disabilities were successfully developed.

Effect of Group-Task-Oriented Training on Gross and Fine Motor Function, and Activities of Daily Living in Children with Spastic Cerebral Palsy.

Aims: To determine the effects of group-task-oriented training (group-TOT) on gross and fine motor function, activities of daily living (ADL) and social function of children with spastic cerebral palsy (CP).Methods: Eighteen children with spastic CP (4-7.5 years, gross motor function classification system level I-III) were randomly assigned to the Group-TOT (9 children received group-TOT for 1 hour, twice a week for 8 weeks) or the comparison group (9 children received individualized traditional physical and occupational therapy). The Gross Motor Function Measure (GMFM)-88, the Bruininks-Oseretsky Test of Motor Proficiency 2nd edition (BOT-2), and the Pediatric Evaluation of Disability Inventory (PEDI) were administered before and after the intervention, and in the Group-TOT, 16 weeks after the intervention.Results: Children in the Group-TOT showed significant improvements in the GMFM-88 standing and walking/running/jumping subscales, the BOT-2 manual dexterity subscale, and the PEDI social function subscale (p < 0.05); changes were maintained 16 weeks after the intervention ended. In contrast, the comparison group improved in only the BOT-2 fine motor integration subscale (p < 0.05).Conclusions: The findings provide evidence of effectiveness of group-TOT in improving gross and fine motor function, and social function in children with CP.

Comparison of Second and Third Editions of the Bayley Scales in Children With Suspected Developmental Delay.

OBJECTIVE: To compare the scores of the Bayley Scales of Infant Development second edition (BSID-II) and the third edition, Bayley-III, in children with suspected developmental delay and to determine the cutoff score for developmental delay in the Bayley-III. METHODS: Children younger than 42 months (n=62) with suspected developmental delay who visited our department between 2014 and 2015 were assessed with both the BSID-II and Bayley-III tests. RESULTS: The mean Bayley-III Cognitive Language Composite (CLC) score was 5.8 points higher than the mean BSID-II Mental Developmental Index (MDI) score, and the mean Bayley-III Motor Composite (MC) score was 7.9 points higher than the mean BSID-II Psychomotor Developmental Index (PDI) score. In receiver operating characteristic (ROC) analysis of a BSID-II MDI score <70, Bayley-III CLC scores showed a cutoff of 78.0 (96.6% sensitivity and 93.9% specificity). In ROC analysis of a BSID-II PDI score <70, the Bayley-III MC score showed a cutoff of 80. CONCLUSION: There was a strong correlation between the BSID-II and Bayley-III in children with suspected developmental delay. The Bayley-III identified fewer children with developmental delay. The recommended cutoff value for developmental delay increased from a BSID-II score of 70 to a Bayley-III CLC score of 78 and Bayley-III MC score of 80.