A pilot study of the neuropsychological benefits of computerized cognitive rehabilitation in Ugandan children with HIV.
OBJECTIVE
Because antiretroviral treatment (ART) fails to improve neurocognitive impairment in children with HIV, we completed a pilot study evaluating the feasibility and cognitive benefit of computerized cognitive rehabilitation therapy (CCRT) in Ugandan children with HIV.


METHODS
Sixty Ugandan children with HIV (23 on ART) were randomly assigned to 10 sessions of Captain's Log CCRT (Sandford, 2007) training configured for attention and memory skills or no intervention. Kaufman Assessment Battery for Children (2nd ed., KABC-2; Kaufman & Kaufman, 2004) performance at baseline indicated pervasive neurocognitive impairment. Cognitive ability was assessed before and after training using the Cogstate computerized neuropsychological test (Darby, Maruff, Collie, & McStephen, 2002). Viral load along with CD4 and CD8 absolute and activation levels also were measured posttest.


RESULTS
CCRT was well received with a 95% adherence rate to scheduled training sessions. CCRT intervention children showed greater improvement on a Cogstate card detection task of simple attention (p = .02), and speed of correct moves on a Groton Maze Learning Task (p < .001). These analyses were completed using an analysis of covariance model that adjusted Cogstate performance for the child's age, standardized weight for age, gender, socioeconomic status, school grade level, and baseline KABC-2 performance. ART treatment was not related to Cogstate performance or improvement as a result of CCRT. CD4 and CD8 activation levels were correlated with Cogstate improvement specifically for the CCRT group.


CONCLUSIONS
CCRT was feasible with our study population and improved maze learning and attention on a detection task. This supports previous findings by our group with cerebral malaria survivors (Bangirana, Giordani, et al., 2009).
Boivin
Michael J
MJ
International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, MI 48824–1315, USA. boivin@msu.edu
Busman
Rachelle A
RA
Parikh
Sujal M
SM
Bangirana
Paul
P
Page
Connie F
CF
Opoka
Robert O
RO
Giordani
Bruno
B
D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D003194:Computer-Assisted Instruction / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D010865:Pilot Projects; D011340:Problem Solving; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014454:Uganda