Game-supported cognitive strategy training for slowed information processing speed after acquired brain injury: study protocol for a randomized controlled trial

IntroductionMany individuals with acquired brain injury tend to experience problems with slowed information processing speed (IPS). A potentially beneficial and cost-effective supplement for cognitive rehabilitation of impaired IPS may be the implementation of serious gaming that focus on compensatory learning as part of cognitive training. However, most digital platforms that are used during cognitive rehabilitation have been focused on restoration of cognitive function, and limited evidence has been found for the generalization of skills that are trained during cognitive rehabilitation to everyday life. ObjectiveThe aim of this study is to investigate the efficacy of a game-supported cognitive strategy training. The training combines a well-validated time pressure management (TPM) cognitive strategy training targeting slowed IPS with a novel game and a mobile application. The game-supported training focuses on the generalization of strategy-use to untrained tasks in everyday life. Methods and analysisThe study is designed as a randomized controlled trial in which the experimental group (Karman Line Tempo module: an 8-week game-supported cognitive strategy training) will be compared with an active control group (CogniPlus training: an 8-week computerized cognitive function training). Data from 60 individuals with acquired brain injury (30 per group, ages between 18 and 70) will be collected at baseline (T0), post-treatment (T1) and at 3-month follow-up (T2). Primary outcome measure is an objective assessment of compensatory strategy-use in an untrained experimental task. Secondary outcome is the attainment of trained and untrained treatment goals assessed by goal attainment scaling (GAS). Pre- and post-training data will be analysed using a 2x2 repeated measure analysis of variance. Ethics and disseminationThis study has been approved by the medical review ethics committee CMO Region Arnhem and Nijmegen (NL74818.091.20) and is registered in the Netherlands Trial Register (NL9437). Research findings will be published in peer-reviewed journals and at conferences. Strengths & Limitations- This study is the first to investigate a compensatory approach in serious gaming, combined with a scientifically validated cognitive training, as an intervention for slowed information processing speed in acquired brain injury. - An adequately powered randomized controlled trial design with block randomization and an active control group to control for confounding effects of computer training in a rehabilitation setting. - Outcome variables that measure the generalization of the intervention to everyday life, especially to the level of activities and participation, in addition to improvement on neuropsychological tests. - To balance sufficient power and the feasibility of the study, a sample size of sixty individuals with ABI will be included in the study. - No 3-month follow-up of the primary outcome measure is included, as only two parallel versions of the Virtual Meeting Task are available.