Culture–specific neurodevelopmental assessment of HIV-affected children

对受艾滋病毒影响的儿童进行文化特定的神经发育评估

• 批准号: 10584607
• 负责人: Michael Joseph Boivin
• 金额: $ 63.58万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-15 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10584607
• 关键词: 12 year old; Affect; Africa; Assessment tool; Attention; Auditory; Behavior; Behavior assessment; Brain; Cellular Phone; Child; Childhood; Clinical Trials; Cognitive; Community Health Aides; Country; Data; Development; Developmental Delay Disorders; Devices; Disease; Distal; Evaluation; Funding; Growth; HIV; HIV Seropositivity; HIV risk; HIV therapy; Injury; Internet; Intervention; Language; Learning; Malaria; Malawi; Measurement; Measures; Monitor; Motor; Motor Skills; Neurocognitive; Neuronal Plasticity; Neuropsychological Tests; Performance; Play; Poverty; Rehabilitation therapy; Resource-limited setting; Risk Factors; Sahara; School-Age Population; Schools; Short-Term Memory; Site; Tablets; Testing; Therapeutic Intervention; Time; Toxicant exposure; Training; Uganda; United States National Institutes of Health; Visual; cognitive change; cognitive rehabilitation; cognitive testing; cognitive training; cohort; computerized; data exchange; design; digital; digital treatment; disability; follow-up; insight; maternal caregiving; mobile application; nutrition; pediatric human immunodeficiency virus; pilot test; rural area; tool; way finding

With NIH funding we have developed BPG (Brain Powered Games), a CCRT (Computerized Cognitive Rehabilitation Therapy) digital games package for HIV+ school children in the sub-Sahara. As a child plays, BPG will gather game data for neurocognitive assessment. BPG has been pilot-tested in HIV+ children. In Study Aim 1 we will evaluate concurrent and predictive validity. Here we will evaluate whether BPG static (baseline) assessment will correspond well to our gold standard static measures (KABC-II, TOVA, CogState). Compared to these, we hypothesize that dynamic BPG assessments will provide for a more sensitive evaluation of brain/behavior function as affected by more proximal factors of HIV exposure, disease and treatment. We also hypothesize that dynamic assessments will be more sensitive to distal developmental risk factors (e.g., SES, nutrition/growth, maternal caregiving quality). In Study Aim 2 we will compare the validity of BPG static and dynamic assessments. Here we will validate BPG static and dynamic assessments with a gold standard of neuropsychological tests previously used with children 5 -12 years old at our two study sites (Kampala, Uganda and Blantyre, Malawi). Children will be in 3 cohorts: 1) HIV-positive; 2) HIV exposed and uninfected (HEU); 3) HIV unexposed and uninfected (HUU). Cohorts will be well characterized due to participating in our previous NIH-sponsored HIV clinical trials. We hypothesize that BGP-based static and dynamic assessments will be sensitive to cohorts’ prior longitudinal trajectories as affected by proximal and distal risk factors that cause developmental delay and cognitive problems, as measured in our previous clinical trial studies with these cohorts. In Study Aim 3 we will test the sensitivity of dynamic assessment to learning loss after training ends. An advantage of dynamic assessment should be its sensitivity to learning loss over time as a measure of strength of positive neuroplasticity in brain/behavior functions. Here we will test sensitivity by evaluating all 3 cohorts with BPG and gold standard tests (KABC-II, TOVA, CogState) 6 months after the children complete their 12 sessions of BPG training. We hypothesize that BPG dynamic assessment of learning loss at 6-month follow- up post-CCRT will be especially sensitive to integrity of brain/behavior function in pediatric HIV. Overall Impact: BPG will be the first CCRT validated for dual cognitive assessment, both static and dynamic. We expect BPG’s dynamic assessment capability will provide fundamental new insights into how HIV disease and treatment affects brain development, enabling sensitive and accessible cognitive measurement tools for clinical trials. BPG can also be an accessible and inexpensive assessment tool in resource-constrained settings to enable community health workers to monitor brain development in children burdened by other diseases and injuries. It can do so as a mobile-based tablet or smart phone device lending itself to easy scalability of language-free cognitive testing, which can be done as part of cognitive rehabilitation intervention.

通过NIH资金，我们开发了BPG（脑力游戏），CCRT（计算机认知 康复疗法）在萨哈拉（Subsahara）的艾滋病毒+学童数字游戏包。小时候玩耍， BPG将收集游戏数据以进行神经认知评估。 BPG已在HIV+儿童中进行了试点测试。 在研究目标1中，我们将评估并发和预测有效性。在这里，我们将评估BPG是否静态 （基线）评估将与我们的黄金标准静态测量（KABC-II，TOVA，Cogstate）良好相对应。 与这些相比，我们假设动态BPG评估将提供更敏感的 评估大脑/行为功能受HIV暴露，疾病和 治疗。我们还假设动态评估将对远端发育风险更敏感 因素（例如SES，营养/增长，母校护理质量）。 在研究目标2中，我们将比较BPG静态和动态评估的有效性。在这里我们将验证 BPG静态和动态评估，具有先前与 在我们的两个研究地点（乌干达，乌干达和马拉维的布兰蒂尔）的5 -12岁儿童。孩子将在3 队列：1）HIV阳性； 2）艾滋病毒暴露和未感染（HEU）； 3）艾滋病毒暴露和未感染（HUU）。 由于参加了我们以前的NIH赞助的HIV临床试验，同时人群将得到很好的特征。我们 假设基于BGP的基于BGP的静态和动态评估将对队列的先前纵向敏感 受到近端和远端风险因素的影响，导致发育延迟和认知 正如我们先前对这些队列的临床试验研究所衡量的问题。 在研究目标3中，我们将测试训练结束后动态评估对学习损失的敏感性。一个 动态评估的优势应该是它对学习损失随着时间的敏感性，以此作为衡量强度的度量 大脑/行为功能中神经可塑性的阳性。在这里，我们将通过评估所有3个队列来测试灵敏度 在孩子们完成12个月后6个月，使用BPG和黄金标准测试（KABC-II，TOVA，Cogstate） BPG培训的会议。我们假设BPG在6个月以后对学习损失的动态评估 - CCRT后的UP将对小儿艾滋病毒中大脑/行为功能的完整性特别敏感。 总体影响：BPG将是第一个用于静态和动态双重认知评估的CCRT。 我们预计BPG的动态评估能力将为艾滋病毒疾病如何提供基本的新见解 治疗会影响大脑发育，为敏感且易于获得的认知测量工具 临床试验。 BPG也可能是资源约束的一种易于访问且廉价的评估工具 设置以使社区卫生工作者能够监视其他其他儿童的大脑发育 疾病和伤害。它可以作为基于移动的平板电脑或智能手机设备贷款来做的 无语言认知测试的可伸缩性，可以作为认知康复干预的一部分进行。