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

基本信息

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
项目类别：
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

项目摘要

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.

在 NIH 的资助下，我们开发了 BPG（脑力游戏）、CCRT（计算机认知游戏）康复治疗）为撒哈拉以南地区的艾滋病毒携带者学童提供的数字游戏包。 BPG 将收集用于神经认知评估的游戏数据 BPG 已在 HIV 阳性儿童中进行了试点测试。在研究目标 1 中，我们将评估并发有效性和预测有效性。在这里，我们将评估 BPG 是否静态。（基线）评估将很好地符合我们的黄金标准静态测量（KABC-II、TOVA、CogState）。与这些相比，我们认为动态 BPG 评估将提供更敏感的评估受 HIV 暴露、疾病和感染等更近端因素影响的大脑/行为功能我们还追求动态评估对远端发育风险更加敏感。因素（例如社会经济地位、营养/生长、孕产妇护理质量）。在研究目标 2 中，我们将比较 BPG 静态和动态评估的有效性。 BPG 静态和动态评估与以前使用的神经心理学测试的黄金标准我们两个研究地点（乌干达坎帕拉和马拉维布兰太尔）的 5 -12 岁儿童儿童年龄为 3 岁。队列：1) HIV 阳性；2) HIV 暴露且未感染 (HEU)；3) HIV 暴露且未感染 (HUU)。由于参与了我们之前 NIH 赞助的 HIV 临床试验，队列将得到很好的表征。确保基于 BGP 的静态和动态评估对群组先前的纵向评估敏感受导致发育迟缓和认知的近端和远端危险因素影响的轨迹问题，正如我们之前对这些队列的临床试验研究所测量的那样。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。动态评估的优点应该是它对随时间推移的学习损失的敏感性，作为强度的衡量标准在这里，我们将通过评估所有 3 个队列来测试敏感性。在孩子们完成 12 个月后 6 个月进行 BPG 和金标准测试（KABC-II、TOVA、CogState）我们勇敢地接受了 BPG 在 6 个月的随访中对学习损失的动态评估。 CCRT 后的研究将对儿科 HIV 患者的大脑/行为功能的完整性特别敏感。总体影响：BPG 将是第一个经过验证可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 HIV 疾病如何发生提供基本的新见解治疗会影响大脑发育，从而为患者提供敏感且易于使用的认知测量工具在资源有限的情况下，BPG 也可以成为一种易于使用且廉价的评估工具。使社区卫生工作者能够监测患有其他疾病的儿童的大脑发育的环境它可以作为基于移动的平板电脑或智能手机设备轻松实现这一点。无语言认知测试的可扩展性，可以作为认知康复干预的一部分来完成。