Feasibility and Efficacy of Working Memory Training in Children with Cochlear Implants: A First Report

Transcription

1 Feasibility and Efficacy of Working Memory Training in Children with Cochlear Implants: A First Report William G. Kronenberger, David B. Pisoni, Shirley C. Henning, Bethany L. Gehrlein, & Lindsey M. Hazzard DeVault Otologic Research Laboratory, Department of Otolaryngology-Head and Neck Surgery Riley Child and Adolescent Psychiatry Clinic, Department of Psychiatry Indiana University School of Medicine

2 Outcome Variability in Cochlear Implant Users Traditional Influences Age of Implantation CI Technology Communication Mode Outcome Measures Speech and Language

3 Outcome Variability in Cochlear Implant Users Novel Influences Auditory deprivation affects neurocognitive processes Sequential Processing (Conway et al., in press) Executive Functioning (Pisoni & Cleary, 2001; Pisoni et al., 2007) Working Memory (Pisoni & Cleary, 2001; Pisoni et al., 2007) Working Memory Domain general neurocognitive process Important for thinking, processing, learning Important for speech-language development

4 Study Purpose and Goals To evaluate in children with cochlear implants: the feasibility (appropriateness) of an existing, evidence-based working memory training program the efficacy of a working memory training program in improving performance on traditional working memory measures the transfer of working memory intervention effects to speech-language outcomes

5 Working Memory Training Intervention: Cogmed RM Computer-based exercises that require the child to retain, recall, and reorganize patterns of visual and/or auditory sequences highly visual adaptive Training 25 days over a 5 week period 40 minutes per day at home coaching calls 1 time per week

6 Cogmed RM : Examples Visual Data Link 4x4 Grid, lights illuminate in succession Recall pattern of lights in succession Input Module 3x3 grid of numbers, numbers are read aloud, with corresponding lights illuminating in succession Recall numbers backward

7 Study Design and Methods 5 Visits Visit 1: Screening Evaluation Visit 2 (2-5 Weeks after V1): Pre-Training Evaluation 5 Week Training Program Between V2 and V3 Visit 3 (5-7 Weeks after V2): Post-Training Evaluation Visit 4: 1 Month Follow-Up Visit 5: 6 Month Follow-Up Visit 1 to Visit 2 change used as a control period Control period compared to change from Visit 2 to Visit 3 (Pre-Post Training) All subjects complete Cogmed Working Memory Training

8 Study Measures Behavioral Questionnaire Measures Behavior Rating Inventory of Executive Function (BRIEF ) Working Memory Subscale Neurocognitive Measures CMS Numbers (Digit Span) WISC-IV- Integrated Spatial Span Speech-Language Measure WRAML-2 Sentence Memory

9 Participants (n=7) Ages: 7-11 years (1 male, 6 female) Age at CI: months of age Hearing Loss: Congenital severe to profound bilateral Device: Multichannel cochlear implants Mode of Communication: Oral or total communication Digit Span or BRIEF -working memory score at or below normative mean

10 Visit 1 Screening Results Task Sample Mean (SD) Normative Mean (SD) WISC-IV Matrix Reasoning 10.7 (3.6) 10 (3) Within Normal Limits CMS Numbers (digit span) 6.1 (5.2) 10 (3) Below Average BRIEF Working Memory 56.3 (7.6) 50 (10) Below Average

11 Study Results Question 1: Feasible for use with children with cochlear implants?

12 Feasibility and Satisfaction My child had difficulty hearing or understanding the exercises 86%=Disagree; 14%=Neutral; 0%=Agree My child had to put in a lot of effort to do the exercises 14%=Disagree; 14%=Neutral; 71%=Agree I had to put in a lot of effort to make my child do the exercises 29%=Disagree; 0%=Neutral; 71% Agree I would recommend the program to other families of children with cochlear implants 0%=Disagree; 43%=Neutral; 57%=Agree

13 Study Results Question 2: Impact on working memory?

14 Change in Working Memory Performance: Group Data Effect size Brief -WM Spatial Span Digit Span Visit 1 to Visit 2 change (pre-training) Visit 2 to Visit 3 change (posttraining) SC=Standardized change (Mean for Time2-Mean for Time1)/SD for Time 1 (analogous to Cohen s d effect size)

15 Change in Working Memory Performance: Individual Data Effect size S1 S2 S3 S4 S5 S6 S7-2 BRIEF -WM Spatial Span Digit Span Values are standardized change scores based on change pre-post training= (Time3 Score-Time2 Score)/Group SD for Time2

16 T-Test Comparisons for Primary Efficacy Variables (N=7) Visit 1-2 Visit 2-3 BRIEF - WM Spatial Span Digit Span t=0.80, p=0.46 t=1.62, p=0.156 t=0.85, p=0.426 t=-3.23*, p=0.018 t=3.10*, p=0.021 t=4.08**, p=0.007

17 Study Results Question 3: Effects on working memoryrelated speech-language measures?

18 Working Memory-Related Speech- Language Standardized Score Change Values Effect size WRAML-2 Sentence Memory Visit 2 to Visit 3 change (posttraining) SC=Standardized change (Mean for Time2-Mean for Time1)/SD for Time 1 (analogous to Cohen s d effect size); t(6)=5.29, p=0.002

19 Change in Working Memory Performance: Individual Data Effect size S1 S2 S3 S4 S5 S6 S7 0 WRAML-2 Sentence Memory Values are standardized change scores based on change pre-post Cogmed= (Time3 Score-Time2 Score)/Group SD for Time2

20 Limitations and Future Directions Small N Exploratory/preliminary findings Unblinded, no placebo, no control group Sample selection characteristics average to poor working memory skills Not clear how would generalize to individuals with better than average working memory Collect long-term outcome data Explore factors that predict success with program Compare with other working memory training programs

21 Summary of Study Findings Feasibility/Acceptability Cogmed RM could be used by the children in our sample, some as young as age 7 Cogmed RM takes much parent and child effort 57% of families would recommend the program, 43% neutral Effect on Working Memory Statistically significant improvement in verbal and nonverbal working memory as well as behavioral ratings of working memory Effect sizes in medium to large range Effect on Working Memory-Related Speech-Language Processes Statistically significant improvement in sentence memory Large effect size

22 Acknowledgements Children and families The DeVault Otologic Research Lab Staff Indiana University Research Support Funds Grant (W. Kronenberger) NIH/NIDCD RO1 DC (D. Pisoni) NIH/NIDCD R55 DC (D. Pisoni)