Treating working memory and decision-making deficits in children following traumatic brain injury.

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In children, acquired brain injury (ABI), and in particular traumatic brain injury (TBI), represents a common interruption to the course of normal development, with both international and local statistics citing an annual rate of 250–300 per 100,000 children (Kraus, 1995). Working memory refers to the capacity to temporarily store information for use in everyday activities (Alloway et al., 2006). Decision-Making is conceived as a complex interplay of high-level cold cognitive processes such as working memory, information processing, problem-solving, and hot emotional processes (Cassotti et al., 2011; Reimann and Bechara, 2010). Efficient working memory and decision-making abilities are essential as they underpin one’s performance in functional skill areas such as academic, adaptive, behavioural and social domains (Catroppa & Anderson, 2006; Ganesalingam et al, 2011; Gathercole et al., 2006; Mandalis et al, 2007; Muscara et al., 2008). Using a prospective, longitudinal design, adaptive abilities, behaviour, educational progress and everyday memory skills were investigated acutely post-injury and again at 12 and 30 months post-injury. Results suggested a strong association between injury severity and outcomes across all domains.With regard to social outcomes following childhood brain injury, deficits have been reported in many areas of social functioning and communication style, often resulting in low self-esteem, isolation, high rates of psychiatric disorder, criminal behaviour, and unemployment, and therefore poor integration into society (Anderson et al., 2009) The overall aim of the proposed study is to enhance working memory and decision-making abilities and therefore potentially strengthen academic, social, behavioural and improving quality of life for children and adolescents post traumatic brain injury (TBI). To achieve this aim, the objectives of the proposed study are: (i) To evaluate the effectiveness of Cogmed using a randomized controlled trial (RCT) to investigate improvements in working memory and decision-making, in children post-TBI, compared to children in an active control group. (ii) To determine whether these improvements in working memory and decision-making generalise into other areas of function and so also improve academic,social, behavioural, and quality of life outcomes. It is hypothesized that (i) Compared to children in the active control group, those children receiving Cogmed will display better working memory and decision-making skills immediately post-intervention and at 6 months post-intervention. (ii) Improvements in working memory and decision-making will result in improvements in functional areas such as academic, social, behavioural and quality of life outcomes.