Ignite Creation Date:
2024-05-06 @ 4:49 PM
Last Modification Date:
2024-10-26 @ 2:16 PM
Study NCT ID:
NCT05093738
Status:
UNKNOWN
Last Update Posted:
2021-10-26
First Post:
2021-09-28
Brief Title:
The Effect of Cognitive Rehabilitation on Cognitive Skills Academic Performance And Quality of Life in Refugee Children
Sponsor:
Hacettepe University
Organization:
Hacettepe University
Study Overview
Official Title:
Investigation of the Effect of School Based Cognitive Rehabilitation on Cognitive Skills Academic Performance and Quality of Life in Refugee Children
Status:
UNKNOWN
Status Verified Date:
2021-10
Last Known Status:
NOT_YET_RECRUITING
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Children are the most vulnerable group to be affected by war The long-term effects of exposure to conflict on childrens mental physical and cognitive development have been documented in the context of war and refugee camps It has been shown that children who experience war have difficulties in cognitive skills such as attention learning new information memory and executive functions Cognitive skills can ensure a childs school readiness and successful participation in school Therefore assessment of childrens cognitive performance components can provide a more fundamental understanding of their skills and barriers in school performance Although there are studies to develop occupational therapy programs in schools for refugee children in the world No intervention studies specifically aimed at cognitive rehabilitation were found Therefore it was aimed to perform cognitive rehabilitation for refugee children and to examine the effects of this on cognitive skills academic performance and quality of life The hypotheses on which there is no effect of school-based cognitive rehabilitation approach on cognitive skills academic performance and quality of life in refugees
The population of the study will be 34 children 17 studies 17 controls between the ages of 12 and 16 who scored 12 points or higher on the Post-Traumatic Stress Scale for Children in Istanbul Secondary School and scored below 21 on the Montreal Cognitive Assessment Scale Loewenstein Occupational Therapy Cognitive Assessment Scale to assess students cognitive status Reading Speed Test and Minnesota Writing Test to assess their academic performance Pediatric Quality of Life Inventory will be used to assess their quality of life Refugee children in the study cognitive rehabilitation intervention and control groups will be evaluated primarily with the help of these assessment scales and the individuals in the study group will be given 2 sessions of intervention per week for 10 weeks with an average of 1 hour per session At the end of 10 weeks the participants will be re-evaluated with the help of the same scales and the effectiveness of cognitive rehabilitation will be examined
The population of the study will be 34 children 17 studies 17 controls between the ages of 12 and 16 who scored 12 points or higher on the Post-Traumatic Stress Scale for Children in Istanbul Secondary School and scored below 21 on the Montreal Cognitive Assessment Scale Loewenstein Occupational Therapy Cognitive Assessment Scale to assess students cognitive status Reading Speed Test and Minnesota Writing Test to assess their academic performance Pediatric Quality of Life Inventory will be used to assess their quality of life Refugee children in the study cognitive rehabilitation intervention and control groups will be evaluated primarily with the help of these assessment scales and the individuals in the study group will be given 2 sessions of intervention per week for 10 weeks with an average of 1 hour per session At the end of 10 weeks the participants will be re-evaluated with the help of the same scales and the effectiveness of cognitive rehabilitation will be examined
Detailed Description:
The criteria for inclusion of volunteers in the study Scoring 12 points or more from the Post-Traumatic Stress Reaction Scale for Children getting a score below 21 from the Montreal Cognitive Assessment Scale being between the ages of 12-16 having experienced war in their country being Turkish literate and volunteering of the child and hisher family to work The exclusion criteria are Having a known neurological developmental or learning disability The data will be collected by asking our questionnaire and scale questions and by evaluating the cognitive skill components such as the attention test practically Data collection methods are survey and observation Quantitative research methods will be used to obtain the data
Post-traumatic stress level and poor cognitive skills are the parameters that will determine the individuals to be included in the study and the questionnaires the investigators will use for these are the Post-Traumatic Stress Response Scale for Children and the Montreal Cognitive Assessment Scale CTSS is used to evaluate specific stress symptoms in individuals who are exposed to violence or trauma Each child should be evaluated by interviewing the participant about the participants own reactions to the crisis This questionnaire has 20 items and scores 7-10 mild post-traumatic stress 10-12 points moderate post-traumatic stress A score of 12 and above indicates severe post-traumatic stress
Montreal Cognitive Assessment Scale is a scale developed to evaluate mild cognitive impairments and evaluates different cognitive abilities consisting of executive functions visuospatial skills memory language attention and concentration abstract thinking calculation and orientation The application takes about 10 minutes and the highest total score that can be obtained from the test is 30 Accordingly scores of 21 and above are considered normal Refugee children who score below 21 will be included in our study To evaluate memory function according to this scale recall from short-term memory five word learning trials and delayed recall after five minutes 5 points to assess visual-spatial skills Clock Drawing Test 3 points and 3D cube copying 1 point to evaluate executive functions Combining consecutive numbers and letters such as 1-A 2-B 3-C adapted from the Trail Making Test-B form 1 point verbal fluency 1 point to evaluate abstract thinking skills making similarity between two-item words 2 points to assess attention concentration and working memory sequential subtraction 3 points determination of the target letter among the read letters 1 point and counting backwards and forwards 1 each for language evaluation Naming three relatively less well-known pictures of animals lion rhinoceros camel 3 points repeating two complex sentences paying attention to the syntax 2 points and time and place orientation questions 6 points are used to evaluate orientation
After the individuals included in the investigators study were selected based on the scales described above the Loewenstein Occupational Therapy Cognitive Assessment Scale was used to evaluate the cognitive status of the refugee children included Reading Speed Test and Minnesota Handwriting Test to assess their academic performance Pediatric Quality of Life Scale will be used to assess their quality of life After the initial evaluation of the intervention group it will be taken into cognitive training for 10 weeks and final evaluations will be made at the end of 10 weeks The control group on the other hand will not be given cognitive training for 10 weeks after the first evaluation and after the final evaluation the participants will be given cognitive training for 10 weeks in terms of ethics after comparison with the intervention group
the Loewenstein Occupational Therapy Cognitive Assessment Scale was developed to assess basic cognitive abilities in people who have suffered brain damage due to traumatic head injuries strokes and brain tumors This scale which is used to evaluate the cognitive status of people whose cognitive skills are affected for any reason Orientation visual perception spatial perception motor planning visual motor organization and thinking ability consisted of six main sections and 26 subtests The application takes 30-45 minutes Six main sections of the Loewenstein Occupational Therapy Cognitive Assessment Scale and subtests of these sections will be applied to refugee children whose cognitive skills have decreased due to the effect of exposure to war experience which the investigators will include in our study In order to evaluate orientation with this scale the answers of the individual will be evaluated with a score between 1-4 using four questions for place and time orientation Four subtests will be used to assess visual perception visual identification of objects visual identification of shapes nested shapes and object constancy The answers of the patients will be scored between 1-4 points For motor planning evaluation 3 tests will be applied and the patients performance will be scored with points given between 1-4 Motor imitation by asking the patient to imitate the 4 movements shown The use of objects will be evaluated by asking the patient to demonstrate how the various given objects have been used Copying geometric figures to assess visual motor organization creating a two-dimensional model by combining the shaped parts in the test booklet copying the figure in the test booklet with nails on the perforated test board forming the butterfly shape shown in the test booklet on the test booklet with the 9 pieces given Scoring will be done by observing the activities of transforming this circle into a clock showing 1015 by placing the numbers of the clock in a circle given as a hollow Finally in order to test the categorization ordering and logic in order to evaluate the thinking ability the individual will be asked to group 18 plastic pieces of 3 different shapes and 3 different colors to sort the 5 picture cards given in a mixed order describing an event and to describe the event
Pediatric Quality of Life Inventory consists of physical health emotional functionality social functionality and school functionality One of the general quality of life scales Pediatric Quality of Life Inventory is a 23-item quality of life scale that is suitable for use in large populations such as schools and hospitals both healthy and diseased children and adolescents Items are scored between 0-100 The answer to the question is scored 100 if it is marked as never 75 if it is marked as rarely 50 if it is marked as sometimes 25 if it is marked as often and 0 if it is marked as almost always The higher the total Pediatric Quality of Life Inventory score the better the health-related quality of life is perceived The most important features of the Pediatric Quality of Life Inventory are that it is short can be filled in about 5-10 minutes and is easy to administer and score by the researcher
For the Reading speed test which the investigators will use to evaluate the participants academic performance the number of words in the text will be divided by the reading time per minute In addition childrens writing functionality for academic performance will be evaluated with the Minnesota Handwriting Test is one of the standardized validated and reliable tests that evaluates various parameters of writing Test writing It evaluates six categories of legibility shape alignment size spacing and typing speed In the test application children copies this string of words written on the paper onto the marked line just below In the scoring stage on the basis of 116 inch 015 cm length all deviations the proportions between letters and the letters within themselves are evaluated by measuring with a ruler over this length The lowest score in each category of this test is 0 and the highest score is 34
After the refugee children in the study cognitive rehabilitation intervention and control non-intervention groups are evaluated with these assessment scales cognitive rehabilitation education will be applied to the participants in the study group 2 sessions a week 1 hour per session for 10 weeks At the end of 10 weeks the participants will be re-evaluated and the effectiveness of the treatment will be compared both within the study group and between the study and control groups in terms of childrens cognitive skills academic performance and quality of life parameters
In the content of the person-centered intervention program attention memory orientation praxis motor planning training metacognition metacognition training visual perception There will be cognitive training for executive functions The intervention will consist of play activities games computer-assisted games for cognitive skills The games will be applied in a way that suits the child from simple to complex
CONTRIBUTIONS AND BENEFITS TO BE PROVIDED TO THE CURRENT SCIENTIFIC KNOWLEDGE AND PRODUCTION WITH THE REALIZATION OF THE STUDY The most vulnerable group affected by trauma and war experience is refugee children and school-based interventions for these children are very limited in our country This thesis will be a school-based first intervention on cognitive skills that include executive functions such as attention memory learning new information and abstract reasoning which are affected by the exposure of refugee children to conflict
No studies have been conducted in the world or in our country to examine the effectiveness of a cognitive rehabilitation program that is predicted to facilitate the social adaptation of refugees in our country in the short medium and long term by contributing to improving the cognitive functionality academic performance and quality of life of children This thesis which will be carried out is important in terms of filling this gap in the literature The findings of this study are aimed to guide health planners and policy makers about school-based intervention approaches to be applied to refugee children who have experienced war and are trying to adapt to a different country
Post-traumatic stress level and poor cognitive skills are the parameters that will determine the individuals to be included in the study and the questionnaires the investigators will use for these are the Post-Traumatic Stress Response Scale for Children and the Montreal Cognitive Assessment Scale CTSS is used to evaluate specific stress symptoms in individuals who are exposed to violence or trauma Each child should be evaluated by interviewing the participant about the participants own reactions to the crisis This questionnaire has 20 items and scores 7-10 mild post-traumatic stress 10-12 points moderate post-traumatic stress A score of 12 and above indicates severe post-traumatic stress
Montreal Cognitive Assessment Scale is a scale developed to evaluate mild cognitive impairments and evaluates different cognitive abilities consisting of executive functions visuospatial skills memory language attention and concentration abstract thinking calculation and orientation The application takes about 10 minutes and the highest total score that can be obtained from the test is 30 Accordingly scores of 21 and above are considered normal Refugee children who score below 21 will be included in our study To evaluate memory function according to this scale recall from short-term memory five word learning trials and delayed recall after five minutes 5 points to assess visual-spatial skills Clock Drawing Test 3 points and 3D cube copying 1 point to evaluate executive functions Combining consecutive numbers and letters such as 1-A 2-B 3-C adapted from the Trail Making Test-B form 1 point verbal fluency 1 point to evaluate abstract thinking skills making similarity between two-item words 2 points to assess attention concentration and working memory sequential subtraction 3 points determination of the target letter among the read letters 1 point and counting backwards and forwards 1 each for language evaluation Naming three relatively less well-known pictures of animals lion rhinoceros camel 3 points repeating two complex sentences paying attention to the syntax 2 points and time and place orientation questions 6 points are used to evaluate orientation
After the individuals included in the investigators study were selected based on the scales described above the Loewenstein Occupational Therapy Cognitive Assessment Scale was used to evaluate the cognitive status of the refugee children included Reading Speed Test and Minnesota Handwriting Test to assess their academic performance Pediatric Quality of Life Scale will be used to assess their quality of life After the initial evaluation of the intervention group it will be taken into cognitive training for 10 weeks and final evaluations will be made at the end of 10 weeks The control group on the other hand will not be given cognitive training for 10 weeks after the first evaluation and after the final evaluation the participants will be given cognitive training for 10 weeks in terms of ethics after comparison with the intervention group
the Loewenstein Occupational Therapy Cognitive Assessment Scale was developed to assess basic cognitive abilities in people who have suffered brain damage due to traumatic head injuries strokes and brain tumors This scale which is used to evaluate the cognitive status of people whose cognitive skills are affected for any reason Orientation visual perception spatial perception motor planning visual motor organization and thinking ability consisted of six main sections and 26 subtests The application takes 30-45 minutes Six main sections of the Loewenstein Occupational Therapy Cognitive Assessment Scale and subtests of these sections will be applied to refugee children whose cognitive skills have decreased due to the effect of exposure to war experience which the investigators will include in our study In order to evaluate orientation with this scale the answers of the individual will be evaluated with a score between 1-4 using four questions for place and time orientation Four subtests will be used to assess visual perception visual identification of objects visual identification of shapes nested shapes and object constancy The answers of the patients will be scored between 1-4 points For motor planning evaluation 3 tests will be applied and the patients performance will be scored with points given between 1-4 Motor imitation by asking the patient to imitate the 4 movements shown The use of objects will be evaluated by asking the patient to demonstrate how the various given objects have been used Copying geometric figures to assess visual motor organization creating a two-dimensional model by combining the shaped parts in the test booklet copying the figure in the test booklet with nails on the perforated test board forming the butterfly shape shown in the test booklet on the test booklet with the 9 pieces given Scoring will be done by observing the activities of transforming this circle into a clock showing 1015 by placing the numbers of the clock in a circle given as a hollow Finally in order to test the categorization ordering and logic in order to evaluate the thinking ability the individual will be asked to group 18 plastic pieces of 3 different shapes and 3 different colors to sort the 5 picture cards given in a mixed order describing an event and to describe the event
Pediatric Quality of Life Inventory consists of physical health emotional functionality social functionality and school functionality One of the general quality of life scales Pediatric Quality of Life Inventory is a 23-item quality of life scale that is suitable for use in large populations such as schools and hospitals both healthy and diseased children and adolescents Items are scored between 0-100 The answer to the question is scored 100 if it is marked as never 75 if it is marked as rarely 50 if it is marked as sometimes 25 if it is marked as often and 0 if it is marked as almost always The higher the total Pediatric Quality of Life Inventory score the better the health-related quality of life is perceived The most important features of the Pediatric Quality of Life Inventory are that it is short can be filled in about 5-10 minutes and is easy to administer and score by the researcher
For the Reading speed test which the investigators will use to evaluate the participants academic performance the number of words in the text will be divided by the reading time per minute In addition childrens writing functionality for academic performance will be evaluated with the Minnesota Handwriting Test is one of the standardized validated and reliable tests that evaluates various parameters of writing Test writing It evaluates six categories of legibility shape alignment size spacing and typing speed In the test application children copies this string of words written on the paper onto the marked line just below In the scoring stage on the basis of 116 inch 015 cm length all deviations the proportions between letters and the letters within themselves are evaluated by measuring with a ruler over this length The lowest score in each category of this test is 0 and the highest score is 34
After the refugee children in the study cognitive rehabilitation intervention and control non-intervention groups are evaluated with these assessment scales cognitive rehabilitation education will be applied to the participants in the study group 2 sessions a week 1 hour per session for 10 weeks At the end of 10 weeks the participants will be re-evaluated and the effectiveness of the treatment will be compared both within the study group and between the study and control groups in terms of childrens cognitive skills academic performance and quality of life parameters
In the content of the person-centered intervention program attention memory orientation praxis motor planning training metacognition metacognition training visual perception There will be cognitive training for executive functions The intervention will consist of play activities games computer-assisted games for cognitive skills The games will be applied in a way that suits the child from simple to complex
CONTRIBUTIONS AND BENEFITS TO BE PROVIDED TO THE CURRENT SCIENTIFIC KNOWLEDGE AND PRODUCTION WITH THE REALIZATION OF THE STUDY The most vulnerable group affected by trauma and war experience is refugee children and school-based interventions for these children are very limited in our country This thesis will be a school-based first intervention on cognitive skills that include executive functions such as attention memory learning new information and abstract reasoning which are affected by the exposure of refugee children to conflict
No studies have been conducted in the world or in our country to examine the effectiveness of a cognitive rehabilitation program that is predicted to facilitate the social adaptation of refugees in our country in the short medium and long term by contributing to improving the cognitive functionality academic performance and quality of life of children This thesis which will be carried out is important in terms of filling this gap in the literature The findings of this study are aimed to guide health planners and policy makers about school-based intervention approaches to be applied to refugee children who have experienced war and are trying to adapt to a different country
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None