Title

Effect of computer based cognitive training on attention and processing speed in children with cerebral palsy

Background

Children with cerebral palsy perform tasks slowly, often struggling to sustain attention and process information efficiently. Literature reports deficits in attention, processing speed, and executive functions in children with cerebral palsy compared to typically developing peers contributing to challenges in learning, behavior regulation, and overall daily functioning. 

Recent studies highlight the potential of computer-based cognitive training, which offers some benefits over traditional pencil-and-paper tasks for cognition in neurologically affected populations. Introducing gaming elements provides added motivation, improving therapy intensity, duration, and adherence. However, existing research largely emphasizes executive functions in isolation, with limited focus on attention and processing speed. The availability of low-cost, accessible computer-based tools for assessment and intervention remain underexplored. This study aims to address these gaps by evaluating targeted, low cost, easily available and engaging assessment tools and interventions.

OBJECTIVE

To evaluate the effect of computer-based cognitive training on attention in children with cerebral palsy

To evaluate the effect of computer-based cognitive training on processing speed in children with cerebral palsy.

HYPOTHESIS

Null hypothesis 

Hn1: There is no significant effect of computer-based cognitive training in comparison with paper-and-pencil cognitive training on attention in children with cerebral palsy.

Hn2: There is no significant effect of computer-based cognitive training in comparison with paper-and-pencil cognitive training on processing speed in children with cerebral palsy.

Alternate hypothesis

Ha1: There is significant effect of computer-based cognitive training in comparison with paper-and-pencil cognitive training on attention in children with cerebral palsy.

Ha2: There is significant effect of computer-based cognitive training in comparison with paper-and-pencil cognitive training on processing speed in children with cerebral palsy.

Material and Methods

(a) Study Design: Experimental study

(b) Sample size and method: 24, purposive sampling

(c)Enrolment period: 6-7 months after RRC and IEC clearance

(d) Total Study duration: 4 weeks

(e) Inclusion and exclusion criteria:

Study Procedures:

After RRC and IEC clearance, subjects will be assessed for eligibility. Pre-intervention tests will be carried out using Psychology Experiment Building Language (PEBL). Randomization will be done using simple random allocation software. Children will be divided into two groups, group-A and group-B.

Group A (Experimental group) will receive Computer Based Cognitive Training and Group-B (Control group) will receive Paper and Pencil Cognitive Training. Both interventions will be carried out for 40 minutes per session, 4 days per weeks for 4 weeks. Post-intervention tests will be carried out Psychology Experiment Building Language (PEBL) 

Assessment tools: From Psychology Experiment Building Language

For Attention :
Number sequencing subtest (Trail Making Test-A)
Digit span
Stroop Color Word Test
Go/No-Go Task
Flanker’s Test

For Processing Speed :
Letter Digit Substitution Task (Trail Making Test-B) 
Connections
Tower of London
Pattern Comparison

Statistical Analysis Plan (SAP): 

Descriptive statistics will be applied to calculate the mean and standard deviation for quantitative variables (age, Trail Making Test, Digit Span, Stroop Color Word Test, Go/No-Go Task, Flanker’s Test, Connections, Tower of London, Pattern Comparison) and frequencies with percentages for categorical variables (e.g., gender). Data normality will be assessed using the Shapiro-Wilk Test. If normally distributed, between-group differences in attention and processing speed (computer-based vs. paper-and-pencil training) will be examined using the independent t-test, while within-group changes will be analyzed using the dependent t-test. For skewed data, the Mann-Whitney U test will be applied for between-group comparisons, and the Wilcoxon signed-rank test for within-group changes across the outcome measures. Data will be initially managed in Excel and then imported into SPSS version 21 for Windows for analysis. Statistical significance will be set at a 5 percent alpha level to determine meaningful differences.