Long-term Effects of Visual Spatial Working Memory Training Program Performed at Preschool Age in Very Preterm Infants With Visual Spatial Working Memory Deficit. A Randomized Controlled Trial

Study Overview
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Brief Summary
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Prematurity tends to increase in France in recent years and more children born extremely premature infants survive. If severe impairments have stabilized, the majority of former extremely premature children have neuropsychological disorders and moderate appearance behavior disorder, but with a significant impact both family, school and social persisting into adulthood. Executive functions (EF), in general, and working memory (MT), in particular, are frequently altered in older children preterm infants compared to controls born at term. The identification process of loss in certain diseases, as well as improving knowledge of brain functioning, and development with the possibility of neuronal plasticity has led research teams to develop intervention programs focused on process cognitive qualified of remediation cognitive (RC). Schematically, the RC is defined as a rehabilitation or altered cognitive functions. MT can be improved by encouraging the operation of the spots mental stimulant. These programs are effective on MT but do not have the expected impact on other FE, language or nonverbal functions (visuospatial). The functional benefit of cognitive remediation remains controversial. Improving mental functions untrained as nonverbal MT, attention and secondarily learning is possible but still unproven on wide population. Similarly, randomized trials are needed to test this type of cognitive remediation among preschoolers old very premature.

Official Title
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Long-term Effects of Visual Spatial Working Memory Training Program Performed at Preschool Age in Very Preterm Infants With Visual Spatial Working Memory Deficit. A Randomized Controlled Trial

Conditions
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Children Born Extremely Premature, Disturbance of Visuo-spatial Working Memory

Intervention / Treatment
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* Other: computerized cognitive remediation program
* Other: standard remediation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Already included in the study EPIPAGE 2, born between 24 and 34 weeks' GA (gestational amenorrhea), Children aged 5 to 6 years, Children exhibiting a total intellectual quotient >70 from the WPPSI IV (during the 5-year assessment in EPIPAGE 2), Children having a visuo-spatial Working Memory impairment defined by a working memory index <85 from the WPPSI IV, Children with parents (or legal guardians) authorizing participation in the study and a signed informed consent form, Children affiliated with medical insurance. Exclusion Criteria: Children with severe cerebral palsy, based on the Gross Motor Function (GMFCS score >2) and Bimanual Fine Motor Function (BFMF >2) classification system (Elvrum AG 2015, Marois P 2015), Children with blindness or amblyopia, defined by a visual acuity <3 (during the 5-year assessment in EPIPAGE 2), Children with deafness, as defined by a prescribed hearing aid, Children with chromosomal disorder or autistic syndrome, Children included in the EPILANG study protocol (an ancillary project to EPIPAGE), Children who do not speak French Children with parents having no internet connection, Triplets.

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 6 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Cognitive remediation parents<br> | Other: computerized cognitive remediation program<br>* a computer program online re-educating the working memory is completed by the parents and the child. The child made a series of interactive exercises accompanied by parents or a practitioner. The exercises are adapted automatically and individually to the performance at each session.<br>|
| Placebo Comparator: Remediation standard<br> | Other: standard remediation<br>* A speech therapy and / or academic support is realized.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Increase of the measuring index visuospatial | This index consists of two subtests : block design and object assembly. The average score is 100 with a standard deviation of 15. | 18 months (more or less 2 months) post inclusion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of intellectual functioning | award of global IQ | 8 months (more or less 2 months) post inclusion | 
| Evaluation of the working memory | administering the questionnaire Wechsler Preschool and Primary Scale of Intelligence (WPPSI IV) | 18 months (more or less 2 months) post inclusion | 
| evaluation of neuropsychological development of children | award of Neuropsychological Assessment test (NEPSY) | 8 months (more or less 2 months) post inclusion | 
| Evaluation of language and skills | passing the test Communicate, Learn to Read and Write (KEY) | 8 months (more or less 2 months) post inclusion | 
| Rating behavior | award of Goodman questionnaire (Strengths and Difficulties Questionnaire (SDQ)) | 8 months (more or less 2 months) post inclusion | 
| Evaluation of parental anxiety | award of Spielberger Trait Anxiety Inventory questionnaire | 8 months (more or less 2 months) post inclusion | 
| Assessing the quality of a child's life | Quality of Life Questionnaire | 8 months (more or less 2 months) post inclusion | 
| Evaluation of Education | Evaluation of Education is evaluated by the global adaptation school score (GSA) survey | 8 months (more or less 2 months) post inclusion |