Conclusions
cognitive and behavioral functioning, brain damage, congenital malformation
This randomized clinical trial demonstrated the efficacy of a drill-based cognitive training delivering exercises tapping on different cognitive domains in improving visuo-spatial working memory in a sample of children with acquired brain damage and congenital malformation. This benefit was probably due to the continuous training of visuo-spatial abilities by all training games, which suggests that the most remarkable cognitive gains are reached through the training of the same cognitive function for a prolonged time period. Notably, benefits were maintained over time and were observed for all clinical subgroups (non-progressive ABI, BT and CBM), suggesting training flexibility in adapting to different cognitive and behavioral functioning. However, no benefits on other cognitive domains were found, indicating only a limited effect of a multidomain cognitive training on the whole cognition. Thus, this study provides support to the usefulness of a prolonged training of the same cognitive ability to reach a significant change, even though future research is needed to further test this hypothesis. With respect to generalization of benefits to patients’ functioning in everyday life, our findings confirmed previous evidence about the absence of transfer effects and, thus, about the limitation of remote drill-based training programs in improving children’s quality of life and behavioral adjustment. Importantly, in contrast with previous studies reporting training adherence issues, particularly in children with CBM