Introduction
congenital malformations, behavioral and affective difficulties, brain damage, lifelong disabilities, injuries
Pediatric brain alterations, both acquired injuries and congenital malformations, are known to cause lifelong disabilities in children, due to cognitive, behavioral and affective difficulties persisting over timeNumerous studies indicated that cognitive rehabilitation, also when delivered remotely, may promote use-dependent brain plasticity leading to favorable cognitive outcomesNevertheless, a high number of patients do not receive adequate and prompt help or support for their condition in many countriesHowever, evidence on efficacy is still controversial, with some experimental studies and reviews reporting limited gains or even absence of benefitsUp to now, numerous reviews addressed the efficacy of remote CCT for children with ABIPreviously reported data on the feasibility of this CCT was highly positive, with 97% of patients showing adherence and 94.2% of training sessions completed in the recommended timeframe of 8 weeksThe study utilized a randomized, stepped-wedge design (Fig. Schematic depiction of the study design.To assess each outcome measure, we computed the change between T1 and T2 (delta 1) as well as between T2 and T3 (delta 2), capturing the difference between the second and first time points. In the Training-first group, delta 1 indicates the effect of the treatment, whereas in the Waiting-first group, it reflects the spontaneous change that occurred over time without intervention. Conversely, delta 2 represents the spontaneous change observed in the Training-first group and the treatment effect in the Waiting-first group.Delta 1 was expected to be significantly higher in the Training-first group than in the Waiting-first group, whereas delta 2 was expected to be significantly higher in the Waiting-first group than in the Training-first group. This pattern of results would indicate that the treatment effect was greater than spontaneous change in either group.Findings of this study could help clarifying whether a drill-based CCT performed at home by patients without any clinical guidance during exercising could generate cognitive benefits, also examining whether different efficacy occurs in the three clinical subgroups. At the same time, it could inform about the usefulness of a multi-domain cognitive training in view of the fact that, up to now, no certain indication on the ideal type of cognitive training—namely single-domain or multi-domain- has been gathered. The hypothesis sustaining the choice of a multidomain training for this study was related to the consideration of the interdependence of different cognitive systems, which led us to expect that a multidomain training could lead to the greatest cognitive benefits regardless the type of brain damage