# A Pilot Feasibility Study of a Home Tablet-Based Neurorehabilitation Program and Serial Brain Vital Sign Monitoring for Survivors of Pediatric Cerebral Malaria

## TL;DR

A home-based neurorehabilitation program and brain monitoring system were found feasible and acceptable for children recovering from cerebral malaria in Africa.

## Contribution

This study demonstrates the feasibility of using a tablet-based neurorehabilitation program and ERP monitoring for cognitive recovery in pediatric cerebral malaria survivors.

## Key findings

- The Dino Island program and Brain Vital Signs system were feasible and easy to implement in home settings.
- Low attrition rates and positive family feedback indicated high acceptability of the interventions.
- Parent reports showed positive behavioral changes in children following the program.

## Abstract

Lasting sequelae are identified in 50% of child survivors of cerebral malaria (CM). Rehabilitation options in malaria-endemic regions are scarce and largely focused on physical deficits, leaving children without support for cognitive recovery. Effective and accessible interventions are vital for improving outcomes. Furthermore, the assessment of brain function and recovery after CM is dependent on behavior-based tests that are time-consuming and require substantial training to administer. Objective, easy-to-use alternatives may be impactful. Children aged 3–12 years who had survived CM were recruited. Participants underwent a 6-month in-home, tablet-based neurorehabilitation program called Dino Island (DI). Participants also underwent serial assessments of brain health that were conducted by measuring event-related potentials (ERPs) using the Brain Vital Signs system. The feasibility, fidelity, acceptability, appropriateness, and affordability of the interventions were evaluated through interviews with the study nurses and the participants’ families. Both programs were feasible and easy to implement. Acceptability was demonstrated by low attrition rates (5%) and positive family ratings (100%). Appropriateness for DI was confirmed by parent reports of positive behavioral changes in their children (60%). For Brain Vital Signs, appropriateness was confirmed by adequate data acquisition for most participants. Finally, positive indicators of affordability from a healthcare perspective were identified. Neurorehabilitation using a home tablet-based program and objective brain health assessment using ERPs was feasible, well accepted, and appropriate in child CM survivors in sub-Saharan Africa. Further development and research into the program’s ability to improve and measure cognitive recovery is justified.