Remote Technology-Based Training Programs for Children with Acquired Brain Injury: A Systematic Review and a Meta-Analytic Exploration

Table 2

Overview of the studies on Behavioral Training Programs.

Study	Research design	Sample	Treatment characteristics	Treatment domain(s)	Outcome measures	Main findings
Wade et al., [72]	Pilot study.; Pre/posttest design.	.; Age: 5-16 years.; Diagnosis: mild to severe TBI at more than 15 months since injury.	Training: OFPS.; Setting: home.; Duration: 6 months for the 8 core sessions +4 supplemental sessions.; Therapist monitoring: weekly Skype sessions with a therapist.	(i) Everyday executive functions; (ii) Behavioral, social, and emotional functioning	Everyday executive functions: (i) BRIEF (parent report): GEC; Behavioral, social, and emotional functioning: (i) HCSBS (parent report): antisocial behavior subscale; (ii) CDI (self-report)	Reduction of antisocial behaviors.
Wade et al., [55]	Randomized controlled study.; Pre/posttest design.; Control group: active control group, assigned to IRC.	(E: 20, C: 19).; Age: 5-16 years.; Diagnosis: mild to severe TBI at 1-24 months since injury.	Training: OFPS.; Setting: home.; Duration: 6 months for the 8 core sessions +6 eventual supplemental sessions.; Therapist monitoring: Skype sessions with a therapist every 1-2 weeks.	(i) Everyday executive functions; (ii) Behavioral, social, and emotional functioning	Behavioral, social, and emotional functioning: (i) CBCL (parent report): externalizing, internalizing, and total problems; (ii) HCSBS (parent report): peer total, self-management/compliance, total scale	Improvement in self-control and compliance with parents.
Wade et al., [22]	Randomized controlled study.; Pre/posttest design.; Control group: active control group, assigned to the same treatment program (TOPS), but without audio.	(E: 5, C: 4).; Age: 11-18 years.; Diagnosis: mild to severe TBI at <24 months since injury.	Training: TOPS with audio.; Setting: home.; Duration: 6 months for the 10 core sessions +4 eventual supplemental sessions.; Therapist monitoring: Skype sessions with a therapist every 1-2 weeks.	(i) Everyday executive functions; (ii) Behavioral, social, and emotional functioning	Everyday executive functions: (i) BRIEF (parent report): GEC; Behavioral, social, and emotional functioning: (i) CBCL (parent report): externalizing, internalizing, and total problems; (ii) CDI (self-report)	Reduction of self-reported depression symptoms and of internalizing symptoms in children of both groups.; Adolescent assigned to the audio condition showed a greater improvement in internalizing symptoms.
Wade et al., [23]	Randomized controlled study.; Pre/posttest design.; Control group: active control group, assigned to IRC.	(E: 16; C: 19).; Age: 11-18 years.; Diagnosis: mild to severe TBI at <18 months since injury.	Training: TOPS.; Setting: home.; Duration: 6 months for the 10 core sessions +4 eventual supplemental sessions.; Therapist monitoring: Skype sessions with a therapist every 1-2 weeks.	(i) Everyday executive functions; (ii) Behavioral, social, and emotional functioning	Everyday executive functions: (i) BRIEF (parent and youth self-report): GEC, BRI, MI	Significant improvement in executive function behaviors in teens with severe TBI.
Wade et al., [58]	Randomized controlled study.; Pre/posttest design.; Control group: active control group, assigned to IRC.	(E: 16, C: 19).; Age: 11-18.; Diagnosis: mild to severe TBI at 3-19 months since injury.	Training: TOPS.; Setting: home.; Duration: 6 months for the 10 core sessions +4 eventual supplemental sessions.; Therapist monitoring: Skype sessions with a therapist every 1-2 weeks.	(i) Everyday executive functions; (ii) Behavioral, social, and emotional functioning	Behavioral, social, and emotional functioning: (i) CBCL (parent and youth self-report): externalizing and internalizing problems	Reduction of parent-teen conflict.; Reduction of internalizing symptoms among adolescents with severe TBI.
Kurowski et al., [53]	Randomized controlled study.; Pre/posttest design.; Control group: active control group, assigned to IRC.	(E: 57, C: 63).; Age: 12-17 years.; Diagnosis: mild to severe TBI at 1-6 months since injury.	Training: CAPS.; Setting: home.; Duration: 6 months for the 10 core sessions +6 eventual supplemental sessions.; Therapist monitoring: weekly Skype sessions with a therapist in months 1-3; be-weekly Skype sessions in months 4-6.	(i) Everyday executive functions; (ii) Behavioral, social, and emotional functioning	Everyday executive functions: (i) BRIEF (parent report): GEC, BRI, MI	Improvement in executive function behaviors observed in older teens.
Kurowski et al., [69] (extension of Kurowski et al., [53])	Randomized controlled study.; Pre/posttest design.; Follow-up: at 12 and 18 months.; Control group: active control group, assigned to IRC.	(E: 65, C: 66).; Age: 12-17 years.; Diagnosis: mild to severe TBI at 1-6 months since injury.	Training: CAPS.; Setting: home.; Duration: 6 months, for the 10 core sessions +6 eventual supplemental sessions.; Therapist monitoring: weekly Skype sessions with a therapist in months 1-3; be-weekly Skype sessions in months 4-6.	(i) Everyday executive functions; (ii) Behavioral, social, and emotional functioning	Everyday executive functions: (i) BRIEF (parent report): GEC, BRI, MI	Improvement in executive function behaviors observed in older teens both at 12- and 18-month follow-up.
Wade et al., [56]	Randomized controlled study.; Pre/posttest design.; Control group: active control group, assigned to IRC.	(E: 65, C: 66).; Age: 12-17 years.; Diagnosis: mild to severe TBI at 1-6 months since injury.	Training: CAPS.; Setting: home.; Duration: 6 months, for the 10 core sessions +6 eventual supplemental sessions.; Therapist monitoring: weekly Skype sessions with a therapist in months 1-3; be-weekly Skype sessions in months 4-6.	(i) Everyday executive functions; (ii) Behavioral, social, and emotional functioning	Behavioral, social, and emotional functioning: (i) CBCL (parent report): externalizing and internalizing problems+aggressive, attention, ADHD, and conduct scales	Improvement in externalizing symptoms in older teens.
Wade et al., [70] (extension of Kurowski et al., 2011, [53]; Wade et al., [56])	Randomized controlled study.; Pre/posttest design.; Follow-up: at 12 and 18 months.; Control group: active control group, assigned to IRC.	(E: 65, C: 66).; Age: 12-17 years.; Diagnosis: mild to severe TBI at <7 months since injury.	Training: CAPS.; Setting: home.; Duration: 6 months, for the 10 core sessions +6 eventual supplemental sessions.; Therapist monitoring: weekly Skype sessions with a therapist in months 1-3; be-weekly Skype sessions in months 4-6.	(i) Everyday executive functions; (ii) Behavioral, social, and emotional functioning	Behavioral, social, and emotional functioning: (i) CAFAS (parent report): total scale	Improvement in everyday functioning, especially in families of lower socioeconomic status.
Wade et al., [71] (extension of Wade et al., [56])	Randomized controlled study.; Pre/posttest design.; Follow-up: at 12 and 18 months.; Control group: active control group, assigned to IRC.	(E: 65, C: 67).; Age: 12-17 years.; Diagnosis: mild to severe TBI at 1-6 months since injury.	Training: CAPS.; Setting: home.; Duration: 6 months, for the 10 core sessions +6 eventual supplemental sessions.; Therapist monitoring: weekly Skype sessions with a therapist in months 1-3; be-weekly Skype sessions in months 4-6.	(i) Everyday executive functions; (ii) Behavioral, social, and emotional functioning	Behavioral, social, and emotional functioning: (i) CBCL (parent report): externalizing and internalizing problems	Improvement in behavior problems in older adolescents and those with pretreatment symptoms.
Tlustos et al., [54]	Randomized controlled study.; Pre/posttest design.; Control group: active control group, assigned to IRC.	(E: 65, C: 67).; Age: 11-18 years.; Diagnosis: mild to severe TBI at 1-6 months since injury.	Training: CAPS.; Setting: home.; Duration: 6 months, for the 10 core sessions +6 eventual supplemental sessions.; Therapist monitoring: weekly Skype sessions with a therapist in months 1-3; be-weekly Skype sessions in months 4-6.	(i) Everyday executive functions; (ii) Behavioral, social, and emotional functioning	Everyday executive functions: (i) BRIEF (parent and youth self-report): GEC; Behavioral, social, and emotional functioning: (i) HCSBS (parent report): social competence subscale; (ii) CBCL (parent report): social competence subscale; (iii) BERS 2 (parent report): social competence subscale	Improvement in social competence.; Greater improvement in younger teens with moderate TBI.
Narad et al., [73]	Pilot study.; Pre/posttest design.; Control group: no control group.	.; Age: 14-17 years.; Diagnosis: mild to severe TBI during childhood (mean age at injury: 7.27 years, mean time since injury: 8.46 years).	Training: SPAN.; Setting: home.; Duration: 4 weeks.; Therapist monitoring: weekly videoconferencing sessions via Skype with a trained college-student coach.	(i) Behavioral, social, and emotional functioning	Behavioral, social, and emotional functioning: (i) CBCL (parent and youth self-report): social competence, social problems and total problems scales	Improvement in social participation.; Medium to large effect sizes were found for adolescent self-reported measures. Negligible effects were observed for parent-reported measures.
Wade et al., [48]	Pilot study.; Pre/posttest design.; Control group: no control group.	.; Age: 14-22 years.; Diagnosis: 9 TBI (moderate or severe); 6 BT (at least 2 years out from treatment completion or from diagnosis if treatment was not indicated).	Training: SPAN.; Setting: home.; Duration: 10 weeks.; Monitoring: weekly videoconferencing sessions via Skype with a coach for 30-60 minutes.	(i) Behavioral, social, and emotional functioning	Behavioral, social, and emotional functioning: (i) CBCL (parent and youth self-report): internalizing, externalizing, and total problems scales+social problems and social competence scales	Improvement in parent reported frequency of social participation and total, internalizing, and externalizing problems; improvement in teen-reported confidence ability to participate and develop social participation goals and plans.
Wade et al., [57]	Randomized controlled study.; Pre/posttest design.; Control group: two versions of the TOPS program (TOPS-F and TOPS-TO) were compared with an active control group, assigned to IRC.	(TOPS-TO): 51; E2 (TOPS-F): 49, C: 52.; Age: 11-18 years.; Diagnosis: mild to severe TBI at <18 months since injury.	Training: TOPS-TO or TOPS-F.; Setting: home.; 6 months for the 10 core sessions +4 eventual supplemental sessions.; Monitoring: Skype sessions with a therapist every 1-2 weeks.	(i) Everyday executive functions; (ii) Behavioral functioning	Behavioral, social, and emotional functioning: (i) CBCL (parent and youth self-report): externalizing problems; Everyday executive functions: (i) BRIEF (parent and youth self-report): GEC	Improvement in executive functioning in the TOPS-F group, as compared to the TOPS-TO group.; Differences between the TOPS-F and IRC groups approached significance.; Maternal education and parental stress levels moderated improvements.

Note: study included in the meta-analytic exploration. Outcomes reported in the table refer only to children. ADHD: attention deficit and hyperactivity disorder; BERS 2: Behavioral and Emotional Rating Scale 2; BRI: Behavioral Regulation Index; BRIEF: Behavior Rating Inventory of Executive Function; BT: brain tumor; C: control group; CAFAS: Child and Adolescent Functional Assessment Scale; CAPS: Counselor-Assisted Problem Solving; CBCL: Child Behavior Checklist; CDI: Children’s Depression Inventory; E: experimental group; GEC: Global Executive Composite; HCSBS: Home and Community Behavior Scale; IRC: Internet Resource Comparison; MI: Metacognition Index; OFPS: Online Family Problem-Solving; SES: socioeconomic status; SPAN: Social Participation and Navigation; TBI: traumatic brain injury; TOPS: Teen Online Problem-Solving; TOPS-F: Teen Online Problem-Solving-Family; TOPS-TO: Teen Online Problem-Solving-Teen Only; WEQ: Website Evaluation Questionnaire.