MSU Researchers Improve the Outlook for African Children with Cognitive Impairment
Using a game designed for Sub-Saharan Africa, MSU researchers are rehabilitating children who suffer from cognitive impairment after surviving life-threatening diseases such as malaria and HIV. Known as Brain Powered Games, the project is the first of its kind, now providing both rehabilitation and computer-based assessment for African children.
“We developed these African Brain Powered Games several years ago to help kids with cognitive damage from malaria, and kids that had cognitive damage from HIV that they had gotten from their parents at birth,” said Brian Winn, Director of the Games for Entertainment and Learning (GEL) Lab. “The Brain Powered Games are a series of games that [children] can play that exercise different cognitive functions, like memory or attention or fine motor skills.”
Released in 2013, the growing collection of digital games was developed in the GEL Lab at Michigan State University. The games serve children in Uganda, Malawi and other countries in Africa, and the project has garnered support from the National Institutes of Health (NIH). In a continuation of the project titled "Culture-Specific Neurodevelopmental Assessment of HIV-Affected Children," the research team received NIH funding, projected to total $3.2 million over the course of five years. In 2019, the NIH granted the project $715,872 for the first year.
What’s in a Game? Tools for Intervention
People have long been concerned with the impacts of malaria and HIV, which can lead to memory loss and neurological damage among others.
According to the NIH, more than 575,000 cases of cerebral malaria occur each year, with most of them occurring in children in sub-Saharan Africa. Survivors of this type of malaria often suffer from brain injury, including neurological and cognitive deficits, behavioral issues and epilepsy, which can lead to long-term neurocognitive impairments.
Many methods of treatment have been introduced to support affected youth, ranging from prescription drugs to educational flash cards that could foster cognitive development, but these methods came with limitations. Some products were not proven to be effective and others were created with western culture in mind, introducing African youth to characters that were not culturally appropriate, such as pirates or Halloween characters.
The Brain Powered Games serve as a tool for Computerized Cognitive Rehabilitation Therapy, or CCRT.
“This was introduced as a different approach,” said Winn. “There was another set of commercially available games that were also used, but they were expensive and not always suitable for this population – and not culturally sensitive or related to the culture.”
MSU researchers are working with a team of interventionists in Africa, who help children learn how to play the games and assist with assessment.
“A lot of the money goes to actually funding the African team that’s on the ground, doing the cognitive rehabilitation and working with the kids,” said Winn. The ComArtSci professor was among those from MSU who traveled to Africa to set up the project. “It was great to go there and actually do a pilot. We found out issues that we didn’t even realize would be issues until we went there.”
Keeping Score for the Sake of Children
The game software – which is available on iPads as well as PC and Mac computers – has built-in technology for tracking children’s growth over time, making the project the first to provide a quality assessment of cognitive development in affected African youth.
The team observed aspects of life in Africa, noticing that even though basic needs were scarce, African children could still benefit from these games.
“You’ll be in these very rustic villages where they don’t even have running water, but internet is available,” said Winn. “The teams want to use games as both sort of an assessment for where the kids are at cognitively, and also a method to rehabilitate them.”
Other variables may also be at play, such as using medication or other treatments. One challenge for the researchers is to track what interventions are being used in addition to the African Brain Powered Games.
"The kids loved the games and quickly adapted to them," said Michael Boivin, Ph.D., professor of director of MSU's Psychiatry Research Program. "With the help of an MSU intramural grant in 2012, we were able to develop the first version of an African version of BPG. In a subsequent clinical trial that we published in Global Mental Health, we presented evidence that Africa BPG was effective in improving attention and working memory in rural Ugandan children living with HIV."
Winn said there were also side benefits, such as introducing children to technology and exposing children to interactive software. The project helped to build skills the children could use in other aspects of their life.
"The data we gather via our mobile platform, linked to the web for secure transmission back to the GEL Lab via secure servers, are of vital importance to this study. This is because this 'cloud' capacity, amenable to artificial intelligence dating mining algorithms, will enable us to establish the optimal manner in which BPG and Village Builder can provide a sensitive dynamic measure of a child’s developing brain," said Boivin. "Furthermore, in time it can be made readily available to any community health worker or even parent with access to a mobile network. We expect to demonstrate that a child’s performance on a neurocognitive 'stress test' — involving game training with an app on a computer tablet — will provide access “where there is no brain or behavior doctor.”
An Idea Generated in the GEL Lab
The Brain Powered Games was one of the first major initiatives to come out of the GEL Lab at MSU’s ComArtSci. It was first developed in 2005 to help aging populations with cognitive skills, and the project has expanded from there, as researchers find new applications.
“We’ve been working on this a long time, almost since the beginning of the GEL Lab itself,” said Winn. “That was one of our first things out of the gate. We worked on that for several years, and then it transformed into this African application of it. We have iterated on it several times over the years, continually improving it based on our research and advancements in technology.”
Faculty and students in the GEL Lab created the collection of digital games, and then collaborated with other researchers and scholars at MSU to find interdisciplinary applications. Working with neurologists and psychiatrists, they customized the game so that it could support rehabilitation for specific audiences.
“The use of the cognitive games with children with HIV is a major thrust of the latest project,” said Winn. “The game can grow with them. It can get harder and harder and harder, and help build their skills up.”
The pilot and early version of the game were used as a CCRT to rehabilitate children in Malawi with cerebral malaria. A later version of the cognitive games were built and tested in Uganda to rehabilitate children infected with HIV.
"Brian and his GEL team are also developing a new prosocial reasoning strategizing game called Africa Village Builder, which will be the first of its kind as an intervention and assessment of ‘frontal lobe’ brain functions," said Boivin.
The project will continue with MSU researchers and teams in Africa working on rehabilitation and assessment for years to come. ComArtSci faculty will visit sub-Saharan Africa again in the coming months, to advance the project and ensure it makes a difference in the lives of African children.
By Melissa Priebe