An interventional study of THE FATIGUE, LEARNING, AND MEMORY ENRICHMENT (FLaME) INTERVENTION - Full intervention and THE FATIGUE, LEARNING, AND MEMORY ENRICHMENT (FLaME) INTERVENTION - Cognitive rehabilitation only in Childhood Brain Tumor, Childhood Brain Tumors and Pediatric Brain Neoplasms, sponsored by Great Ormond Street Hospital for Children NHS Foundation Trust. Not yet recruiting at 1 site in United Kingdom. Open to participants aged 7 Years to 18 Years. Per ClinicalTrials.gov, last updated 2025-01-13.
Sponsored by Great Ormond Street Hospital for Children NHS Foundation Trust · Not applicable, Interventional, and Treatment
Medical treatments have improved survival rates for children with brain tumours. However, most children experience long-term difficulties with 'cognition' (thinking skills such as memory and paying attention) and cognitive fatigue (excessive mental tiredness) after treatment. Thinking difficulties and fatigue can affect a child's ability to learn, and their social and emotional wellbeing. National guidance recommends treatment called 'cognitive rehabilitation' which teaches skills to improve or manage cognitive difficulties. Families often request this, but it is not usually available due to little research. Fatigue may also get in the way of children using and benefiting from cognitive rehabilitation. No research study has offered a fatigue treatment for children recovering from brain tumours. The study aims to see if it is practical and helpful to families to provide cognitive rehabilitation for children affected by brain tumours. The treatment focuses on strategies to help cognition. The investigators will see if adding strategies to manage fatigue helps. The study will include thirty-six 7-17-year-olds who have been treated for brain tumour at Great Ormond Street Hospital. All participants will have had an assessment describing cognitive strengths and weaknesses as part of usual care. Participants will be randomly allocated to one of three groups: 1) cognitive rehabilitation with fatigue management (12 weeks), 2) cognitive rehabilitation only (6 weeks), or 3) usual care. Each child and their carer will complete questionnaires before, during, and after the treatment, and an interview at the end of the treatment. This information will help the researchers see if families find the treatment helpful and practical to take part in, and if adding fatigue strategies is beneficial. Researchers will look at information such as the number of appointments attended, feedback about the treatment, and information about fatigue levels, cognition, and wellbeing. The findings will be used to develop a UK-wide study.
Treatment advances for childhood brain tumour in recent decades have substantially improved mortality rates but come at significant cost to the child's cognitive abilities, alongside the effects of the tumour itself. Up to 100% of children treated for a brain tumour experience some degree of cognitive difficulty despite most having achieved typical cognitive development prior to diagnosis. In most cases the child will experience multiple cognitive difficulties (e.g., with memory, attention, and speed of processing) that severely impact quality of life, mental health, access to education, academic and vocational attainment, and progress towards becoming an independent adult. These cognitive difficulties often emerge and become more severe over time (called 'late effects'). These difficulties have been frequently found in research studies and have informed a strong emphasis on the need for neurorehabilitation in national guidance for childhood brain tumour (e.g. NICE, 2005). Interventions aimed to address cognitive difficulties and support children to resume their developmental trajectory as closely as possible are clearly paramount. However, recent evidence finds that the recommendation for neurorehabilitation is rarely implemented, with cognitive rehabilitation almost entirely unavailable. Poor adherence to national guidance is compounded by the very limited research into cognitive rehabilitation interventions for children treated for brain tumour. The few interventions tried have also had poor feasibility of implementation (e.g., low completion rates) and low acceptability for patients and families.
Cognitive rehabilitation interventions typically involve either 1) 'massed drill-based' practice (sometimes called 'brain training') on cognitive training tasks where the individual repeats a cognitive training exercises over many sessions such as remembering an array of dots; 2) strategy-based approaches which teach strategies to optimise cognition (e.g., memory techniques such as mnemonics), and/or 3) external compensatory aids (e.g., visual reminders). There are few studies of cognitive rehabilitation for children with brain tumour, particularly good quality trials. A small number of studies have focused on drill-based rehabilitation, however, the feasibility and acceptability for this approach for children with brain tumour is low and has well documented problems in poor generalisation to skills beyond the repetitively trained task and poor maintenance of improvements. Rehabilitation in childhood brain injury has greatest potential when it includes cognitive strategy-use, is adapted for developmental level, involves systemic support, and empowers children to develop their own strategies. There is currently one good quality trial of a cognitive rehabilitation intervention that incorporates strategy-use for children with brain tumour. The intervention resulted in improvements in academic attainments and parental report of child attention skills, but with small effect sizes. The program also included a demanding drill-based practice component (requiring 50 hours in total), with only 60% of participants completing the intervention. A subsequent study omitted the drill-based practice and extended the strategy-use component, combining it with parent and teacher strategy support in a smaller pilot study. The power and generalisability of the findings are limited by a small sample size, however some improvements for cognition were found. Parents and children also rated high levels of satisfaction, particularly because the intervention improved their understanding of their cognitive strengths and weakness. Despite some promising findings for strategy-based cognitive rehabilitation, poor feasibility continues to be reflected in low completion rates. No cognitive rehabilitation intervention has addressed the high prevalence of cognitive fatigue (extreme mental tiredness) for children with brain tumours that could predictably limit engagement and completion of interventions. Despite strong recommendations a targeted intervention has yet to be developed for cognitive fatigue for children with brain tumours.
The research was designed to answer two key questions where there is a substantial evidence gap: 1) is a novel strategy-based cognitive rehabilitation intervention acceptable and feasible to children treated for brain tumour and their families, and 2) does adding fatigue management to the intervention improve feasibility and acceptability. The intervention is called The Fatigue, Learning and Memory Enrichment [FLaME] programme. The findings will tell us about the feasibility, acceptability, and preliminary outcomes of the FLaME programme. That is, it will tell us if there are any barriers to putting this intervention in place for young people with brain tumours, how acceptable they find it, and what the level of demand and satisfaction there is with the intervention. We will also seek preliminary information about intervention effectiveness to inform the optimum outcome measurement. This information will inform progress to a larger scale randomised controlled trial (RCT) to meet a substantial evidence gap in an under-researched group. There has been no cognitive rehabilitation trial for childhood brain tumour in the UK before, including within the National Health Service.
2,229 studies on the registry are indexed under Fatigue; 426 are open to participants now.
This study's planned enrollment of 36 is below the median of 54 across 1,757 interventional studies indexed under Fatigue.
Browse Fatigue studies →Great Ormond Street Hospital for Children NHS Foundation Trust is the lead sponsor of 82 studies on the registry; 19 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
A 12-week block of intervention (strategy-based cognitive rehabilitation with fatigue management)
Behavioral: THE FATIGUE, LEARNING, AND MEMORY ENRICHMENT (FLaME) INTERVENTION - Full intervention
A 6-week block of intervention (strategy-based cognitive rehabilitation alone)
Behavioral: THE FATIGUE, LEARNING, AND MEMORY ENRICHMENT (FLaME) INTERVENTION - Cognitive rehabilitation only
Standard care only
A novel strategy-based cognitive rehabilitation intervention that can be delivered with or without cognitive fatigue management. Skills are targeted sequentially based on a developmental hierarchical model where cognitive fatigue can be addressed first, followed by adult-supported compensatory strategies, with independent use of strategies for specific impairments delivered only once these earlier levels have been addressed. The 'FLaME' program incorporates strategies that have been trialled and found successful in fatigue (e.g., pacing and activity scheduling) and cognitive rehabilitation (e.g., chunking, elaborative encoding techniques) interventions for children. The intervention address two key issues: 1) to deliver strategy-based cognitive rehabilitation as an alternative to prevailing drill-based approaches, and 2) to integrate fatigue management to improve feasibility and acceptability of cognitive rehabilitation. This arm include the full intervention.
A novel strategy-based cognitive rehabilitation intervention that can be delivered with or without cognitive fatigue management. Skills are targeted sequentially based on a developmental hierarchical model where cognitive fatigue can be addressed first, followed by adult-supported compensatory strategies, with independent use of strategies for specific impairments delivered only once these earlier levels have been addressed. The 'FLaME' program incorporates strategies that have been trialled and found successful in fatigue (e.g., pacing and activity scheduling) and cognitive rehabilitation (e.g., chunking, elaborative encoding techniques) interventions for children. The intervention address two key issues: 1) to deliver strategy-based cognitive rehabilitation as an alternative to prevailing drill-based approaches, and 2) to integrate fatigue management to improve feasibility and acceptability of cognitive rehabilitation. This arm includes the cognitive rehabilitation only.
Goal Based Outcome for management of fatigue
The GBO tool is a way of evaluating progress towards goals in clinical work with children, young people, and their families and carers. The GBO compares how far a child or young person feels they have moved towards reaching a goal that they have set for themselves at the beginning of an intervention, on a scale between 0 and 10. 1-3 therapeutic goals are developed collaboratively with a psychologist
Time frame: From enrolment to week 14
Goal Based Outcome for management of cognitive difficulty
The GBO tool is a way of evaluating progress towards goals in clinical work with children, young people, and their families and carers. The GBO compares how far a child or young person feels they have moved towards reaching a goal that they have set for themselves at the beginning of an intervention, on a scale between 0 and 10. 1-3 therapeutic goals are developed collaboratively with a psychologist
Time frame: From enrolment to week 14
Multidimensional Fatigue Scale
A self-report symptom-specific instrument to measure fatigue in patients with acute and chronic health conditions. Multiple dimensions of fatigue are measured including general fatigue, sleep/rest fatigue, and cognitive fatigue.
Time frame: From enrolment to week 14
Individual daily fatigue analogue scale
Rating of subjective fatigue from 0-10 (0 = no fatigue, 10 = severe fatigue) for the morning and afternoon
Time frame: From enrolment to week 14
% School attendance
UK Govt. method: each day = 2 sessions and averaged per term and conventional threshold of \>=10% of sessions missed as persistent absence)
Time frame: From enrolment to week 14
Behaviour Rating Inventory of Executive Function, Second Edition (BRIEF2)
The BRIEF2 screens for executive function skills/difficulties in children and adolescents ages 5 to 18 years. Three domains evaluate cognitive, behavioural, and emotional regulation, and a Global Executive Composite score provides and overall evaluation of executive functioning
Time frame: From enrolment to week 14
Paediatric Quality of Life Inventory (PedsQL) Core + Brain Tumour Module Cognitive Problems scale
The core PedsQL is a brief measure of health-related quality of life in children and young people and includes scales on physical functioning, emotional functioning, social functioning, and school functioning. Additional modules can be added for common quality of life difficulties in specific health populations. The Brain Tumour module includes a cognitive problems scale of seven items on the specific cognitive difficulties young people with brain tumours frequently report.
Time frame: From enrolment to week 14
The Brief Illness Perceptions Questionnaire (BIPQ)
A brief measure of how an individual cognitively and emotionally represents their illness and its impact.
Time frame: From enrolment to week 14
Plan to share: No
This study is not yet recruiting, as verified in Jan 2025. You cannot join it, but the record below documents what was studied.
Get an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.
Great Ormond Street Hospital for Children NHS Foundation Trust