Investigation of the Effect of School Based Cognitive Rehabilitation on Cognitive Skills, Academic Performance and Quality of Life in Refugee Children

The criteria for inclusion of volunteers in the study; Scoring 12 points or more from the Post-Traumatic Stress Reaction Scale for Children, getting a score below 21 from the Montreal Cognitive Assessment Scale, being between the ages of 12-16, having experienced war in their country, being Turkish literate, and volunteering of the child and his/her family to work. The exclusion criteria are; Having a known neurological, developmental or learning disability. The data will be collected by asking our questionnaire and scale questions and by evaluating the cognitive skill components such as the attention test practically. Data collection methods are survey and observation. Quantitative research methods will be used to obtain the data.

Post-traumatic stress level and poor cognitive skills are the parameters that will determine the individuals to be included in the study, and the questionnaires the investigators will use for these are the Post-Traumatic Stress Response Scale for Children and the Montreal Cognitive Assessment Scale. CTSS is used to evaluate specific stress symptoms in individuals who are exposed to violence or trauma. Each child should be evaluated by interviewing the participant about the participant's own reactions to the crisis. This questionnaire has 20 items and scores 7-10, mild post-traumatic stress; 10-12 points, moderate post-traumatic stress; A score of 12 and above indicates severe post-traumatic stress.

Montreal Cognitive Assessment Scale is a scale developed to evaluate mild cognitive impairments and evaluates different cognitive abilities consisting of executive functions, visuospatial skills, memory, language, attention and concentration, abstract thinking, calculation and orientation. The application takes about 10 minutes and the highest total score that can be obtained from the test is 30. Accordingly, scores of 21 and above are considered normal. Refugee children who score below 21 will be included in our study. To evaluate memory function according to this scale; recall from short-term memory, five word learning trials, and delayed recall after five minutes (5 points); to assess visual-spatial skills; Clock Drawing Test (3 points) and 3D cube copying (1 point); to evaluate executive functions; Combining consecutive numbers and letters (such as 1-A, 2-B, 3-C) adapted from the Trail Making Test-B form (1 point), verbal fluency (1 point); to evaluate abstract thinking skills; making similarity between two-item words (2 points); to assess attention, concentration and working memory; sequential subtraction (3 points), determination of the target letter among the read letters (1 point) and counting backwards and forwards (1 each), for language evaluation; Naming three relatively less well-known pictures of animals (lion, rhinoceros, camel) (3 points), repeating two complex sentences paying attention to the syntax (2 points), and time and place orientation questions (6 points) are used to evaluate orientation.

After the individuals included in the investigators' study were selected based on the scales described above, the Loewenstein Occupational Therapy Cognitive Assessment Scale was used to evaluate the cognitive status of the refugee children included; Reading Speed Test and Minnesota Handwriting Test to assess their academic performance; Pediatric Quality of Life Scale will be used to assess their quality of life. After the initial evaluation of the intervention group, it will be taken into cognitive training for 10 weeks and final evaluations will be made at the end of 10 weeks. The control group, on the other hand, will not be given cognitive training for 10 weeks after the first evaluation, and after the final evaluation, the participants' will be given cognitive training for 10 weeks in terms of ethics, after comparison with the intervention group.

the Loewenstein Occupational Therapy Cognitive Assessment Scale was developed to assess basic cognitive abilities in people who have suffered brain damage due to traumatic head injuries, strokes and brain tumors. This scale, which is used to evaluate the cognitive status of people whose cognitive skills are affected for any reason; Orientation, visual perception, spatial perception, motor planning, visual motor organization and thinking ability consisted of six main sections and 26 subtests. The application takes 30-45 minutes. Six main sections of the Loewenstein Occupational Therapy Cognitive Assessment Scale and subtests of these sections will be applied to refugee children whose cognitive skills have decreased due to the effect of exposure to war experience, which the investigators will include in our study. In order to evaluate orientation with this scale, the answers of the individual will be evaluated with a score between 1-4 using four questions for place and time orientation. Four subtests will be used to assess visual perception: visual identification of objects, visual identification of shapes, nested shapes, and object constancy. The answers of the patients will be scored between 1-4 points. For motor planning evaluation, 3 tests will be applied and the patient's performance will be scored with points given between 1-4. Motor imitation, by asking the patient to imitate the 4 movements shown; The use of objects will be evaluated by asking the patient to demonstrate how the various given objects have been used. Copying geometric figures to assess visual motor organization; creating a two-dimensional model by combining the shaped parts in the test booklet; copying the figure in the test booklet with nails on the perforated test board; forming the butterfly shape shown in the test booklet on the test booklet with the 9 pieces given; Scoring will be done by observing the activities of transforming this circle into a clock showing 10:15 by placing the numbers of the clock in a circle given as a hollow. Finally, in order to test the categorization, ordering and logic in order to evaluate the thinking ability, the individual will be asked to group 18 plastic pieces of 3 different shapes and 3 different colors, to sort the 5 picture cards given in a mixed order describing an event, and to describe the event.