PASTEC - a prospective, single-center, randomized, cross-over trial of pure physical versus physical plus attentional training in children with cancer.

Despite recent improvements in survival rates in children with cancer, long-term toxicities remain a major concern. Physical activity could reduce the impact of long-term sequelae, notably in neuropsychological and physical areas. We report of a randomized trial of pure physical versus physical/attentional training in pediatric oncology patients. Twenty-two patients aged 6-18 y.o. were included, irrespective of their clinical diagnosis or treatment status, stratified by age and randomized 1:1 into pure physical vs. physical/attentional activity arms, with a cross-over at study midpoint. Neurological, motor and neuropsychological assessments were performed at inclusion, start, crossover and end of the program. Feasibility, defined as > 80% patients attending > 80% of sessions, was the primary endpoint. Secondary outcomes were improvements in neuropsychological and motor performance tests. While 68% of patients attended more than 80% of sessions during the pre-crossover phase of the study, this dropped to 36% post-crossover. Our study therefore failed to meet our primary endpoint. Nonetheless, significant improvements in anxiety (p<0.001), emotional control (p = 0.04), organization skills (p = 0.03), as well as motor deficit scores (p = 0.04) were observed. We noted no significant difference between the pure physical and the physical/attentional training arms, or when analyzing subgroups by age or sequence of intervention. We conclude that physical activity has a positive impact on anxiety, emotional and organizational aspects as well as motor deficits. Attendance dropped during the course of the study and motivational interventions should be included in future studies or equivalent programs.Supplemental data for this article is available online at https://doi.org/10.1080/08880018.2021.1994677 .

Confabulations in a teenager with a right frontal hemispherotomy: Possible underlying mechanisms.

Objective: Confabulations, i.e. false memories without intention to deceive, can be observed in adults with frontal brain damage. Confabulations are typically associated with episodic memory and/or executive disorders although the severity of these impairments is highly variable. Confabulations may also be associated with emotional/motivational particularities, as a positive bias seems to prevail in such situations. Several distinct cognitive and socio-affective processes may account for the various types of confabulations and these issues remain open. Method: We present the case of a teenager with an early acquired frontal damage, referred for "strange lies." Besides a standard neuropsychological assessment, we explored (1) source memory, using a reality-monitoring task, (2) episodic autobiographical memory, including both the recollection of the past memories and the ability to imagine future personal events, with an episodic future thinking task (EFT), (3) the sense of self, with questionnaires targeting self-representations, self-esteem and self-competence. Results: The results showed the expected source memory deficits and poor episodic future thinking, whereas episodic autobiographical memory was preserved, contrary to the episodic memory dysfunction usually evidenced in adult confabulators. The confabulations produced by this teenager displayed a clear positive bias, seemed to fit to personal/social goals and to wishful ideations, and were associated with an above average self-esteem and self-representation. Conclusions: These results support the hypothesis of self-identity and emotional regulatory roles of the confabulations. Although the literature on confabulating children/teenagers is nearly non-existent, a more systematic screening of confabulations should be conducted in order to avoid false interpretation to strange discourse or behavior.