How effective is phone aided cognitive rehabilitation (PACR) in improving cognition in patients with cognitive decline due to hippocampal sclerosis (HS) and temporal lobe epilepsy (TLE) at the National Hospital of Sri Lanka?

Study setting: National Hospital of Sri Lanka Method of randomization: none, this is a single arm uncontrolled study. Intervention: This is a phone aided cognitive rehabilitation (PACR) programme and involves hyper casual mobile phone games which have been developed as a PACR programme to aid neuroplasticity / brain stimulation. The games are formulated in a manner in which with each attempted play the level of difficulty and level of saturation for the game is increased or adjusted based on the capacity of the patient with a view to aid neuroplasticity / brain stimulation. Two games focused on nonverbal memory (one) and verbal memory (one) will be administered to study participants based on their respective cognitive deficits which are assessed at baseline and will depend on which hemisphere is affected (dominant hemisphere – verbal memory non-dominant hemisphere – non-verbal memory). The games will be administered by a trained psychologist. During the intervention, all participants will begin the training at the beginner level. Difficulty will increase throughout the intervention period based on their performance. At the end of each training session, game progress will be saved, and participants will begin the next session at that point. Game performance will be recorded for each participant. Moreover, for their training sessions at home, participants will be asked to train at the same time of the day to maintain consistency. Duration of training time for each participant: 35 minutes p/day for 6 days p/week for a period of 12 weeks (2520mins)
The game performance will be monitored through meta-data accrued during each playtime or event and stored centrally on a remote server.

1. All patients (males and females) with a confirmed diagnosis of TLE and HS aged 18 – 60 years with cognitive impairment detected at baseline of the study
2. Subjects who have access to a smart phone of any kind and can operate the phone.

1. Patients with active psychotic and mood symptoms assessed through the Short General Health Questionnaire (GHQ-12)
2. Patients having delirium/ acute confusion resulting from a recent acute event including seizures.
3. IQ below 70. This will be assessed using Test of Nonverbal Intelligence (TONI-3) study instrument.
4. Patients with an existing diagnosis of learning disability
5. Patients with established cognitive impairment due to other causes than TLE
6. Patients with hearing and visual impairment compromising the ability to coorporate with the tests and the intervention
7. Presence of another neurological disorder (e.g. dementia, stroke, epilepsy, and traumatic brain injury resulting in a loss of consciousness for more than 30 minutes)
8. Patients with a history of photosensitive seizures
9. Patients who are undergoing/have similar intervention/s currently or in the recent past
10. Patients who are undergoing treatment changes or have planned changes to the treatment in the next six months
11. Patients who develop lack of capacity to continue during the study period.