Virtual classrooms, real resilience: how AI tutors enhance cognitive rehabilitation in pediatric cancer survivors.

Background: Paediatric cancer survivors often experience cognitive late effects, including impairments in working memory, processing speed, and executive function, which can adversely affect academic performance, psychosocial development, and long-term functional outcomes. Traditional educational interventions may be limited by stigma, accessibility, and inconsistent engagement. Artificial intelligence (AI)-driven virtual tutors represent a promising, personalised approach to cognitive rehabilitation in this population.

Methods: A mixed-methods RCT with 150 survivors compared AI Tutor, Traditional Tutoring, and Control groups. Assessments included neurocognitive tests (WISC-V, Flanker, N-Back), academic metrics, psychosocial scales, and participant/parent/educator interviews. Subgroup analyses and ethical considerations (bias, equity) were explored. The study aimed to support and measure cognitive rehabilitation outcomes in this population.

Results: Participants in the AI Tutor group demonstrated significantly greater cognitive rehabilitation gains, particularly in working memory, processing speed, and maths performance compared to both the Traditional Tutoring and Control groups (p < 0.001). Flanker task error reduction and N-Back task performance indicated enhanced executive function, particularly among adolescents. Engagement metrics (e.g., session completion rates) were higher in the AI group, with younger children showing increased consistency and participation. Qualitative findings highlighted the AI tutor's non-judgmental nature, reduced perceived stigma, and effective use of gamification to foster motivation and routine.

Conclusion: AI-driven virtual tutors provide a scalable, personalised, and stigma-reducing approach for cognitive rehabilitation in paediatric cancer survivors, effectively complementing traditional methods across settings. Addressing ethical concerns like algorithmic fairness and access is crucial for equitable implementation. This study supports integrating AI tutors into survivorship care.