Pay Attention!!, Schemes and Mind Maps of History

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Pay Attention!!

Attention and Attention Process Training in Brain Injury

Course Objectives

• Participants will understand and define 2 types of attention
• Participants will list specific behaviors/symptoms of

attention deficits related to brain injury

• Participants will understand the role of APT in improving

attention following brain injury

• Participants will list strategies and generalization activities

to train attention across therapy.

Attention Deficits in Brain Injury

• Cognitive deficits occur in more than half of stroke survivors, with

impaired attention being the “most prominent” change. (Barker-

Colloo et al., 2009)

• Sustained attention 2 months after stroke predicts functional

recovery in 2 years. (Robertson et al (1997)

• Attention is also correlated to boarder outcomes including physical,

mental health etc.

• In mild TBI attention disturbances include slower processing,

sustained attention and working memory

Types and Models of Attention

Cognitive processing models- based on information from observations of unimpaired individuals

and describe how we process information.

i.e. Mirsky et al (1995)- 4 distinct components based on a factor analysis of performance on a range of attention tests and included--focus-execute, sustain, encode and shift

Neuroanatomic model of attention(Posner & Rothbart, 2006) -- 3 distinct networks- alternating

(vigilance), orienting (selecting information) and executive control

Sohlberg and Mateer (2001) -clinical model of attention- divided attention into 5 components

focused, sustained, selective, alternating attention and divided attention.

Intensity & Selectivity

Intensity = processes responsible for attending over a given period of

time

Selectivity = components responsible for choosing among multiple or

competing stimuli.

Assessing Attention

 Attention disorders are common in TBI

 Can interfere with rehabilitation

 Important for other cognitive domains

 How do we assess this?

 Behavioral observations

 Importance of obtaining a thorough history

 Subjective report

 Objective testing

Clinical Interview

Patient report

Caregiver report

Developmental history

 Learning disorders

 ADHD

Psychiatric history

 Anxiety

 Depression

 Obsessive-Compulsive Disorder

Neuropsychological Testing

Attention & Concentration

 Digit Span subtest from the WAIS-III, WMS-III, WAIS-IV

 Spatial Span subtest from the WMS-III

 Spatial Addition subtest from the WMS-IV

 Digit Symbol subtest from WAIS-III

 Coding subtest from the WAIS-IV

 Continuous Performance Test

 Paced Auditory Serial Addition Task

 Stroop Color and Word Test

 Digit Vigilance Test

 Consonant Trigrams

Observations of Attention Deficits

Sustained – Short attention spans, or good attention/accuracy at first that decreases over

time. Lose concentration over time.

Working memory: Decreased recall of short term information (i.e., multistep directions)

Selective - Most common in individuals who are easily disrupted by external distractions

but also internal distractions (i.e., anxiety, worry). Unable to attend in distracting

environment.

Alternating- Difficulty initiating a task after they have been engaged in a different activity.

May continue to perform activity related to the previous one. Perseverate

Observations of Attention Deficit

Divided – Difficulty doing two tasks– i.e. eating and talking, or answering

questions while doing simple tasks (i.e. folding laundry). Almost always leads

to performance issues

Alternating – Difficulty switching between 2 activities- i.e. reading a recipe

and cooking, lose their place easily

What is Attention Process Training (APT)

• Direct attention training approach aimed at improving underlying

attention deficits related to acquired brain injury.

• Intensively presented attention drills that stimulate impaired components

of attention can enhance the corresponding processing abilities.

• Uses structured drills and tasks for specific attention areas.
• Based on repeated activation and stimulation of a particular

subcomponent of attention, activates that areas on the brain and

strengthens the connection in the neural network ---neuroplasticity again!

• Discrete attention tasks delivered in conjunction with strategy training

and generalization activities.

APT 1 and II

APT I: significant impairment

APT II: less severe impairments

APT III: mild to severe impariment

Serino et al., 2006- compared attention training to non specific stimulation in 9 adults with TBI

• Experimental- repetitively administered working memory tasks of holding onto number sequences or add pairs of numbers.
• Control- Non specific attention stimulation

Attention training had benefit on improving a number of attention and executive function subsystems and generalized to everyday life.

Sohlberg et al.,2000- Crossover design with 14 people with moderate-severe TBI.

• Experimental- APT for 24 hours over 10 weeks.
• Control- 10 hours Brain injury education, supportive listening.

Training showed improvement on neuropsychological tests for attention and memory and more reports of improvement to daily life (via questionnaires).

Serino et al., 2006- 23 patients with moderate-severe TBI compared attention training (APT) to non specific stimulation.

• Experimental-APT tasks
• Control- Non specific attention stimulation

Post-testing showed significant improvement on PASAT and Consonant trigrams. No significant improvement on BDI. .