TYPES OF ATTENTION

a) Focused Attention: respond to discrete visual, auditory, or tactile stimuli

b) Sustained Attention: vigilance and working memory

c) Selective Attention: ability to ignore irrelevant or distracting stimuli

d) Alternating Attention: Set shifting, mental flexibility

e) Divided Attention: ability to respond to multiple, simultaneous tasks

PEOPLE WITH TRAUMATIC BRAIN INJURY MAY EXPERIENCE:

  • Problems with concentration
  • Distractibility
  • Forgetfulness
  • Problems with ability to perform multiple task at one time
  • Problems in independent living: self-care, productivity, & leisure

ATTENTION PROCESS TRAINING

a)designed to remediate attention deficits in individuals with brain injury

b)hierarchically organized tasks

c)

c)

d)

e)

f)

g)

h)

i)

j)

k)

l)neuropsychological

STRENGHTS OF THE APT:

a)Based on a theoretical and clinical rationale b) Therapy is tailored to each specific individual

c) standardized tools for scoring

WEAKNESSES OF APT:

a)Size and set of training materials b) Activities are not functional c) Whether gains are generalizabled)Not enough emphasis on the whole person APT-IIe)What population can benefit from it?

ENVIRONMENTAL SUPPORTS

  • Used later in recovery phase to assist in reintegrating client into their home or work environments
  • Self-management strategies:client learns to initiate
  • Environmental Supports:Environment is modified to decrease attention problems

STRENGTHS OF ENVIRONMENTAL SUPPORTS:

a) Theoretical foundation b) Integrates clients back into their ‘natural’ environment c) Client-centredd) Measurement e) Cost-effective

WEAKNESSES OF ENVIRONMENTAL SUPPORTS:

a) Difficult to train clients with attention deficitsb) Time consumingc) May not be able to transfer strategies to different environments

EXTERNAL DEVICES

  • Used to assist client’s with attention deficits to track, organize, and respond to information
  • Possible Devices:

•Written calendars/Day planners

•Written checklists

•Electronic organizers

•Voice activated message recorders

•Task specific devices

STRENGTHS OF EXTERNAL AIDS:

a)Theoretical foundationb) client-centred c) save time d) cost-effective e) aids can be general or specific f) can be used with clients with attention, memory, and/or executive function deficits

WEAKNESSES OF EXTERNAL AIDS:

a)Difficult to train individuals with cognitive problemsb) clients may not remember to consult aids

c) Client may be effective with aid in therapy, but cannot transfer these strategies

PSYCHOSOCIAL SUPPORT

  • Addresses the possible reactive effects experienced as a result of changes in functioning
  • Reactive effects (grief, anger, denial, depression, anxiety) negatively affects one’s information processing capacity and pose as barriers to rehabilitation

Intervention Examples:

Stress managementRelaxation therapy

Brain injury educationPersonal relation therapy

Family therapyPsychotherapy

Grief therapySupportive listening

Kay (1992)- Believes that psychosocial approaches should be used in conjunction with

cognitive rehabilitation in order to address both organic brain damage and

psycho-emotional effects of brain injury

 this can be achieved through client-centred practice and the client therapist relationship

 by involving the client this a) increases control over their situation b) decreases feelings of victimization/discouragement

Outcomes- Decreases depressive symptoms and anxiety

- Empowers clients to understand & change their behaviour/circumstances

REFERENCES

Blundon, G., & Smits, E. (2000). Cognitive rehabilitation: A pilot survey of therapeutic modalities used by Canadian occupational therapists with survivors of traumatic brain injury. Canadian Journal of Occupational Therapy, 67(3), 184-196.

Evans, J., Wilson, B., Needham, P., & Brentnall, S. (2003). Who makes good use of memory aids? Results of a survey of people with acquired brain injury. Journal of the International Neuropsychological Society, 9, 925-935.

Glang, A., Todis, B., Cooley, E., Wells, J., Voss, J. (1997). Building social networks for children and adolescents with traumatic brain injury: A school-based intervention. Journal of Head Trauma Rehabilitation, 12(2), 32-47.

Lopez-Luengo, B., & Vazquez, C. (2003). Effects of attention process training on cognitive functioning of schizophrenic patients. Psychiatry Research, 119, 41-53.

Mateer, C., & Robert, M. (1996). Understanding, evaluating, and managing attention disorders following traumatic brain injury. Journal of Head Trauma Rehabilitation, 11(2), 1-16.

Palmese, C., & Raskin, S. (2000). The rehabilitation of attention in individuals with mild traumatic brain injury, using the APT-II programme. Brain Injury, 14(6), 535-548.

Shallice, T., & Burgess, P. (1991). Deficits in strategy application following frontal lobe damage in man. Brain, 114(2), 727-741.

Singer, G., Glang, A., Nixon, C., Cooley, E., Kerns, K., Williams, D., & Powers, L. (1994). A comparison of two psychosocial interventions for parents of children with acquired brain injury: An exploratory study. Journal of Head Trauma, 9(4), 38-49.

Solberg, M., & Mateer, C. (2001). Cognitive Rehabilitation. New York: The Guilford Press.

Solberg, M., McLaughlin, K., Pavese, A., Heidrich, A. (2000). Evaluation of attention process training and brain injury education in persons with acquired brain injury. Journal of Clinical and Experimental Neuropsychology, 22(5), 656-676.