Table Appendices

Attention and Concentration

Individual Studies

Table 7.1 Treatment to Improve Attention and Concentration Post ABI

Treatment of Communication and Attention Deficits

Author/Year/ Country/Study design/PEDro & D&B Score

Methods

Outcomes

Amos (2002)

Australia

RCT

D&B = 15

PEDro = 4

 

N=32 Subjects (24 with ABI, eight without) were randomly assigned into three treatment groups: no treatment, external inhibition and increased stimulus salience. All treatment groups were compared to the normal controls. The Wisconsin Card Sorting Test (WCST) was employed to measure preservative error and random error.

There were no significant differences in total errors between groups, but groups differed significantly in total number of trials (p= 0.025), perseveration (p= 0.033) and categories achieved (p= 0.001). Comparisons between the unaided ABI group and the aided ABI groups and between the aided ABI groups and the control group showed that either aid significantly improved deficits in the ABI population on all measures. Comparisons between the inhibition and salience group revealed significance only for perseveration (p< 0.045); the external inhibition group displayed much less.

Drill and Practice

Author/Year/ Country/Study design/PEDro & D&B Score

Methods

Outcome

Novack et al.,

(1996)

USA

RCT

D&B = 15

PEDro = 5

N=44 Individuals suffering from severe TBI, but able to communicate, were provided 30 min. of cognitive remediation five times per week in either a focused hierarchical stimulation program (attention skills) or an unstructured intervention program. The following tests were used to measure change: Wechsler Memory Scale-Revised (WMS-R), the simple and choice reaction time, functional independence, FIM scores pre and post treatment.

Analysis of digit span, mental control sub-tests of WMS-R, simple & choice reaction time, and functional independence revealed no significant differences in attention & function skills, general cognitive abilities, or daily living activities between groups. 

Mindfulness Based Medical Techniques

Author/Year/ Country/Study design/PEDro & D&B Score

Methods

Outcome

McMillan et al.,

(2002)

UK

RCT

D&B=17

PEDro=5

N=145 Individuals who has sustained a TBI were randomly assigned to one of 3 treatment groups: ACT group (n=44), PE group (n=38), Controls (n=48). In total 25 individuals did not complete the treatment. Those in the ACT group received 5-45 min session of supervised practice over a 4 week period; those in the PE group received audio-tape based training, and therapist contact. Control group individuals received no therapist contact. All were assessed pre-post treatment and a 12 months follow-up. 

Results showed no significant differences at either of the post-treatment follow-up assessments between the groups. The exception to this was the results of the Cognitive Failure Questionnaire where those in both treatment groups had lower scores following treatment. Overall, ACT training was not found to result in any significant changes or worthwhile changes.

Dual Task Training

Author/Year/ Country/Study design/PEDro & D&B Score

Methods

Outcome

Couillet et al.,

(2010)

France

RCT

D&B= 20

PEDro = 5

N=12 Each phase of the study consisted of 6 weeks of training. During this time period, participants received four 1-hour training sessions per week. The “A” of the AB/BA design referred to the control training, while the “B” referred to experimental rehabilitation. The control trainings used various cognitive tasks that did not tap on divided attention or working memory. During the experimental phase, patients were given specific dual task training. The object of the experimental phase was to train the participants to perform 2 tasks concurrently. Participants were initially trained to perform each task independently, then simultaneously. Treatment began with simple and automatic tasks building to more complex demanding tasks.

Following treatment, there was a significant improvement in the 2 tasks that targeted divided attention. Those who received the experimental rehab training performed better than the group who received the control training. On the digit span dual-task the BA performed significantly better than the AB group (p<0.02). Experimental training was also found to have a large effect on reaction times and omissions as reported on the divided attention subtest of the TAP (Test Battery for Attentional Performance). The control training  lead only to minor changes.

Fasotti et al.,

(2000)

Netherlands

RCT

D&B = 19

PEDro = 5

N=22 Severe, closed TBI patients with evidence of slowed speed of information processing (assessed by PASAT, ACT, and CRT) randomized into a Time Pressure Management (TPM) treatment group (mean age: 26.1 years; chronicity 9.8 months) for 1 hour sessions 3x/week and a concentration training control group (mean age: 30.1 years, chronicity: 8.3 months) for 2-5 hrs/week over 3-4 weeks both using Waterbed (WB) and Harvard Graphics (HG) tasks.  Neuropsychological tests and psychosocial questionnaires administered 2 weeks prior, at end, and 6 months following training.

Scores on two of three standardized memory variables and all three attention variables increased significantly in treatment group; No memory variables and 1 of 3 attention variables increased significantly for the control group. Follow-up data for 10 in the treatment group and 9 of control group: pre-training follow-up showed a significant time effect (p < .05) but no significant group time interaction (p = .23) indicating that there still was a significant improvement after 6 months but that this improvement could not be attributed specifically to the treatment or control group.

Cognitive RehabilitationStrategies

Author/Year/ Country/Study design/PEDro & D&B Score

Methods

Outcomes

Sohlberg et al.,

(2000)

USA

RCT

Pedro = 8

D&B = 22

N=14 Those in Condition A (n=7) received 24 hours of attention process training (APT), in 3 one-hour sessions each week for a total of 10 weeks.  Attention process training is a cognitive rehab program that has been used to remediate attention deficits following an ABI. Tasks chosen for each subject were specific to his or her needs. Tasks were designed to place increasing demands on complex attentional control and working memory. Those assigned to Condition B (n=7) received a combination of brain injury education, supportive listening and relaxation training. Sessions ran for 10 weeks, one hour per week. All subjects worked directly with a therapist for the length of the study. Following therapy subjects were assessed using various scales (Paced Auditory Serial Addition Task (PASAT), Gordon Diagnostic Vigilance and Distraction, Controlled Oral Word Association Task (COWAT)) and interviews.

Those in the APT group reported significantly more changes following intervention then those in the brain injury education group (p<0.05). The greatest number of changes was reported in attention and memory than in psychosocial functions.  Changes in PASAT scores were greater for those who reported more than 2 cognitive changes. Results of the PASAT also found that those with higher levels of vigilance had higher PASAT scores. Those with higher vigilance scores had higher COWAT scores.

Computer Assisted Technology for Attention

Author/Year/ Country/Study design/PEDro & D&B Score

Methods

Outcomes

Thomas-Stonell et al., (1994)

Canada

RCT

PEDro = 4

D&B = 15

 

N=12 Patients (6 treatment, 6 control) participated in an individualized 8 week period of a computer-based program called TEACHware of remediating cognitive-communication skills in individuals with ABI.

Significant group differences on several of the standardized test measures with the remediation group performing significantly better than the control group in all cases.  The remediation group improved significantly on all of the standardized assessment measures.  Subjects in both groups increased total scores on the screening module with the remediation group improving 16.5% on average and the control group improving by 6.3%.  The difference between groups significant at p<.05.  No group differences for total time taken to complete the screening module.  No significant relationship between total correct and total time scores from screening module and test scores from the broad language measures.

Gray et al.,

(1992)

UK

PEDro=5

D&B=16

N=31 Individuals were randomized to either the treatment group (n=17) or the control group (n=14). The experimental group received micro-computerized attentional retraining and the control group received recreational computing. Working memory function was assessed using the Digit span, backward digit span, PASAT score, longest string, Wisconsin Card Sorting Test.

Pre-testing indication only the comprehension score indicated a non-significant difference between the groups. The post-testing, the experimental group showed significant improvement on the WAIS-R picture completing and the PASAT. At the 6th month follow-up, differences between the groups indicated significant improvement on the Backward Digit Span (p-0.007), the WAIS-R arithmetic (p=0.014), information processing rate and the PASAT (p<0.05) and the WAIS-R Block Design (p=0.44). Course improvement was seen in the experimental group during the intervention phase. The control group also showed improvement but this was less strong.

Ruff and Bergquist

(1994)

USA

RCT

D&B = 16

PEDro = 3

 

N=15 Severe head injured subjects between 16 and 50 with GOAT entry score > 70, 6 months post-injury, and a DRS score > 100 were divided into 2 attention and memory training groups – the first (A) received attention followed by memory training, the second (B) vise versa through prototypical exercise modules with variable difficulty levels developed from the THINK-able computer program. 

Analysis performed on entire sample due to group size. Attention: Computer based attention training results in significant improvement (p=0.003) Memory: Significant improvement in Memory-II (p=0.021).  Gains were significant for Rey Verbal  (p=0.004) and Corsi Block Learning (p=0.03) total correct; Patient and observer memory ratings (p=0.04, p<0.001).  WMS-part III (p=0.004), and part IV (p=0.013). Psychometric:  significant improvements in digital symbol scores (p<0.001).

Calendar to Improve Orientation

Author/Year/ Country/Study design/PEDro & D&B Score

Methods

Outcomes

Watanabe et al.,

(1998)

USA

RCT

D&B = 20

PEDro = 3

N=30 Severe TBI subjects (determined by length of PTA @ acute rehabilitation admittance) consecutively admitted to a BI inpatient unit (16 traumatic, 14 non-traumatic- without aphasia or severe visual deficits) were randomized into treatment (n=14), and control groups (n=16) to determine whether the presence of a calendar affected the score from the Temporal Orientation Test (TOT).

Presence of a calendar did not significantly affect TOT scores.