6.1 Remediation of Attention, Concentration & Information Processing Speed

Evaluating the efficacy of remediation or rehabilitation of attention deficits following a brain injury is complicated by a number of factors.  First, there is no consensus regarding a definition of attention.  Is it a general construct or does it reflect more specific sub-components or systems of functioning (e.g., sustained, divided, focused, selective, vigilance, speed of information processing, etc).  Second, different researchers and clinicians will report using the same or similar tests to measure different aspects of attention.  Third, a study may use the same outcome measures repeatedly, thereby confounding practice and treatment effects (e.g., PASAT performance improves significantly with repeated exposure to the test).  Finally, studies may not consider and account for the rate of spontaneous recovery following brain injury (i.e. Would participants naturally show recovery of function in the absence of treatment?).

Comparing the efficacy of various remediation efforts is also complicated by cross-study variability in treatment duration (e.g. from 30 minutes once a day for 5 days to 5 hours, every day for 6 weeks). Severity of injury and time since injury may also fluctuate from study to study.

Cicerone et al. 1reviewed 13 studies investigating the effectiveness of attentional retraining interventions during rehabilitation following traumatic brain injury and stroke. In 2005, five studies were added specific to the TBI population.Cicerone et al. 2recommended strategy training for persons with TBI for improving deficits of attention. It should be noted, however, that there was insufficient evidence to distinguish the effectiveness of specific attention training during acute stage rehabilitation from improvements made from spontaneous recovery or from more general cognitive interventions 2

According to ABIKUS Recommendations 3

Cognitive Rehabilitation

All patients after moderate to severe ABI should be referred for neuropsychology, occupational therapy and speech language assessment to evaluate cognitive functioning. (ABIKUS C) (G32-p.21)

The treatment team should be multidisciplinary and is based on the individual’s developing needs as determined by initial and ongoing assessment and goals. (ABIKUS C) (G33-p.21)

  • In order to facilitate/achieve generalization of skill/strategies to daily activities, rehabilitation should :Focus on engaging in activities that are perceived as meaningful
  • Include therapy interventions in the affected person’s own environment and/or application to the person’s own life (ABIKUS (G34-p.21)
  • Strategy training across all cognitive domains is recommended during postacute rehabilitation for persons with TBI (ABIKUS A, adapted from Cicerone et al. 2005) (G35-p.21)
  • Cognitive rehabilitation should include the use of periodic, random auditory alerting tones to improve sustained attention in subacute ABI/TBI. (ABIKUS A, adapted from Cicerone et al. 2005) (G36-p.22)