Attention! Therapy

3 Jun

I’ve been posting about specific things you could try in therapy for specific deficits, but I wanted to make a little disclaimer: It is very unlikely that you’ll encounter patients who just have issues in one of these areas. Patients post-stroke or BI are going to make ALL sorts of things going on, both mentally and physically. They might have any combination of deficits including but not limited to speech, expressive language, expressive language, pragmatics, memory, attention, fatigue  – you have to treat EVERYTHING…TOGETHER. You’re treating the whole person and all of their deficits. So when you’re reading these little blurbs about therapy ideas – try to imagine what it’d be like to treat expressive aphasia in someone who also has difficulty with selective attention, or treating someone who has comprehension issues and also memory deficits. We need to be very holistic and take SO MANY things into account.

That being said, after brain trauma many people have difficulty paying ATTENTION. They’re easily distracted, tangential, can’t filter, can’t focus on details. We learn about different kinds of attention and the types that I saw people having the most difficulty with were: selective attention, alternating attention, and a general complaint of boredom, fatigue, disinterest.

These are very typical issues post stroke or TBI. When I talk about selective attention I mean that the person can’t filter. They can’t focus on what I’m saying to them and NOT pay attention to the sounds in the hallway. Easily distracted by noises and visual information. They need training in what is relevant and not relevant information in reading and listening. When I talk about alternating attention, I mean that they have trouble bouncing between tasks. For example, right now I’m writing this blog and my mom is watching TV behind me. Every now and then I’ll stop and watch the TV or say something to my mom. When I’m done doing that I can come back to writing and I’m able to pick right back up where I’ve left off. In terms of boredom – you’ll often find patients will state that they feel foggy, they get zoned out, they just can’t focus.

What to do with this stuff? Well. Usually you want to start with removing distracting stimuli from the environment and then slowly incorporating it back into therapy. There are tasks such as APT which has levels to move up in attention capabilities. For selective attention, tasks that require someone to filter out information such as errors in spelling or text or locating something specific in the text like the word “the”. I always encourage my patients to approach this sort of task in steps. First scan and read the text. Then go back through and highlight what we’re looking for. Then check your work. If it’s an actual story they’re reading, it is very easy to get caught up in the actual story and not pay attention to the task at had. So giving them an opportunity to read it once for content is a way to reduce that phenomenon.

In alternating attention you may want to do a “switch” task. This is where you give the person three things to do and then make them switch between the tasks every few minutes. They’ll need to compensate by re-reading directions, marking places they’ve left off, and completing something before moving onto the next and not just abandoning a prompt in the middle. You might also give them something to do during a task, like count how many times they hear an overhead page or how many people walk by.

Don’t forget to TEACH how to do these tasks. Don’t just give someone three worksheets and then make them switch, or hand them an article and tell the to count the “the’s”. Train your patients for success. Scaffold. TREAT. You’re intervening!

When a patient tells me they can’t follow a conversation or get zoned out, I usually recommend we work on functional note taking. I had a patient who absolutely COULD NOT listen to her mother (haha) so we worked on taking notes during a conversation. Writing down the Who/What/When/Where/Why. I told her you don’t have to write down every single word that anyone says but at least try to jot down some simple key words so that (a) you’re actively listening and (b) you have a record of the conversation in case you can’t remember it later. Just like in school.

Like I’ve said before, this is not a be all end all of ideas, but just some things to consider or things to try. Every patient is going to be different and will require different supports.

NP: Brass in Pocket


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