Summary – Module 4 Interventions for deficits in attention, processing speed and working memory
Attention
We will review 2 types of interventions for deficits in attention:
1. Metacognitive Strategy Training
2. Computerized cognitive training: direct attention training using computer programs. In this module,
we will review two programs: APT-III and RehaCom.
The combination of both strategies, metacognitive strategy training and computerized cognitive training, has
been recommended as a practice standard in interventions of attention deficits after traumatic brain injury or
stroke (Cicerone et al., 2019):
Practice Standard: "Treatment of attention deficits should incorporate both direct-attention training and
metacognitive strategy training to increase task performance and promote generalization to daily functioning
after TBI or stroke during the post-acute stages of recovery".
In the case of interventions for cognitive deficits in Multiple Sclerosis, the evidence is not conclusive. Some
evidence suggests that direct attention training (using RehaCom or APT) may be effective, but more research
is needed to support these effects. There was no data available on the efficacy of metacognitive strategies for
this population (Goverover et al., 2018).
Metacognitive Strategy Training (CH. 14 + knowledge clip)
Attention in adults
Attention problems are difficult to address due to the difficulty defining and operationalizing this concept.
Attention may be explained as the processes whereby information processing resources are differentially
allocated. This allocation occurs in two modes (endogenous and exogenous) and across four domains (time,
space, sense, task).
1. Endogenous: internally generated, non-reflexive, stimulus independent, top-down processes.
2. Exogenous: externally cued, reflexive, stimulus driven, bottom-up processes.
So, attention measurements can only be collected indirectly. Measured on a behavioral level it may include
speed and accuracy of responses on a task, and on a neural level it may be the variation in relevant parameters
(i.e., regional cerebral blood flow on an fMRI), over different epochs, or in response to events.
Attention models
An influential framework of Petersen and Posner (1990, 2012) describes as having three functions across a
network of brain areas.
1. The alerting system: also called arousal, sustained attention, vigilance, and wakefulness. Its function
is to maintain a state of readiness to respond, this state varies through the day. All tasks involve
alertness, with the demands varying e.g., due to more complexity.
o The alerting network includes the brain stem, reticular formation and thalamus, and is largely
right hemisphere-lateralized.
2. The orienting system: also called selective attention; serves to prioritize info across sensory modality
and space. It has two components. (1) Deploying rapid control over attention, related to a dorsal
network (predominantly an endogenous process). (2) Responding to sensory events and switching
attention, related to a ventral and right-lateralized network. Both components work independently, but
almost always at the same time.
o Includes areas of the frontal love (specifically those involved in making eye movements), the
parietal lobe, and the temporoparietal junction.
3. Executive attention: consists of two processes. (1) setting up a task according to the main goal, and
(2) maintaining focus on that task. Focusing on a task leads to a knock-on effect on other aspects of
the system as our attention is captured, our resources available for other purposes are temporarily
reduced. This limited capacity is also called attentional switching or divided attention.
Linking theory with practice
There is a lack of integration between the theoretical and applied work on attention, i.e., terms like speed and
control refer to behaviorally observable characteristics of attention, rather than mechanistic processes through
, which the brain creates attention. There also is a large overlap between attention and other concepts, i.e.,
information processing speed.
Fixed batteries are necessary when measuring attention in clinical research. Test selection will of course
depend on study-specific matters (i.e., research question, client group), but there are also a number of guiding
principles to follow: (1) use multi-trial measures; (2) include measurement of top-down and bottom-up
processes; (3) consider speed, accuracy and response variability; (4) consider modality and especially spatial
vs. non-spatial attention; (5) consider the time span and include measurement over longer time periods if
possible (to consider variations in alertness and the impact this will have on behaviour); and (6) consider
complexity and include tasks of varying complexity if possible.
