Comparison of attention process training and activity-based attention training after acquired brain injury: A randomized controlled study

Abstract

Objectives: To compare the effects of 2 interventions for attention deficits in people with acquired brain injury, Attention Process Training (APT) and Activity--based Attention Training (ABAT), on activity and participation. Design: Randomized controlled study. Patients: The study included 51 patients in out-patient rehabilitation 4–12 months after stroke or traumatic brain injury. Methods: Intervention: 20 h of attention training. Measurements: Assessment of Work Performance (AWP), Work Ability Index (WAI), Canadian Occupational Performance Measure (COPM), and Rating Scale of Attentional Behavior (RSAB). Results: Between-group comparisons showed significantly improved process skills after APT: Mental Energy (p = 0.000, ES = 1.84), Knowledge (p = 0.003, ES = 1.78), Temporal Organization (p = 0.000, ES=1.43) and Adaptation (p = 0.001, ES = 1.59). For within-group comparisons significant improvement was found between pre- and post-measures for both groups on COPM Performance (APT: p = 0.001, ES=1.85; ABAT: p = 0.001, ES = 1.84) and Satisfaction (APT: p = 0.000, ES=1.92; ABAT: p = 0.000, ES = 2.40) and RSAB Total Score (ABAT: p = 0.027, ES = 0.81; APT: p = 0.007, ES = 1.03). Conclusion: We found significant differences favouring APT before ABAT for process skills (AWP). There were no discernible differences in global measures of activity between the 2 approaches: both groups improved significantly, as indicated by ES. The results of this study highlight the complexities of influencing behaviour on the level of body functions while measuring effects on activity. Lay Abstract The focus of this study is on training of attention deficits after acquired brain injury. The study compared 2 training methods; one directly training attention (Attention Process Training; APT) and another training attention in daily activities (Activity-based Attention Training; ABAT). The APT group improved somewhat more in work performance skills regarding organization of tasks, maintaining focus and adjusting to changes, compared with the ABAT group. The APT group rated an improvement from poor to moderate work ability, while the ABAT group maintained poor work ability. Self-assessed work ability was not estimated “excellent” for any participant at any assessment point. Both groups demonstrated medium to large improvements in performance ratings for daily activities and for satisfaction in performance. Their attention improved, as observed by physiotherapists/occupational therapists during training. Lay Abstract The focus of this study is on training of attention deficits after acquired brain injury. The study compared 2 training methods; one directly training attention (Attention Process Training; APT) and another training attention in daily activities (Activity-based Attention Training; ABAT). The APT group improved somewhat more in work performance skills regarding organization of tasks, maintaining focus and adjusting to changes, compared with the ABAT group. The APT group rated an improvement from poor to moderate, while the ABAT group maintained poor work ability. Self-assessed work ability was not estimated “excellent” for any participant at any assessment point. Both groups demonstrated medium to large improvements in performance ratings for daily activities and for satisfaction in performance. Their attention improved, as observed by physiotherapists/occupational therapists during training.

Keywords

• cognitive rehabilitation
• performance-based assessments
• stroke
• traumatic brain injury
• process skills
• work ability