Focused versus Unstructured Intervention for Attention Deficits after Traumatic Brain Injury

EFNS Guidelines on cognitive rehabilitation: report of an EFNS Task Force

“…Using a multiple-baseline design, with patients at 4-6 years after head injury, Wood (1986) found that contingent token reinforcement was effective in increasing patients' ability to sustain attention on a task. Several studies (Ponsford and Kinsella, 1988;Niemann et al, 1990;Novack et al, 1996) have explicitly incorporated and/or evaluated therapeutic interventions such as feedback, reinforcement and strategy teaching into the attention rehabilitation programmes.…”

“…Thirteen studies were reviewed by Cicerone et al (2000), including three class I prospective RCTs (Niemann et al, 1990;Gray et al, 1992;Novack et al, 1996), four class II controlled studies (Sohlberg & Mateer, 1987, Strache, 1987Ponsford and Kinsella, 1988;Sturm and Wilmes, 1991); and six Class III studies (Wood, 1986;Ethier et al, 1989;Gray and Robertson, 1989;Gansler and McCaffrey, 1991;Wilson and Robertson, 1992;Sturm et al, 1997). Most controlled studies compared attention training with an alternative treatment, without including a no-treatment condition; a very important distinction is between studies conducted in the acute and postacute stage.…”

“…The Class I study of Novack (1996) compared the effectiveness of ÔfocusedÕ treatment consisting of sequential, hierarchical interventions directed at specific attention mechanisms versus ÔunstructuredÕ intervention consisting of non-sequential, non-hierarchical activities requiring memory or reasoning skills. Both groups improved, but there were no intergroup differences: the observed improvements are probably due to spontaneous recovery.…”

Computerized working memory training after stroke–A pilot study

“…Attention training was evaluated in the phase of spontaneous recovery, only weeks after brain injury, in four controlled studies [11][12][13][14]. Several interventions resulted in improved performance on trained tasks, compared to a control group, but the training effect did not generalize to measures of attention in daily life.…”

“…Several interventions resulted in improved performance on trained tasks, compared to a control group, but the training effect did not generalize to measures of attention in daily life. Alternative treatments were compared in three studies [11][12][13]. In two studies, significant improvements were found on cognitive functions tested after as compared to before training, but this improvement was not significantly larger than the spontaneous recovery in the control group.…”