Training of goal-directed attention regulation enhances control over neural processing for individuals with brain injury

Abstract

Deficits in attention and executive control are some of the most common, debilitating and persistent consequences of brain injuries. Understanding neural mechanisms that support clinically significant improvements, when they do occur, may help advance treatment development. Intervening via rehabilitation provides an opportunity to probe such mechanisms. Our objective was to identify neural mechanisms that underlie improvements in attention and executive control with rehabilitation training. We tested the hypothesis that intensive training enhances modulatory control of neural processing of perceptual information in patients with acquired brain injuries. Patients (n=12) participated either in standardized training designed to target goal-directed attention regulation, or a comparison condition (brief education). Training resulted in significant improvements on behavioural measures of attention and executive control. Functional magnetic resonance imaging methods adapted for testing the effects of intervention for patients with varied injury pathology were used to index modulatory control of neural processing. Pattern classification was utilized to decode individual functional magnetic resonance imaging data acquired during a visual selective attention task. Results showed that modulation of neural processing in extrastriate cortex was significantly enhanced by attention regulation training. Neural changes in prefrontal cortex, a candidate mediator for attention regulation, appeared to depend on individual baseline state. These behavioural and neural effects did not occur with the comparison condition. These results suggest that enhanced modulatory control over visual processing and a rebalancing of prefrontal functioning may underlie improvements in attention and executive control.

Rehabilitation of Executive Functions in Patients with Chronic Acquired Brain Injury with Goal Management Training, External Cuing, and Emotional Regulation: A Randomized Controlled Trial

“…GMT has received empirical support in studies of patients with neurological conditions (e.g., ABI) and in healthy elderly adults (e.g., Grant, Ponsford & Bennett, 2012;Levine et al, 2000; Miotto et al, 2009;Novakovic-Agopian et al, 2011; van Hooren et al, 2007; Stubberud, Langenbahn, Levine, Stanghelle & Schanke, 2013) The present study addresses the methodological weaknesses of prior studies by having a robust randomized controlled trial design, an active control group, long term follow-up, blinded assessments, and radiological injury descriptions. The study also included a new module addressing emotional dysregulation, and both groups received external cueing by text messages in order to facilitate effective goal management in everyday life.…”

“…GMT has received empirical support in studies of patients with neurological conditions (e.g., ABI) and in healthy elderly adults (e.g., Grant, Ponsford & Bennett, 2012;Levine et al, 2000;Miotto et al, 2009;Novakovic-Agopian et al, 2011;van Hooren et al, 2007;Stubberud, Langenbahn, Levine, Stanghelle & Schanke, 2013). Studies of GMT for patients with ABI have reported improved sustained and executive attention (error reduction, planning and time allocation) (Levine et al, 2000;Metzler-Baddeley et al, 2010;Novakovic-Agopian et al, 2011;Schweitzer et al, 2008), and reduction of ED in daily life (Miotto et al, 2009;Spikman et al, 2010).…”

“…Other studies are single case-studies (Levine et al, 2000;Schweitzer et al, 2008;Metzler-Baddeley et al, 2010), or include small samples and are only partially randomized (Levine et al, 2011). Only two group-based GMT studies (Levine et al, 2011;Novakovic-Agopian et al, 2011) have reported follow-up analyses more than three months post-intervention, limiting the evidence for long-term effects.…”

“…& Levine, 2002;Novakovic-Agopian et al, 2011), and may disrupt the ability to effectively use intact functions or compensatory strategies, undermine efficient self-management (Lewis, Babbage & Leathem, 2011), hamper the rehabilitation process (Robertson & Murre, 1999), and is also associated with long-term negative psychosocial and vocational outcome (Draper & Ponsford, 2008;Ylvisaker & Feeney, 2000). Thus, techniques for reducing ED might significantly impact functional outcome (Manly & Murphy, 2012).…”

Impaired auditory selective attention ameliorated by cognitive training with graded exposure to noise in patients with traumatic brain injury

“…A key executive control function that may underlie these impairments is the capacity to select goal-relevant signal for further processing while safeguarding it from irrelevant noise (Chen et al, 2011;Awh and Vogel, 2008;Repovs and Baddeley, 2006). Although prefrontal regions are implicated for this kind of top-down control (Shimamura, 2008), cognitive impairments of this nature are not exclusive to frontal lobe injury (Fork et al 2005;Scheid et al, 2006).…”