Evaluation of attention training after aquired brain injury : an occupational perspective

Abstract

AIM: The aim of this thesis was to evaluate the effects of two different approaches of attention training, Attention Process Training (APT) and Activity-based Attention Training (ABAT) after ABI, on level of activity and participation. To be able to assess the effect of attention training on work performance, the aim of the first study in this thesis was to develop and validate a structured attention-demanding work task to be used as a task application for the Assessment of Work Performance (AWP). The second study in this thesis aimed to evaluate the effects of APT and ABAT in the sub-acute phase after ABI, on daily activity, work performance and perceived work ability.

METHOD: Study I was a methodological pre-study developing and validating a simulated work task, the Attention-demanding Registration Task (AdRT). 65 individuals with attention deficits due to ABI and 47 healthy individuals performed the task and the performance was analysed using the statistical method the Area Under the Receiver Operating Characteristic (ROC) Curve (AUC). In Study II, 51 participants with stroke or traumatic brain injury (TBI) 4-12 month-post injury were randomized to 20 hours of attention training with APT or ABAT. Effect in daily activity, work performance and perceived work ability was evaluated pre- and post-intervention as well as after three months.

RESULTS: The Structured Work Task application AdRT showed high sensitivity and specificity in differentiating between individuals with attention deficits due to ABI and healthy individuals when comparing performance of the work task. Therefore, in the following randomized controlled trial, the AdRT was used together with the AWP to evaluate the effect of attention training after ABI on actual work performance. Attention training after ABI resulted in significant improvements on measures of daily activity with strong effect sizes in both intervention groups. Furthermore, assessment with AWP showed that process skills in the group receiving APT continued to improve to the three-month follow-up. Thereto the WAI showed a moderate work ability at the follow-up for the APT group whereas the ABAT group maintained a poor work ability.

CONCLUSIONS: To assess work performance, the use of the Structured Work Task application AdRT, linked with the AWP, proved to be sensitive to attention deficits. Both approaches of attention training resulted in significantly improved performance in daily activity. Training with APT may have an additional positive effect on work performance and perceived work ability.