April 8, 2001

Real Life Skills "Retraining" May be a More Effective Treatment Following Brain Injury Than What's Currently in Use, According to Research Review

Practical treatments that have significance to patients' daily lives may be best way to restore attention

WASHINGTON - Treatment programs for people who suffer from attention problems following a stroke or from other traumatic brain injuries often involve abstract cognitive exercises designed to directly restore impaired attention processes. But a review of 30 studies involving a total of 359 participants shows that an alternative and lesser-used therapy that teaches patients to relearn the tasks that affect their daily lives the most -- real life skills like driving -- may be more effective. The results are published in the April issue of Neuropsychology, a journal of the American Psychological Association (APA).

The meta-analysis by psychologists Norman W. Park, Ph.D., of the Baycrest Centre for Geriatric Care in Toronto and Janet L. Ingles, Ph.D., of Dalhousie University is the first quantitative review of research on attention rehabilitation after an acquired brain injury. Attention deficits are among the most common cognitive problems to result from traumatic brain injuries and stroke. Such deficits can make it difficult to do everyday activities that were once taken for granted, such as driving a car or having a dinner conversation at a restaurant where there are many distractions.

In the usual direct retraining method, patients are required to complete a series of repetitive exercises or drills in which they respond to visual or auditory stimuli. For example, patients are told to press a buzzer whenever they hear the number three. A more difficult task using the same method has patients view a calendar year and press a buzzer whenever a month is repeated. Drs. Park and Ingles found this type of retraining to be of little benefit to patients.

Instead, the authors theorized and have shown that It may be more effective for patients to bypass the damaged area of the brain and learn attention tasks using alternative brain processes. In this specific skills approach, people with brain damage learn to perform attention skills in a way that is different from non-brain-damaged people. The idea, according to the authors, is to have patients train on the tasks that are most important to their lives, in situations that are similar to their everyday activities, like reading, driving or carrying on a conversation.

In one study, for example, participants whose brain injuries affected their ability to drive a car used small electric cars in the lab to practice specific driving exercises, such as steering between pylons that were moved closer and closer together. Those that practiced specific exercises showed substantial improvement on a variety of driving related tasks compared to those who drove the car, but did not practice the exercises.

"The direct-retraining methods used in the reviewed studies produced only small, statistically nonsignificant improvements in performance," said the authors, "whereas the few studies that attempted to rehabilitate specific skills requiring attention showed statistically significant improvements after training."

The researchers caution that it is premature to stop using the direct retraining approach altogether. They say it is possible that the direct method is more effective for patients whose brain damage is milder than for those included in these studies, all of whom had either a stroke or a moderate to severe traumatic brain injury.

Article: "Effectiveness of Attention Rehabilitation After an Acquired Brain Injury: A Meta-Analysis," Norman W. Park, Ph.D., Baycrest Centre for Geriatric Care and Janet L. Ingles, Ph.D., Dalhousie University; Neuropsychology, Vol. 15, No. 2.

Lead author Norman W. Park, Ph.D., is available for interviews. To schedule on interview, please contact Kelly Connelly, Media Relations Officer, Baycrest Centre for Geriatric Care at (416) 785-2432.

The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 155,000 researchers, educators, clinicians, consultants and students. Through its divisions in 53 subfields of psychology and affiliations with 59 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.