Attention process training: its effectiveness in remediating attention and memory deficits following mild traumatic brain injury

Thesis (Ph. D.)--University of Washington, 1996Traumatic brain injury is an insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes. Statistics show a rapid increase in the number of brain injuries each decade in both developed and developing countries. Disorders of memory and attention are among those regarded as most prominent following non-penetrating traumatic brain injury (TBI). The purpose of this study was to investigate the effectiveness of Attention Process Training (APT) in remediating attention deficits and memory dysfunctions following mild TBI.A convenience sample of four (three females, one male) automobile accident survivors with mild TBI underwent APT. Baseline data was obtained over a period of 3-6 sessions (one session per day), randomly assigned to the four subjects. The RAPT and the PASAT were utilized to measure baseline performance in attention. To obtain baseline data for memory performance, the CVLT, the Rey CFT, and the PROMS, were used. The APT-II Questionnaire was used to obtain baseline data on perceived difficulty of attentional problems in everyday life. The intervention consisted of APT auditory and visual attention tasks administered over four alternate (ABAB) study phases, each approximately 3 weeks long, a total of 12-14 weeks. To obtain post-training performance in attention, measures included the RAPT, PASAT, DVT, and the MTVAT. The CVLT, Rey CFT, and PROMS were used to measure outcomes on memory performance. The APT-II Questionnaire, the APT-II Attention Lapse and Success Log, including probes, were used to measure generalization to naturalistic settings. To analyze data, mean outcome scores were compared with baseline scores.Findings on the RAPT suggested increased performance in divided attention for all four subjects. Increased performance was also suggested for two subjects in sustained, selective, and alternating levels of visual attention, and for one subject in auditory alternating attention. Findings on the PASAT suggested a more general increase for all subjects. In contrast, findings on the DVT and MTVAT suggested very limited increases in performance. The rate of response was found to be a more efficient measure for assessing attention performance in the mild TBI sample. Modality specificity was suggested only by the DVT data.Findings on the Rey CFT showed an increased performance in figure reproduction and in the organization of visual information. Data from the CVLT suggested increased performance for two subjects in immediate recall and reduction of perseverations. Limited increases occurred in short-delay recall, consistency of item recall, target recognition, and reduction of false positive responses. There was no increase in verbal organization as determined by the semantic clustering ratio of the CVLT. Higher performance in prospective memory occurred in associative-cued compared to time-cued tasks. The Rey CFT showed better performance in delayed-recall compared to immediate and short-term recall. There was evidence of moderate generalization of behavior to naturalistic settings. In summary, findings suggested the APT was selectively effective in remediating attention and memory deficits for mild TBI. More research is recommended to validate these findings