Research has suggested that individuals with aphasia (IWA) have deficits in attention (Murray et al., 1997a, 1997b) with few treatments available. Mindfulness meditation (MM) has successfully improved attention in neurologically intact (NI) individuals (Rutschman, 2004; Valentine & Sweet, 1999). Therefore, MM was employed in 3 IWA utilizing a single-subject design over a 9 to 13 week period. The effects of relaxation on attention and sense of effort were also examined. Several implications regarding future research are discussed; however, no conclusive evidence on the effects of MM can be offered based on the results of this study at this time

Orenstein, Ellen

Shisler Marshall, Rebecca

The Aphasiology Archive

 1 Research has determined that individuals with aphasia (IWA) often present with deficits in divided attention (Murray, Holland, & Beeson, 1997a, 1997b; Murray, 1999; Murray, 2000). It is theorized in current literature that deficits in the overall capacity for attention and/or the ability to allocate and inhibit attention resources may contribute to the deficits observed (Murray, 1999; Shisler, 2005). When compared to the severe linguistic deficits in IWA, these subtle attention deficits are often overlooked. This can be problematic given the fact that the recovery process requires multiple domains of cognition—including attention (Helm-Estabrooks, 2002; Ramsberger, 2005).  In addition, the literature has reported that IWA may misjudge the amount of effort required to complete a demanding task. This inaccurate perception of task demand, or sense of effort (SOE), has been speculated as a possible source for decreased performance on tasks which require divided attention (Clark & Robin, 1995; Murray et al., 1997a). Subsequently, SOE has been used as a means for evaluating attentional performance. Currently, there are limited available treatments to specifically address attention deficits in IWA (Helm-Estabrooks, 2002). Meditation has been indicated as a successful treatment for attention deficits in other health-related disorders for neurologically intact individuals (NI). For example, research has shown that individuals with ADHD benefit from meditation when it is applied as a complementary treatment to medication (Arnold, 1999). In particular, the extensively researched meditative technique of Mindfulness has been found to elicit benefits for attention for NI (Rutschman, 2004; Valentine & Sweet, 1999; Wenk-Sormaz, 2005).  Therefore, mindfulness meditation (MM) may be a potentially promising treatment for IWA. In addition, MM has been cited in many studies as having positive outcomes for individuals suffering from affective disorders such as depression and anxiety (Grossman, Niemann, Schmidt, & Walach, 2004; Kabat-Zinn et al., 1992; Miller, Fletcher, & Kabat-Zinn, 1995). This is relevant to IWA, as research has shown that this population may suffer from depression, which can negatively affect the recovery process (Pachalska, Knapik, Smolak, & Pytel, 1987; Sarno, 1993). Because this type of meditation has been found to improve attention as well as affective disorders in NI, MM could be a possible complementary treatment for IWA. The following study aimed to evaluate MM as a potential complementary treatment for divided attention deficits in IWA.  Divided attention was evaluated in 3 IWA utilizing a dual, non-linguistic task similar to that of Erickson and colleagues’ (1996) study. Performance on the task along with relaxation and SOE measures were evaluated as well. A multiple baseline single-subject design was used to show the effects of implementing MM as a treatment for IWA.   Method A multiple baseline single-subject ABA design across individuals was used for this study.  Three individuals between the ages of 45 and 59 with a history of left-hemisphere brain damage and aphasia were included in the study. All participants completed and passed a hearing screening prior to data collection.  Measures. Attention was measured via completion of a divided attention task which involved the simultaneous completion of identifying a target tone and sorting cards. Data were collected on the RT and accuracy on identifying the correct tone. While identifying tones, the participants simultaneously completed a second task of sorting cards. This task involved sorting cards from the Blink© game card deck either by shape, number, or color. Cards were continuously sorted for the duration of the presentation of tones over a 5 minute span.   2 Following the divided attention task, each participant completed a rating of his/her perceived SOE in order to determine the amount of effort expended during the task (Erickson et al., 1996; Murray et al., 1997a). In addition to the SOE scale, a Relaxation Inventory was administered every other session.  Informal language measures were collected pre- and post-treatment in order to determine if MM resulted in any change in language. A connected speech sample was obtained with four stimuli: description of the “cookie theft” picture, a sequence of six pictures from the BDAE, CIUs were also obtained by asking the participant to answer one question about personal information and by describing one procedural event. Receptive language was assessed by using partial auditory comprehension subtests of the BDAE.  Phase B introduced the training of MM. The length of the training increased gradually beginning with 5 minutes of practice and building to 30 minutes. Treatment continued until no visual trends were evident for the accuracy of the tone identification task and card sorting task on at least three data points.  Movement to phase A2, or the maintenance phase, was determined by reaching 30 minutes of MM practice and stability for both accuracy on the tone identification task and card sorting task. Phase A2 then consisted of the completion of 5 sessions in order to determine if effects of treatment remained stable. During this phase, direct MM training ceased but data collection for performance on the divided attention task continued. Participants were instructed to continue practicing MM for at least 30 minutes each day on their own.   Results   All dependent variables were recorded and graphed each session. Movement between phases was dependent on relative stability of at least three data points for accuracy of the tone identification task, card sorting task, and total number of cards sorted. The following variables were recorded each session and graphed: percent accuracy for sorting cards, the number of target tones correctly identified, total number of cards sorted, RT for the identification of target tones, and SOE rating. A relaxation score was obtained every other session. Results showed no changes in performance on the divided attention task, in language, or in relaxation as a result of the implementation of MM. Measures of SOE revealed a relatively intact evaluation of task demand. All 3 participants exhibited high performance on the divided attention task with no obvious changes observed as a result of the implementation of MM (see Figures 1-3 and Table 1).   Discussion The above findings suggest potential implications regarding attention and aphasia. First, the high performance on the divided attention task differed from Erickson et al. (1996), which could indicate that not all IWA have deficits in divided attention. Alternatively, the high performance observed may reveal that IWA have varying degrees of attentional impairment which may only surface when certain demands are presented. The attention task chosen may have led to the high performance for these participants. Another possibility for the lack of change in attention could be due to the abstract nature of MM. That is, IWA may require more direct and concrete forms of treatment to generate the benefits of attention that were seen in other populations. Furthermore, it is important to consider individual differences of time post onset of injury, type of resulting aphasia, and severity of insult. Any or all of these factors have the likely potential to influence outcomes of treatment and of course, attentional performance.   3 Additional research is needed to determine the effects of MM on attention in IWA. The lack of change observed in the present study yield inconclusive results. While the present study found no changes in task performance as a result of practicing MM, several aspects of the findings warrant further observation. Future studies should continue to address the source and nature of attentional impairment in IWA as well as potential treatments.    4 Figure 1. Performance on dependent variables for L.N. 305070901101301501 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19-149141 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 1905001000150020002500300035001 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19High est Reaction TimeAverage Reaction TimeLowest Reaction Time0123451 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 197075808590951001 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19010203040506070801 3 5 7 9 11 13 15 17 19P hy siological T ension ScaleC ognit ive T ension  ScaleP hy sical A ssessm ent  ScaleTotal Number ofCards SortedTotal Number of Tones IdentifiedReaction Times (ms)Sense of EffortPercent AccuracyRelaxation ScoreA1 (Baseline) B (Treatment) A2 (Maintenance) 5 Figure 2. Performance on dependent variables for J.J. 305070901101301501 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21024681012141 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2105001000150020002500300035001 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21Highest Reaction TimeAverage Reaction TimeLowest Reaction Time0123451 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 217075808590951001 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 210204060801 4 6 8 10 12 14 16 18 20 21Physiological Tension ScaleCognitive Tension ScalePhysical Assessment ScaleTotal Number ofCards SortedTotal Number of Tones IdentifiedReaction Times (ms)Sense of EffortPercent AccuracyRelaxation ScoreA1 (Baseline) B (Treatment) A2 (Maintenance) 6 Figure 3. Performance on dependent variables for M.W.   305070901101301501 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26024681012141 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 2605001000150020002500300035001 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26Highes t Reaction TimeA verage Reaction TimeLowest Reaction Time0123451 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 267075808590951001 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 260204060801 4 6 8 10 12 14 16 18 20 22 24 26Physiological Tension ScaleCognitive Tension ScalePhysical Assessment ScaleTotal Number ofCards SortedTotal Number of Tones IdentifiedReaction Times (ms)Sense of EffortPercent AccuracyRelaxation ScoreA1 (Baseline) B (Treatment) A2 (Maintenance) 7         Table 1  Pre- and Post-treatment Language Scores   Pre-treatment Post-treatment Participant Receptive language score WPM %CIUs CIUs/min. Receptive language score WPM %CIUs CIUs/min. L.N. 84% .91 65% .64 74% .97 59% .62 J.J. 68% .97 61% .61 61% 1.65 65% .89 M.W. 90% 1.28 86% 1.07 87% 1.17 84% 1.0 Note.  WMP = words per minute; CIU = correct information unit.  8 References Arnold, L. E. (1999). Treatment alternatives for attention deficit hyperactivity disorder  (ADHD). Journal of Attention Disorders, 3, 30-48. Clark, H. M. & Robin, D. A. (1995). SOE during a lexical decision task: Resource allocation deficits following brain damage. American Journal of Speech-Language Pathology, 4, 143-147. Erickson, R. J., Godinger, S. D., & LaPointe, L. L. (1996). Auditory vigilance in aphasic individuals: Detecting nonlinguistic stimuli with full or divided attention. Brain and Cognition, 30, 244-253. Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57, 35-43. Helm-Estabrooks, N. (2002). Cognition and aphasia: A discussion and a study. Journal of Communication Disorders, 35, 171-186. Kabat-Zinn, J., Massion, A. O., Kristerller, J., Peterson, L. G., Fletcher, K. E., Pbert, L. et al. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. The American Journal of Psychiatry, 149, 936-943. Miller, J. J., Fletcher, K., & Kabat-Zinn, J. (1995). Three-year follow-up and clinical implications of a MM-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17, 192-200. Murray, L. L. (1999). Attention and aphasia: Theory, research and clinical implications. Aphasiology, 13, 91-111. Murray, L. L. (2000). The effects of varying attentional demands on the word retrieval skills of adults with aphasia, right hemisphere brain damage, or no brain damage. Brain and Language, 72, 40-72. Murray, L. L., Holland, A. L., & Beeson, P. M. (1997a). Accuracy monitoring and task demand evaluation in aphasia. Aphasiology, 11, 401-414. Murray, L. L., Holland, A. L., & Beeson, P. M. (1997b). Auditory processing in individuals with mild aphasia: A study of resource allocation. Journal of Speech, Language, and Hearing Research, 40, 792-808. Pachalska, M., Knapik, H., Smolak, M., & Pytel, T. (1987). The dynamics of anxiety in the process of non-verbal psychotherapy for patients with aphasia. Aphasiology, 1, 283-285. Ramsberger, G. (2005). Achieving conversational success in aphasia by focusing on non-linguistic cognitive skills: A potentially promising new approach. Aphasiology, 19, 1066-1073. Rutschman, J. R. (2004). Effects of techniques of receptive meditation and relaxation on attentional processing. Canadian Undergraduate Journal of Cognitive Science, 3, 6-16. Sarno, M. T. (1993). Aphasia rehabilitation: Psychosocial and ethical considerations. Aphasiology, 7, 321-334. Shisler, R. J. (2005). 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EFFECTS OF MINDFULNESS MEDITATION ON THREE INDIVIDUALS WITH APHASIA

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EFFECTS OF MINDFULNESS MEDITATION ON THREE INDIVIDUALS WITH APHASIA

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