Stroke Patients: Sustaining Attention And Focus After Brain Injury

how long can a stroke person keep attention

A stroke is a life-threatening medical emergency that occurs when the brain doesn't get the blood and oxygen it needs, resulting in brain cells dying at a rate of almost 2 million per minute. The effects of a stroke can include physical symptoms such as weakness and paralysis, as well as emotional and cognitive symptoms like depression, impulsivity, and memory problems. Attention impairments are common among stroke survivors, with over 80% of patients exhibiting some form of attention deficit. These attention deficits can have serious consequences on rehabilitation outcomes and quality of life, affecting everyday functioning and leading to difficulties in balance and daily living activities. The presence of attention disorders constitutes a significant obstacle to recovery, and their occurrence is well-documented in clinical studies.

Characteristics Values
% of patients with impairment in both intensive and selective aspects of attention 44.4%
% of patients with a deficit only in the intensive component 5.6%
% of patients with deficits only in selective tasks 31.8%
% of patients with deficits in at least one attentional measure 81.8%
% of patients with a pathological speed performance in all tasks 45%
% of patients with impairment in the Go-No Go task 47%
% of patients with impairment in the Divided Attention task 40%
% of patients with omissions in the Divided Attention task 71%
% of patients who made false reactions in the Go-No Go task 41%

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Tonic and phasic alertness

Alertness deficits in patients with hemispatial neglect have been shown to interact with lateralised attention processes. Therefore, improving both tonic (general) and phasic (moment-to-moment) alertness can help to reduce spatial bias. Tonic alertness refers to intrinsic arousal that fluctuates over minutes to hours and is essential for sustaining attention and performing more complex functions such as working memory and executive control. Phasic alertness, on the other hand, refers to the rapid changes in attention due to brief events and forms the basis for operations like orienting and selective attention.

In one study, researchers employed a novel version of a continuous performance task called Tonic and Phasic Alertness Training (TAPAT) to activate both tonic and phasic alertness mechanisms. The training involved three rounds of a 12-minute task, performed daily for 9 days, where patients were required to respond to non-target stimuli and withhold their response to target stimuli. The results showed that the group trained on TAPAT exhibited significant improvements in both spatial and non-spatial measures of attention compared to a control group. Moreover, TAPAT was effective for patients with a range of behavioural profiles and lesions, suggesting that it may rely on distributed or lower-level attention mechanisms that remain intact in patients with neglect.

In another study, TAPAT was compared to a control training procedure where patients searched for missing objects among scenes for the same amount of time each day. The results indicated that TAPAT was more effective in improving spatial attention than the control procedure, suggesting that training alertness may be a more effective treatment approach than directly training spatial attention in patients with chronic neglect.

Overall, tonic and phasic alertness training has shown promising results in improving attention deficits in patients with hemispatial neglect. By targeting both tonic and phasic alertness, TAPAT has the potential to enhance attention and reduce spatial bias in these patients. However, further research is needed to determine the long-term effectiveness of this therapy.

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Divided attention

Following a stroke, many people have problems with attention. They are unable to concentrate for long periods of time and are easily distracted, being unable to focus on a specific task in the presence of competing information. Cognitive rehabilitation involves providing therapeutic activities to reduce the severity of a cognitive impairment following damage to the brain.

There is limited evidence that cognitive rehabilitation may improve some aspects of attention in the short term, but there is insufficient evidence to support or refute the persisting effects of cognitive rehabilitation on attention, or on functional outcomes in either the short or long term.

The effectiveness of cognitive rehabilitation for attention deficits following stroke remains unconfirmed. The results suggest there may be a short-term effect on attentional abilities, but future studies need to assess the persisting effects and measure attentional skills in daily life.

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Selective attention

In a study of 204 stroke patients, 44.4% had an impairment in both intensive and selective aspects of attention, 5.6% had deficits only in the intensive component, and 31.8% had deficits only in selective tasks. Overall, 81.8% of patients fell in at least one attentional measure while 18.2% showed no attention deficits.

In another study, 11 patients were treated as inpatients and included in intensive selective attention training four times a week for 3 months. The results indicated a moderate to strong increase in performance on the divided attention test and a mild effect on the alertness test.

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Vigilance

Following a stroke, vigilance is often impaired, with patients exhibiting slower reaction times and an inability to focus on particular tasks. These attention deficits are quite common, with an incidence ranging from 46% to 92% in stroke survivors. The right hemisphere of the brain plays a crucial role in maintaining vigilance, and damage to this area can result in decreased alertness and impaired attention control.

The presence of attention disorders in stroke patients has important implications for their everyday functioning and can constitute a serious obstacle to rehabilitation. These disorders can lead to greater functional impairment and negatively impact daily activities such as balance and coordination.

The assessment and understanding of attentional deficits in stroke survivors are crucial, as they can influence the rehabilitation process and overall quality of life. While some improvements are possible after the first six months post-stroke, they will be much slower, and most patients reach a relatively steady state at this point.

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Cognitive therapy

  • Memory exercises: Card games, puzzles, computer games, reading and summarizing texts, and conversation practice help improve short-term memory, attention, concentration, and information processing.
  • Visual-spatial orientation tasks: These tasks aid in improving perception and awareness, such as navigation exercises.
  • Problem-solving tasks: Activities like puzzles and board games enhance cognitive flexibility and decision-making skills.
  • Language and communication exercises: Reading, writing, and conversation practice assist in regaining language abilities and improving communication.
  • Drawing and artistic activities: These can enhance hand-eye coordination and fine motor skills.
  • Virtual reality (VR): VR simulations of activities of daily living (ADLs) can target underlying cognitive skills like information processing, attention, and memory.
  • Metacognitive strategy training: This approach helps individuals become aware of their cognitive deficits and adapt strategies to improve accuracy and performance in everyday tasks.
  • Dual-task training: Combining motor and cognitive tasks, such as walking while performing verbal reasoning, improves divided attention and cognitive-motor dual-tasking.
  • Mindfulness and meditation: These practices can enhance attention, mental flexibility, emotional regulation, and overall brain health.
  • Social interaction: Engaging in social activities and support groups improves attention and problem-solving skills while reducing feelings of isolation.

The intensity and duration of cognitive therapy depend on the severity of the stroke and the individual's progress. Starting rehabilitation as soon as possible is crucial, and continued practice of cognitive exercises promotes neuroplasticity and lasting improvements.

Frequently asked questions

Attention deficits are common in stroke patients, with 81.8% of patients falling below the cut-off point on at least one attention task. The ability to pay attention can be divided into two broad subsystems: intensive processes (e.g. alertness and vigilance) and selective attention processes (e.g. focused and divided attention). The intensity aspects are a prerequisite for the more complex ones. Patients with a right-hemispheric lesion (RHL) tend to be more impaired than those with a left hemispheric lesion (LHL), especially in tonic and phasic alertness.

An easy way to remember the symptoms of a stroke is the acronym BE FAST:

- Balance: watch out for a sudden loss of balance.

- Eyes: look out for a sudden loss of vision in one or both eyes, or double vision.

- Face: ask the person to smile and look for a droop on one or both sides of their face, a sign of muscle weakness or paralysis.

- Arms: ask them to raise both arms. If they have one-sided weakness, one arm will stay higher while the other will sag and drop downward.

- Speech: strokes often cause a person to lose their ability to speak. They might slur their speech or have trouble choosing the right words.

- Time: time is critical, so don't wait to get help!

Call 911 (or your local emergency number) immediately. Do not wait or call your doctor or family members first. Say "I think it's a stroke" to let the dispatcher know to act quickly and send an ambulance right away.

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