Attention and RehaCom

Attention training

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

Attention deficits • Deficits of the attention achievements are (apart from disturbances of the memory) the most frequent impairments after brain-damage or -illness (approx. 80%).

• By their basis character disturbed attention achievements can entail restrictions in all areas of life.

• Other cognitive and motor achievements depend much on the momentary attention achievement (e.g. fatigue).

• An intact attention represents an important potential for the compensation of deficit achievements within other ranges.

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Sub forms of attention The definition and organization of the sub forms of the attention achievements are not always uniform within the neuropsychology.

Five attention components are essentially differentiated: 1.

2.

3.

4.

5.

Alertness, Vigilance (continuous attention), selective attention, visuo spatial attention, divided attention.

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Diagnosis • The diagnosis of attention deficits in possible by the computerassisted procedures • According to the quality of the disturbance, attention disturbances must be trained highly specifically • Especially on disturbances of elementary aspects of attention (Alertness, Vigilanz), • if you use too complex, unsuitable therapy procedures, • a further degradation of the function may come (Prof. W. Sturm)

• Attention training is the only one training, which is possible without strategy learning (stimulation therapy)

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Alertness Term of the Alertness (activatingness or awakeness) describes • on the one hand the general awakeness / activatingness of an individual (tonic component) as well as • on the other hand the ability to increase the activation level on a warning attraction (phasic component).

• The Phasic Alertness can be defined thus as increase in attention on an event, taking place in near future, if this event is announced before.

As measure usually serves the difference between the response time to simple visual stimuli with and without warning stimulus/tone.

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Alertness

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• In RehaCom are 3 procedures for training of alertness (reaction training)

Reaction abilities (REA1) An endless number of stimulus-reactioncombinations can be provided.

Acoustic reactivity (AKRE) Reaction behavior (REVE) Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

Vigilance (continuous attention) • The ability, to uphold attention over longer, nonstop time periods, (Vigilance) • It is also subsumed by some authors under the concept of Alertness (Säring, 1987) • With tests, that determine the vigilance-performance, stimuli are presented normally over a longer times period. The relevant stimuli appear very rarely and in irregular sequence. Between the relevant stimuli numerous irrelevant stimuli appears (monotonous stimuli-situation).

• If the relevant stimuli are coming more often, the term “duration attention” is used. For this type of the longer-time attention also the term "sustained attention" can be used.

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Vigilance (continuous attention) (VIGI)

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Selective attention • Selective attention is marked through a filter-process, that promotes or suppresses the reception of information.

• Under selective attention (also named as focused or pointed attention) we understand the focusing to a behavior relevant stimulus, if this stimulus is surrounded by non behavior relevant stumuli.

• Typical diagnostic tasks are “multi reaction tasks”, where the patient has to react quick to relevant stimuli, while irrelevant stimuli has to fade off.

• The concept of the selective attention is synonymously used with concentration-ability.

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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RehaCom training “Attention and concentration” (AUFM)10

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

Divided attention • Divided attention means the focusing to more than one types of stimuli, while integrating this stimuli spatial or temporal into behavioral-irrelevant stimuli.

• Patients with a disturbance of the divided attention frequently complain over difficulties to concentrate on several tasks simultaneously • They have difficulties with tasks, in which they have to observe simultaneously two stimuli-sources (e.g. an acoustic one and a visual one)

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Divided attention (GEAU)

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Disturbances of visuo-spatial attention • Frequent after brain damage (30-50% after left hemispheric damage, 50-70% after right hemispheric damage) • Subdivision in 4 main categories

Category

Description

Synonym(s)

Spatial-perceptive

Elementary perception ability without motor or memory portion

“spatial-visual” performance

Spatial-cognitive

Spatial performance, requires a transformation in addition to perception

“visual spatial operations”, “mental-spatial”

Spatial-constructive

Motor acting in the space; this can be done with hand or another part of the body

“constructive”, “constructiveapractice”, “visuo-constructive”

Spatial-topographical

Spatial navigation and orientation within 3-dimensional space, requires memory abilities

“spatial orientation”, “spatialtopographical memory”, “Learning of ways”

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Clinical image • Depending on size an localization of damage, patients show one or more of these 4 disturbances • Problems in daily living • Dress • Reading watches and gauges • Write- and calculation-disturbances • Reading draws and plans • Recognize directions • Learn and recognize ways

• Problems are not recognized by the patient, but actually simple things succeed no more

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Spatial-perceptive disturbances Losses of elementary perceptive abilities • Main-area-axes, (visual vertical and horizon) • • • •

Vertical standing Go straight ahead To hang up of pictures Horizontal hold of a rod

• Orientation-estimate (comparison parallelism of two lines) • Longitudinal-estimate (expansion within objects) • Distance-estimate (expansion between objects) • Table cloths

• Form-estimate • Subjective straight ahead-direction, line-halving • Cut cakes in equally-big pieces

• Position-perception Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Spatial-perceptive disturbances

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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RehaCom: Spatial operations (RAUM)

Positions estimate

Angle estimate

Container fill

Size estimate

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Spatial-cognitive disturbances • Requires mental spatial operation (mental rotation, scale transformation) • Patients are often slowly • They have no idea like an object looks of the side / from above • Problems on draw with the perspective or scale right • Practical problems: • Rearrange a room • To estimate of quantity in different saucepans / cooking dishes / containers • Navigate of a map • Occupation: e.g. construction of conductor plates

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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RehaCom: 2-dimentional operations (VRO1)

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Spatial-constructive disturbances • Disability, to compose individual elements of a figure to a total • To interact adept with bodies in room / area • Sitting on a bench • Laying on a flor matte • Rank with wheelchair • Drawing a geometric figure • Understand composition of a dice

• Everyday-problems • Dress • Transfers with the wheelchair • Packing packet or gift

• Increasingly through other disturbances (Neglect, intelligencedecrease, planning-disturbance) Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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RehaCom: Visuo-constructional ability (KONS)

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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Spatial-topographic disturbances • Deficits at navigation at real 3-dimetional space • Loss of familiarity in formerly known surroundings • No more idea over spatial connection of individual positions in the surroundings • Everyday-problems: • Patients rarely go from the house • Avoid new ways • Problems using public local traffic • Fear, not to find the way back • Aggravation of the condition in the twilight, night, subway • At the restaurant: after the way to the toilet problems to find the right table again

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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RehaCom: Spatial operations 3D (RO3D)

Attention training • Frank Schulze, Germany • Wednesday, September 19, 2012

Wednesday, September 19, 2012

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