Remediation of 'working attention' in mild traumatic brain injury

Several studies have reported beneficial effects of treatments for attentional deficits following traumatic brain injury. Improvements in speed of processing appear to be less robust than improvements on non-speeded tasks, while several studies suggest greater benefits of training more complex forms of attention. The present study presents preliminary results concerning the effectiveness of an intervention for attentional deficits after mild traumatic brain injury. The treatment was based upon the conceptualization of deficits and interventions as a function of the central executive component of working memory, or 'working attention'. A prospective, case-comparison design was employed comparing four treatment participants with an untreated comparison sample. Treatment tasks were derived from experimental procedures which have been demonstrated to elicit working memory demands, consisting of 'n-back', random generation, and dual-task procedures. The intervention emphasized the conscious and deliberate use of strategies to effectively allocate attentional resources and manage the rate of information during task performance. Treatment participants were more likely to exhibit clinically significant improvement on measures of attention and reduction of self-reported attentional difficulties in their daily functioning. Further analysis suggested that the principal effect of the intervention was on working memory, i.e. the ability to temporarily maintain and manipulate information during task performance, with no direct effect on processing speed. The results are consistent with a strategy training model of remediation, in which the benefits of treatment are due to participants' improved ability to compensate for residual deficits and adopt strategies for the more effective allocation of their remaining attentional resources.