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(Stroke. 2009;40:3293.)
© 2009 American Heart Association, Inc.

Original Contributions

Reducing Attention Deficits After Stroke Using Attention Process Training

A Randomized Controlled Trial

Suzanne L. Barker-Collo, MA, PhD; Valery L. Feigin, MD, MSc, PhD, FAAN; Carlene M.M. Lawes, PhD, FAFPHM; Varsha Parag, MSc; Hugh Senior, DPH, MSc, PhD Anthony Rodgers, PhD

From the Clinical Training Programme (S.L.B.-C.), Department of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand; National Research Centre for Stroke (V.L.F.), Applied Neurosciences and Neurorehabilitation, Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand; Clinical Trials Research Unit (C.M.M.L., V.P.), School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; The George Institute for International Health (H.S., A.R.), University of Sydney, Australia.

Correspondence to Dr Suzanne Barker-Collo, Department of Psychology-Tamaki Campus, The University of Auckland, Private Bag 92019, Auckland, New Zealand. E-mail s.barker-collo{at}auckland.ac.nz

Background and Purpose— Impaired attention contributes to poor stroke outcomes. Attention process training (APT) reduces attention deficits after traumatic brain injury. There was no evidence for effectiveness of APT in stroke patients. This trial evaluated effectiveness of APT in improving attention and broader outcomes in stroke survivors 6 months after stroke.

Methods— Participants in this prospective, single-blinded, randomized, clinical trial were 78 incident stroke survivors admitted over 18 months and identified via neuropsychological assessment as having attention deficit. Participants were randomly allocated to standard care plus up to 30 hours of APT or standard care alone. Both groups were impaired (z–2.0) across measures of attention at baseline, with the exception of Paced Auditory Serial Addition Test, which was below average (z–1.0). Outcome assessment occurred at 5 weeks and 6 months after randomization. The primary outcome was Integrated Visual Auditory Continuous Performance Test Full-Scale Attention Quotient.

Results— APT resulted in a significantly greater (P<0.01) improvement on the primary outcome than standard care. Difference in change on the Cognitive Failures Questionnaire approached significance (P=0.07). Differences on other measures of attention and broader outcomes were not significant.

Conclusion— APT is a viable and effective means of improving attention deficits after incident stroke.

Key Words: attention • rehabilitation • neuropsychology • randomized clinical trial • stroke