This study supports the findings from a previous RCT,17 demonstra

This study supports the findings from a previous RCT,17 demonstrating the beneficial effects of APT on complex attention. Unlike the earlier study, this study combined APT with compensatory strategy training and psychotherapeutic treatment. While it is therefore not a pure test of APT, it is representative of clinical practice. Two studies evaluated direct attention OSI-744 mouse training after stroke

or TBI, based on the assumption that training would increase working memory capacity, which would then generalize to other cognitive systems. A class I study10 utilized an automated, computerized training program to treat adults who had sustained a stroke 1 to 3 years earlier. The treatment protocol required home use of computer software, completing 90 trials (taking about 40min) daily, 5 days a week for 5 weeks. Weekly telephone feedback was provided, with no other therapist involvement. When compared with an untreated control group, participants who completed

the computerized intervention demonstrated improvements ATM/ATR phosphorylation on untrained working memory and attention tests, as well as a decrease in self-rated cognitive symptoms. A class III study15 compared general stimulation with repeated administration of working memory tasks to remediate central executive deficits after TBI. No improvements in neuropsychologic performance were seen after general stimulation; following the working memory training there were significant improvements on executive aspects of attention and self-reported everyday functioning. Although improvements in attention-executive functioning have been related to self-reported improvements in attention and memory, there is limited evidence of improvement in everyday functional activities after attention Morin Hydrate training. Three class III studies11, 12 and 13 used single-subject methods to investigate the effects of direct attention training for individuals with mild aphasia after stroke. In 2 cases, improvements in reading comprehension

were seen after APT.11 and 12 In 1 case,13 improvement was limited to trained attention tasks with nominal change in auditory comprehension. This recent evidence is consistent with our recommendation of strategy training for attention deficits during postacute rehabilitation for people with TBI (Practice Standard) ( table 2) and with ANCDS evidence-based practice guidelines for direct attention training. Remediation of attention deficits after TBI should include direct attention training and metacognitive training to promote development of compensatory strategies and foster generalization to real world tasks. Direct attention training through repeated practice using computer-based interventions may be considered as an adjunct to treatment when there is therapist involvement (Practice Option) (see table 2). Consistent with the task force’s prior recommendations, sole reliance on repeated use of computer-based tasks without some involvement and intervention by a therapist is not recommended.

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