Stroke Attention Rehabilitation Trial (START): Impact of Attention Process Training (APT) on Attention and Quality of Life

This randomised controlled trial will examine the effectiveness of implementing an attention rehabilitation programme, Attention Process Training I (APT- I), by comparing two groups of persons who have recently suffered a stroke: those who receive APT with those who receive standard care. Those who recieve APT will also recieve standard care. Average duration of standard care is 3 weeks. APT materials consist of a group of hierarchically organised tasks that exercise different components of attention, including sustained, selective, alternating, and divided attention. As an individual moves through the program the tasks place increasing demands on complex attention control. The program activities are not functional and resemble laboratory tasks. This is because most functional tasks (e.g., meal planning) are multifaceted and require activation of many different cognitive processes. Use of discrete attention tasks allows stimulation of isolated components of attention. Examples of APT activities identified by the authors of the intervention, Sohlberg and Mateer, that correspond to the different facets of attention are: (1) Sustained Attention: listening for target words or sequences within an array and pressing a button when the target is identified, listening to paragraphs and showing comprehension of content, and mental arithmetic; (2) Alternating Attention: Exercises that require listening for one type of target word or sequence and then switching to listening for a different type of word or sequence mid-way through the task, paper-and–pencil tasks that require alternating between generating numbers and letters that come before or after a presented target,; (3) Selective attention: Completion of sustained attention tasks with the addition of distractor noise or movement, completion of paper-and-pencil tasks with the addition of visual distracters (i.e., transparent overlays); (4) Divided Attention: reading paragraphs for comprehension while simultaneously scanning for a target word (i.e., counting the number of times “and” appears), completing a sustained attention activity while simultaneously tracking elapsed time. A maximum of 30 hours of APT is to be provided in one-to-one sessions daily (weekdays). Sessions will occur once daily and be 90 minutes in length (with a mid-session break) and be conducted over 4 weeks. Clients are typically discharged after 3 weeks of inpatient rehabilitation. Those discharged before the end of the APT intevention will be followed-up for treatment and assessment at place of discharge. Standard care includes daily sessions of occupational and physiotherapy, and other therapies (e.g., speech therapy) as required, and will be provided to both groups. In order that the provision of any other interventions that impact attention can be determined, all other rehabilitation interventions provided will be monitored in both groups until the end of the study (i.e., 6-months post-randomisation).