Neuropsychological Rehabilitation of attention is a central component in neuropsychological practice, especially for individuals with acquired brain injuries (ABI), traumatic brain injuries (TBI), or other neurological disorders. Attention difficulties can significantly impact daily functioning, including memory, planning, academic performance, and even social engagement. This article explores evidence-based methods and practical strategies for the rehabilitation of attention from a clinical neuropsychology perspective.
Understanding Attention Impairments #
Attentional problems may manifest in several ways, including difficulties with sustaining focus, shifting attention between tasks, ignoring distractions, or managing multiple tasks simultaneously. These deficits are frequently observed following brain injury, stroke, or neurological illness, and they may also occur alongside mood disturbances, anxiety, or fatigue.
Neuropsychological Assessment for attention difficulties typically involves a combination of clinical interview, standardised neuropsychological tests (such as the TEA or similar measures), and, importantly, gathering insights about attention challenges in everyday life situations.
Evidence-Based Approaches to Attention Rehabilitation #
Current clinical guidelines, such as those from Cicerone and INCOG, highlight a range of interventions with varying levels of empirical support. Key recommendations include combining direct attention training with metacognitive strategies to foster generalisation to real-world activities.
Metacognitive Strategy Training #
One of the most effective approaches is metacognitive strategy training. This involves encouraging individuals to reflect on their cognitive processes, recognise when lapses occur, and employ compensatory strategies. Examples include developing an internal dialogue (“Stop and think” or “Focus”), regularly self-monitoring attention, and systematically using self-cues or checklists to ensure necessary items or steps aren’t forgotten.
Direct Attention Training #
Direct attention training often takes the form of repetitive tasks designed to challenge and gradually improve specific components of attention—such as sustained focus, selective filtering of distractions, and the ability to alternate between tasks. Early computer-based programmes were popular, but research now suggests they only show benefit when paired with the guidance of a clinical neuropsychologist or similar clinician, and where there are opportunities to apply learned strategies to real-life scenarios.
Compensatory Techniques #
Practical tools and environmental adaptations are often essential, particularly for everyday functioning. Examples can include using visual reminders (such as sticky notes or signs), alarms, or setting up routines that minimise the cognitive load. In more complex situations, these may be paired with family or carer involvement to assist with monitoring and reinforcing strategies.
Examples of Attention Rehabilitation Strategies #
Goal Management Training (GMT) #
GMT teaches individuals to pause, clarify their current goal, and periodically review their progress. This helps to disrupt ‘autopilot’ behaviour and decrease attentional errors. One practical exercise often used requires responding differently to certain cues—helping patients practise breaking habits and maintaining vigilance.
Self-Alerting Techniques #
Originally developed for stroke patients and later extended to groups such as those with ADHD, these techniques guide patients to internally prompt themselves to refocus their attention at regular intervals. For example, pairing a deliberate action (like tapping) with the command “focus” can, through practice, become internalised and used automatically in daily life.
Time Pressure Management #
This approach is particularly helpful for individuals who struggle under time constraints. It involves developing plans to anticipate and reduce pressure, such as breaking down complex tasks, preparing materials in advance, and rehearsing steps mentally before initiating an action. An emergency plan (such as stopping and recalibrating) may also be prepared for moments when tasks become overwhelming.
Considerations for Different Populations #
Working with Children #
In paediatric settings, interventions must be adapted to developmental stage and individual ability. Techniques may include environmental modifications, skills-building activities with frequent prompts and reinforcement, and collaborative work with parents and teachers. More abstract metacognitive approaches are typically reserved for older or higher-functioning children.
Holistic and Individualised Care #
It is vital to consider psychological factors that may exacerbate or mask attention problems—such as anxiety, low motivation, fatigue, or pain. Collaboration with families, carers, and teachers (where relevant) ensures interventions are relevant, practical, and supported across contexts.
Measuring Progress and Generalisation in Attention Rehabilitation #
Tracking meaningful change in attention rehabilitation should focus on real-world outcomes, not just improvements in test scores. Monitoring might include self-reported attentional lapses, feedback from family or employers, frequency of task completion, or reductions in everyday errors.
Generalisation—the ability to apply strategies in new situations—remains a key challenge. Involving patients in setting personal functional goals, rehearsing strategies in varied settings, and gradually withdrawing external cues are critical for long-term success.
Conclusion #
Rehabilitation of attention requires a blend of evidence-based techniques, creativity, and patient-centred adaptation. Combining direct training and metacognitive interventions, supported by collaborative problem-solving, offers the best chance for individuals to regain independence and improve their quality of life following attentional difficulties. Consistent evaluation, individual tailoring, and a focus on practical gains are central to effective neuropsychological rehabilitation of attention.
References & Further Reading for Rehabilitation of Attention #
• Bayley, M. T., & Ponsford, J. (Eds.). (2023). INCOG 2.0 guidelines for cognitive rehabilitation following traumatic brain injury, part II: Attention and information processing speed. Journal of Head Trauma Rehabilitation, 38(1), 38-51. https://doi.org/10.1097/HTR.0000000000000839
• Cicerone, K. D., Goldin, Y., Ganci, K., Rosenbaum, A., Wethe, J. V., Langenbahn, D. M., Malec, J. F., Bergquist, T. F., Kingsley, K., Nagele, D., Trexler, L., Fraas, M., Bogdanova, Y., & Harley, J. P. (2019). Evidence-based cognitive rehabilitation: Systematic review of the literature from 2009 through 2014. Neuropsychological Rehabilitation, 29(6), 847-884. https://doi.org/10.1080/09602011.2017.1332005
• Cicerone, K. D., & Maestas, K. L. (2014). Rehabilitation of attention and executive function impairments. In M. Sherer & A. M. Sander (Eds.), Handbook on the neuropsychology of traumatic brain injury (pp. 191-211). Springer Science + Business Media. https://doi.org/10.1007/978-1-4939-0784-7_10
• Soule, A. C., Fish, T. J., Thomas, K. G. F., & Schrieff-Brown, L. (2024). Attention training after moderate-to-severe traumatic brain injury in adults: A systematic review. Archives of Physical Medicine and Rehabilitation, 105(12), 2234-2245. https://doi.org/10.1016/j.apmr.2024.07.010
