“Pay Attention or You Might Forget!”

Pauline Fiorello, OTR/L, CBIS

Linda Garrity, MA, CCC-SLP, CBIS

What is attention?

•It is your brain’s ability to focus on and process incoming information from the inner or outer environment.

•It is a skill required for new learning and successful cognitive function.

•Attention requires a conscious effort.

• Attention is the foundation for all cognitive domains.(Mason 2004)

• Attention is necessary for creating memories and for the development of executive functions (planning, organizing, problem solving, decision making, initiation, self monitoring, self awareness……)

Why is attention important?

Attention is needed to keep you SAFE.

Whose job is it to pay attention in the brain?

• Multiple regions of the brain play a part in attention.The right side of your brain plays a significant role.

• The right side of your brain helps with alertness, arousal, sustained attention and visuo-spatial attention.

Types of Attention

•Simple Attention - (Alertness/Arousal)

•Sustained Attention

•Selective Attention

•Divided Attention

•Alternating Attention

Simple Attention

•Being awake

•Being aware of your surrounding environment

•Being able to process sensory stimulation and respond appropriately in a timely manner

Example: Fire alarm….you hear it, process what it means and move out of danger

Sustained attention• Being able to pay attention to a task over a

period of time

• Listening to this exciting lecture

• Watching a movie in a theater

• Paying your bills

• Playing cards or a board game

Selective Attention

• The ability to pay attention to a task while ignoring distractions in the environment

• Having a conversation with a family member at a party while ignoring all the other conversations

• Listening to your therapist’s instructions during a therapy session in a noisy gym

• Watching a movie while trying to ignore the noisy popcorn eater next to you

Divided Attention• Paying attention to two or more tasks at the same

time or “multi-tasking”

• Cooking dinner with potatoes on the stove, a roast in the oven and you are also making a salad

• Talking on your cell phone while driving and listening to the radio (which no one should be doing!)

• Listening to your husband talk about sports while you are watching The Bachelor and checking your text messages on your phone

Alternating Attention

• Switching your attention from the task at hand, to another task and then back to the original task

• You are emptying the dishwasher and the phone rings. You talk on the phone and then go back to the dishwasher.

• You are paying your bills, stop and put a load of laundry into the washing machine, then return to bills

How does a brain injury affect attention?

• Distractibility

• Difficulty shifting focus or being flexible

• Decreased speed of processing

• Impaired self-awareness and self-monitoring

• Fatigue

How does a brain injury affect attention? (cont.)

• Decreased ability to focus over long periods of time

• Impaired visual skills (e.g., blurry vision, double vision, slowed visual processing)

• Impaired sensory skills (e.g., loss of sensation)

• Impaired auditory/communication skills (e.g., difficultylistening to and understanding conversation so yourattention wanders)

Improving our attention skills

Restorative• Improve attention by “exercising” your brain

Remedial• Compensate by using strategies that improve

your ability to pay attention

Restoration of brain function

Engaging in tasks that challenge attention like:• reading a book

• taking a class

• computer games and Apps

• puzzles (Sudoku, crossword puzzles)

• crafts-hobbies-adult coloring books

• playing cards, board games

• mindfulness, meditation (Lutz, et. al., 2007; Tang, et. al., 2008)

Compensatory strategies to improve attention (Remediation)

• Be positive and relax

• Limit internal distractions: hunger, pain, anxiety, stress

• Limit external distractions: turn off tv/radio, wear ear plugs, turnoff cell phone volume

• Reduce fatigue: get enough sleep, take breaks, pace yourself, plan activities when you have the most energy

• Avoid crowds: Go to shops or restaurants at off peak hours

Compensatory strategies to improve attention (Remediation)

• Maintain good health: stay hydrated, eat healthy food, exercise, yoga, meditation

• Create a daily written schedule: “to do list”, alternate easy and difficult tasks, take breaks, include fun and social activities

• Reminders: alarms, visual calendars, timers, signs/post it notes, phone alerts, create an “out-the-door list”

Compensatory strategies cont. (Remediation)

• Create a checklist of steps to complete a task. For example, if using a recipe while cooking, check off the steps as you complete them

• Be flexible: If you are having difficulty concentrating on a task, take a break and go back to it.

• Allow plenty of time to complete a task so that you don’t rush and make mistakes

• Wear glasses/contacts/hearing aids

Post-it Checklist

Compensatory strategies to improve attention (Remediation)

• Organize your home (Hall, 2013):

– Organize so all items are in consistent places

“A place for everything and everything in its place”

– Return items to their place when you are finished using them

– Schedule a weekly time to clean and organize your activity areas

Compensatory strategies cont. (Remediation)

• Avoid multitasking: One thing at a time

• Listen carefully: - eliminate/reduce background noise- repeat or paraphrase to make sure you

understood- ask person to repeat if needed- encourage person to speak slowly

• Consult with doctor to discuss the possibility of using attention-enhancing medications

Time to stretch

Before we start…

Stages of Memory (Sohlberg & Mateer, 2001)

AttentionProcesses that allow a person to gain access and use

incoming information

Encoding Initial stage of memory that analyzes material to be remembered

in order for it to be stored properly.

Storage Transfer of a transient memory to a form or location in the brain

for permanent retention/access.

Retrieval Searching for or activating existing memory traces

Types of Memory

•Short Term - Temporal decay - Capacity limits (e.g., phone numbers)

•Working - Holding onto information in order to manipulate it (e.g., mental math)

•Long Term – Unlimited amount of information – More permanent

Memory and Attention

• Optimal working memory performance is connected to the ability to focus attention on task-relevant information and to ignore distractions (Zanto & Gassaley, 2009)

• Improvement as a result of practice in working memory is due to increasing the ability to focus and disregard distractions. (Berry, et. al., 2009)

How are memories encoded

•Visual Memory

•Auditory Memory

•Sensory or tactile

•Procedural or Kinesthetic

•Emotional

Types of Long Term Memory

Level of difficulty with memory

The severity of the memory impairment can impact a person’s learning capacity, spatio-temporal orientation, the awareness of the impairment, and the ability to carry out activities of daily living (ADLs). (Ptak, et al., 2010)

Ways to Improve Memory

• Get a good night’s sleep

• Get regular exercise, eat a balanced diet, stay hydrated

• Decrease stress

• Increase attention (mindfulness, meditation, restorative methods mentioned earlier) and pay attention to things you want to remember!

Ways to Improve Memory (cont.)• Play word games, card games, word or number

puzzles, etc.

• Repetition – Do it or say it over and over

• Break down info into small parts

• Redundancy (See it, Say it, Write it)

• Chewing gum ?? (Morgan, et. al., 2014)

Compensatory memory strategiesWrite it down

• dry erase board/cork board

• daily planner book

• schedule in phone

• take notes at MD office

• keep a note pad near phone

• reminders to turn off stove

• appliances how to instructions

• calendars

• out-the-door post it notes

• allow calls to go to voice mail

Compensatory memory strategies (cont.)

• Use mnemonics; run thru alphabet

• Chunking (e.g., security codes, phone #’s)

• Follow a routine

• Make associations

Out the Door List- Check appliances- Cell phone- Wallet/Purse- Keys- Eyeglasses- Planner- Therapy homework

Assistive Technology for Memory• Phone alerts/alarms; autodial stored #’s• Text to Speech landline phones• iPads• Watch alarms• Electronic pill boxes• Automatic adaptive stove controls to turn off electric

stoves• Motion sensor reminders• Locator devices or Apps.• Talking memo pens or watches• GPS route finders

What can I do to help myself?

• Not being able to pay attention or having memory problems is not visible to others

• Let others know about your challenges (self-advocacy)

• Share strategies with family/friendsFor example: “I need the tv/radio off, so that I can pay attention to our conversation and enjoy our visit together”

• Integrate recommendations/strategies from healthcareprofessionals into your daily routine

ASK FOR HELP!!!

What can others do to help?• Shorten length of verbal directions

• Speak slowly to allow people time to process information

• Make sure most important information is at beginning of sentence

• Avoid conversations that rely on memory

• Repetition of information may be necessary

• Summarize conversations

• When asked by individual for specific appointment times or dates, direct person to refer to their daily planner instead of providing details

What can others do to help?• Decrease environmental stimuli and clutter

• Encourage use of daily written schedules and routines

• Be aware that fatigue, sleep disorders or depression can negatively impact memory and attention

• Keep back up items like reading glasses or keys

• Use visual cues or reminders such as photos (e.g., take pictures of places to remind folks where they need to go.)

• Accompany loved one to appointments to help with recall and carryover of recommendations and strategies

Be patient!!!

Memory and Attention activities

ReferencesBaddeley, Alan D.; Hitch, Graham (1974). Gordon H. Bower, ed. Working Memory. The psychology of learning and motivation. 2. Academic Press. pp. 47–89.

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