Cognitive therapy
Divided Attention 2
www.rehacom.com
Cognitive therapy
by Hasomed GmbH
This manual contains information about using the RehaCom
therapy system.
Our therapy system RehaCom delivers tested methodologies
and procedures to train brain performance.
RehaCom helps patients after stroke or brain trauma with the
improvement on such important abilities like memory, attention,
concentration, planning, etc.
Since 1986 we develop the therapy system progressive. It is our
aim to give you a tool which supports your work by technical
competence and simple handling, to support you at clinic and
practice.
User assistance information:
Please find help on RehaCom website of your country. In case of
any questions contact us via e-mail or phone (see contact
information below).
Germany / Europe:
HASOMED GmbH
Paul-Ecke-Str. 1
D-39114 Magdeburg
USA / America:
HASOMED, Inc.
18245 Paulson Drive
Port Charlotte, FL 33954
Tel: +49 (391) 610 7650
w w w .rehacom.com
Tel: +1 (800) 490 0271
w w w .rehacom.us
Contents
I
Dear user,
please read the entire instruction manual before trying to operate RehaCom.
It's unsafe to start using RehaCom without reading this manual.
This manual includes lots of advice, supporting information and hints in order to reach
the best therapy results for the patients.
Table of contents
Part 1 Training description
1
1 Training
...................................................................................................................................
task
1
2 Performance
...................................................................................................................................
feedback
5
3 Levels
...................................................................................................................................
of difficulty
6
4 Training
...................................................................................................................................
parameters
9
5 Data
...................................................................................................................................
analysis
11
6 System
...................................................................................................................................
requirements / Troubleshooting
12
Part 2 Theoretical concept
14
1 Foundations
................................................................................................................................... 14
2 Training
...................................................................................................................................
aim
16
3 Target
...................................................................................................................................
groups
17
4 Bibliography
................................................................................................................................... 18
Index
© 2014 HASOMED GmbH
21
1
Divided Attention 2
1
Training description
1.1
Training task
The patient drives a car during this training. Its task is to watch the passing scenery
and the dashboard of the car as well as responding to acoustic information
differentially. Initially, only the speed of the car is to regulate. Later, with a decreasing
level of difficulty, more tasks are added, which expect reactions of other attention
levels.
Fig. 1: View of training screen
© 2014 HASOMED GmbH
Training description
2
Fig. 2: View of training screen w ith paramater "Cockpit view "
A view through the front window of a car and on the dashboard is simulated on the
screen (figure 1). Through the window the street in front of the car is seen, which
loses itself in the distance of the landscape. On the left side is the speedometer, to
display the speed. In the speedometer is a green area, which marks the to be driven
speed. Underneath the green area is a red arrow, which indicates the current speed.
The red arrow must be always in the green area of the speedometer. For the
acceleration of the car the "faster button" (arrow up) has to be pressed. To brake
the "slow down button" (arrow down) has to be pressed. On the right side the way to
be driven and the elapsed time are displayed. The goal is it, to drive a certain
distance in a limited time. It is important to ensure that the bar for the way (blue bar)
is always ahead of the bar for the time (red bar). A level is finished, when the time
has expired or the way to be driven is reached.
The car always moves on the road in a determined track (in curves too), so the
patient must not pay attention to keep the car on the road.
If the car is actuated by pressing the arrow keys on the RehaCom panel, irrelevant
and relevant objects move perspective towards the viewer. Irrelevant objects are
trees, bushes, pedestrian crossings without waiting pedestrians, open railroad
crossings and green traffic lights. Irrelevant objects do not require a reaction of the
patient. Relevant objects do require a reaction of the patient. Along with the visual
relevant/ irrelevant objects are the relevant/ irrelevant acoustic stimuli. The following
chart shows which relevant objects/ relevant acoustic stimuli require which reaction.
In the evaluation of a level only relevant objects and relevant acoustic stimuli are
considered.
Relevant objects / relevant acoustic
© 2014 HASOMED GmbH
Description / necessary reaction
3
Divided Attention 2
stimuli
Traffic sign with speed limit (from level 1) If the new maximum speed is below the
current maximum speed, the patient has
to slow down to the new maximum speed
before reaching the traffic sign.
Is the new maximum speed higher than
the current maximum speed, the patient
has to wait until he passed the traffic sign
to speed up.
Only those reactions to the speed limits
are considered, which are below the
maximum speed of the level (up to level 2
- 60 km/h, from level 3 - 80 km/h).
Each transgression of the allowed speed
limit is a mistake. When exceeding this
speed a red arrow (arrow down) flashes,
to inform the patient to reduce its speed.
Unless the patient can hear traffic news,
an acoustic warning sounds and reminds
the patient to slow down. If the patient has
not slowed down the car after five
seconds, a new error for exceeding the
speed limit is counted.
In case the client stops on a track for no
apparent reason, a red arrow (arrow up)
flashes and a honking signal sounds. A
stopping of the car will never be punished
with an error.
Acoustic request "turn left/ turn right"
At the prompt to turn, the clients has to
(arrow left/right) flashes in red color (from press "arrow to the left" or "arrow to the
level 3)
right" before reaching the intersection, to
activate the turning signal. After pressing
an arrow key, the particular arrow flashes
in green. The turning signal is deactivated
automatically after the curve.
When the request to turn comes, the car
has to slow down to 40 km/h before
reaching the intersection. Up to level 6 the
car slows down automatically before the
intersection.
© 2014 HASOMED GmbH
Training description
4
indicator light refueling (from level 4)
When the red indicator light for refueling
flashes, the client must press the OK
button within 6 seconds. If he does not
press the OK button, the car will stop and
the client can continue driving by pressing
the "faster" button (arrow up).
indicator light oil pressure (from level 8)
When the red indicator light for oil
pressure flashes, the patient must press
the OK button within 6 seconds. If he
does not press the OK button, the car will
stop and the client can continue driving by
pressing the "faster" button (arrow up).
Additional attention level (with police car
from level 9)
Optional a police car can be set in the
parameter menu, as a additional visual
stimulus. the police car appears at certain
intervals in the driving mirror. The client
must have stopped the car within 6
seconds. If the client manages to stop the
car in time, the blue light of the police car
gets turned off and the patient may go on
its ride. If the car does not stop in time,
the police car passes and an error for the
client is counted.
Acoustic traffic news (from level 11)
During the ride acoustic traffic news, for
various highways, are displayed. The
client must press the "plus button" when
traffic news about a certain highway
sound. Before each level, the client is
informed after which announcement the
"plus button" must be pressed.
After the beginning of the announcement
the client has 10 seconds to react to the
traffic news.The name of the highway is
called within the announcement after 4 to
5 seconds.
The name of the highway the client has to
react to is always displayed on the right
side, above the indicator for the way.
Railroad crossings (from level 13)
© 2014 HASOMED GmbH
Sometimes during the ride a railroad
crossing is crossed.
When the railroad crossing is closed it
5
Divided Attention 2
must be stopped in front of it. After
opening the barriers, the client can
accelerate the car again.
Pedestrian crossings (from level 15)
Traffic lights (from level 17)
On a couple track sections are
pedestrian crossings. In case a
pedestrian stands on the side of the road,
it must be stopped in front of the
pedestrian crossing. Only when the
pedestrian crossed the road, it may go
on.
In front of some intersections are traffic
lights. Is the traffic light "red", the client
must stopped in front of it. Only when the
lights turn "green", it may go on.
Stop signs (from level 19)
If there is a stop sign on the road, the
client has to stop shortly in front of the
sign and then the ride can be resumed
immediately.
Obstacles (from level 21)
On some roads encounter obstacles
during the drive (cows, deer or similar).
It must be stopped before the obstacles.
Once the obstacle is gone, it can be
continued.
Tab. 1: Tasks during training
The RehaCom-module Divided Attention 2 gives level depending instructions.
Because every level of difficulty has new tasks, which need a description, it is
instructed staggered. Via the menu item "Restart with instructions" in the
therapist menu, a instruction series corresponding to the current training status may
be generated at the beginning of the training.
The module can be used without the RehaCom panel too.
1.2
Performance feedback
At too high speed a red arrow (arrow down) flashes. Unless a traffic sign is heard,
the client is pointed acoustically to slow down the car. If the "Plus button" is not
pressed when relevant traffic news sound or if the "Plus button" is pressed when
irrelevant traffic news sound, the identifier of the relevant highway flashes up red
briefly. After a correct reaction, the name of the highway flashes up green. Overrun
obstacles and closed railroad crossings are covered with a crash sound.
© 2014 HASOMED GmbH
Training description
6
After processing a level, the mistakes are mentioned:
driven too fast: x times
pressed no button in case of relevant traffic news: x times
pressed a button in case of irrelevant traffic news: x times
not flashed: x times
flashed wrongly: x times
not stopped at pedestrian crossing: x times
not stopped at railroad crossing: x times
overlooked an obstacle on the road: x times
overlooked a red traffic light: x times
overlooked a stop sign: x times
not stopped for a police car: x times (from version 6.2)
indicator light for refuelling missed: x times (from version 6.3)
indicator light for oil pressure missed: x times (from version 6.3)
or
Sorry, you did not manage the distance in the given time.
1.3
Levels of difficulty
The module works adaptive. All in all 22 levels were validated. The level of difficulty
varies within the training by increasing the attention level and by changing the
stimulus interval. In the following chart the allowed speed limits and the average
number of stimuli per route are summarized. The course of the road from the curve/
intersection to the next curve/intersection is called a route. Starting with RehaCom
version 6.0, 5 km/h tolerance to the speed limit are assured to the client, before a
speed violation is considered as an error.
Note: If the speed is used with mph instead of km/h at the training, all speed
information listed here are converted from km/h to mph.
Level no. : Number of the respective level
max. v: maximum speed limit on the whole distance
rel. v-signs: Number of the relevant speed signs per distance
v : average speed to drive, to achieve the whole distance in the given time
Stimulus interval: average distance of the stimuli within a distance
Distance info turning signal before intersection: indicates the distance to
the intersection, until the acoustic and visual information to turn is reproduced
auto. v-reduct. at intersection: When the information to turn at the
intersection is given, one must reduce the speed to a maximum of 40 km/h until
the intersection. Up to level six, braking happens automatically. From level
© 2014 HASOMED GmbH
7
Divided Attention 2
seven, the client must slow down the car by himself.
Traffic news: average number of traffic news per distance
Railroad crossings: average number of railroad crossings per distance
Pedestrian crossings: average number of pedestrian crossings per distance
Traffic lights: average number of traffic lights at the end of a distance
Stop signs: average number of stop signs at the end of a distance
Obstacles: average number of obstacles per distance
No. differ. cars (oncoming traffic): number of different car brands, which are
visible as oncoming traffic
min. duration until the next oncoming traffic: minimum indifference
between two cars, which are visible as oncoming traffic
No. houses: total number of houses, which are distributed in the respective
level of difficulty
Advertisement / Distance: average number of billboards next to the road
min. duration until police car: minimum time differences between the
appearing of the police cars in the rear view mirror (from vision 6.2)
min. duration until indicator light refueling: minimum time difference
between the flashing of the indicator light for refueling +/- 60 seconds (from
Version 6.3)
min. duration until indicator light oil pressure: minimum time difference
between the flashing of the indicator light for oil pressure +/- 60 seconds (from
Version 6.3)
Levemaxv rel.
l no. v [km v[km//h] sign
h]
s
[-]
Stim
ulus
inter
val
[-]
1
2
3
4
5
6
7
8
9
10
11
12
13
14
high
low
high
low
high
low
high
low
high
low
high
low
high
low
60
60
80
80
80
80
80
80
80
80
80
80
80
80
40
40
40
40
55
55
55
55
55
55
55
55
55
55
2
2
2
2
2
2
2
2
2
2
1
1
1
1
Distancauto.
e
vblink reduct.
info
at
before Interse
interse ctions
ction [-]
[-]
----high
yes
high
yes
low
yes
low
yes
high
no
high
no
low
no
low
no
low
no
low
no
low
no
low
no
Traffic Railro Pedest Traffi Stop Obst
news ad
rian
c
sign acle
[-]
crossi crossinlight s [-] s
ngs gs
s
[-]
[-]
[-]
[-]
0
0
0
0
0
0
0
0
0
0
2
2
2
2
0
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
© 2014 HASOMED GmbH
Training description
15
16
17
18
19
20
21
22
80
80
80
80
80
80
80
80
55
55
55
55
55
55
55
55
1
1
1
1
1
1
1
1
high
low
high
low
high
low
high
low
low
low
low
low
low
low
low
low
no
no
no
no
no
no
no
no
2
2
2
2
2
2
2
2
0,5
0,5
0,7
0,7
0,7
0,7
0,4
0,4
1
1
0,7
0,7
0,7
0,7
0,4
0,4
0
0
0,8
0,8
0,2
0,2
0,3
0,3
0
0
0
0
0,6
0,6
0,3
0,3
8
0
0
0
0
0
0
0,5
0,5
Tab. 1: Levels of difficulty Part 1
Lev No. of
min.
No.
el different duration house
no. cars
until the s[-]
(oncoming next
traffic)
oncoming
[-]
traffic
[s]
Advertise
ment /
Distance
[-]
min.
duration
until
police car
(from
Version
6.2)
[s]
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
0
0
0.2
0.2
0.4
0.4
0.6
0.6
0.8
0.8
1.0
1.0
1.2
1.2
1.4
1.4
1.6
1.6
1.8
1.8
2.0
2.0
90
90
80
80
70
70
60
60
50
50
40
40
30
30
0
0
0
0
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
6
6
6
100
100
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
Tab. 2: Levels of difficulty Part 2
© 2014 HASOMED GmbH
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
min.
duration
until
indicator
light
refueling
(from
version
6.3)
[s]
120
120
120
120
120
120
120
120
120
120
120
120
120
120
120
120
120
120
120
min.
duration
until
indicator
light oil
pressure
(from
version
6.3)
[s]
180
180
180
180
180
180
180
180
180
180
180
180
180
180
180
9
1.4
Divided Attention 2
Training parameters
In the Basic manual RehaCom general hints are given about the training parameters
and their effects. These hints shall be taken into consideration subsequently.
Fig. 3: parameter menu
Consultation time in min:
We recommend a length of 25 - 30 minutes.
Level up:
A percentage is calculated, which sets the correct and timely reactions in relation to
the total number of the relevant results. The next higher level of difficulty is started
when "enough right" decisions are made and the percentage exceeds "Level up".
The way to be driven must be managed in the given time (max. duration of a level).
Level down:
The next lower level starts when "to many" incorrect and/ or to late decisions were
made and the percentage comes below the value "Level down". If the percentage
is between "Level up" and "Level down" the training continues with the same level
of difficulty. The next lower level is started when the route is not managed in the
given time (max. duration of the level).
Max. duration of a level:
The maximum duration of the work in a level is set. On the basis of these duration
and the given average speed (see chart 1 Levels of difficulty) the way to be driven is
calculated.
Acoustic stimuli:
The module "Divided Attention 2" can be trained without acoustic stimuli. All traffic
news and acoustic suggestions omit. As a feature the levels 11 and 12 omit when
deactivating the acoustic stimuli, because this levels are just using the traffic news
as a new stimulus.
© 2014 HASOMED GmbH
Training description
10
With billboards:
On the left side and right side of the road are billboards. The number of billboards
varies, depending on the level of difficulty (see chart 1 Levels of difficulty).
With big signs:
To ensure a better visibility of the traffic signs, they are viewed 1.5x bigger as usual.
Additional attention level (with police car starting from level 9):
Optionally, a police car can be set as a additional visual stimulus. Starting with level
9, the police car appears from time to time in the rear view mirror.
Relevant objects, relevant acoustic stimuli:
The percentage can be determined for relevant traffic news, closed railroad
crossings, crosswalks with pedestrians and red traffic lights. The more relevant
objects are used during training the higher is the stress level for the client to
accomplish it in time.
Cockpit view:
The items of the speedometer are shown in a realistic representation when using the
cockpit view. This display is just suitable for clients with a high performance level.
The cockpit view is only available for a screen resolution of 1024 x 768 pixels or
higher.
Realistic movement:
The user's field of vision is adapted to the road gradient to provide the patient with a
realistic driving experience.
When newly defining a training, the system automatically uses the following default
values:
Current level of difficulty
Consultation time
Level up
Level down
Max. duration of level
Acoustic stimuli
With billboards
With big signs
Additional attention level
(with police car starting from level 9)
Relevant traffic news
Closed railroad crossings
Crosswalk with pedestrians
Red traffic lights
Cockpit view
© 2014 HASOMED GmbH
1
30 minutes
90
70
600 s =10 min
On ([X])
On ([X])
On ([X])
Off ([ ])
20 %
20 %
20 %
20 %
Off ([ ])
11
Divided Attention 2
Realistic movement
Off ([ ])
Tab. 3: standard parameters
1.5
Data analysis
The various possibilities of analyzing the data in order to find strategies how to
continue the training are described in the Basic manual RehaCom.
In the graph as well as in the tables you find - beside the setting of the training
parameters - the following information:
Level
Distance
Current level of difficulty
Distance traveled in comparison to the whole
distance given in %
Stimuli
Number or relevant stimuli
Correct
Number of correct reactions to relevant stimuli
Correct %
Correct reactions to relevant stimuli in %
Mistakes
Number of incorrect reactions to stimuli
Omissions
Number of missed reactions to relevant stimuli
Omissions %
Missed reactions to relevant stimuli in %
No. too fast
Number of exceeding the maximum speed limit
Correct speed changes
Number of correct reactions in relevant speed
changes
Mistakes indicator
Use of the wrong turning signal when turning at an
intersection
Mistakes traffic news
Number of reactions to irrelevant traffic news
Omissions indicator
No turning signal when turning at an intersection
Omissions traffic news
Number of non-reactions to relevant traffic news
Omissions railroad crossings Number of non-stops at closed railroad crossings
Omissions pedestrian
Number of non-stops at crosswalks with pedestrians
crossings
Omissions traffic light
Number of non-stops at red traffic lights
Omissions stop signs
Number of non-stops at stop signs
Omissions obstacles
Number of non-stops in front of obstacles
Omissions police cars
Number of non-stops for a police car
Omissions refueling
No reaction to a flashing indicator light for refueling
Omissions oil pressure
No reaction to a flashing indicator light for oil
pressure
Train. time task
Effective consultation time in h:mm:ss
Breaks
Number of breaks caused by the client
Tab. 4: Result data
© 2014 HASOMED GmbH
Training description
12
Due to a detailed analysis of the training, it is possible to indicate deficits to the
client and to draw conclusions for further training.
1.6
System requirements / Troubleshooting
System requirements:
For the module "Divided Attention 2", at least the following system requirements
should be fulfilled:
Intel Core i3, i5, i7 or equivalent
4 Gb of internal memory
Graphics card: DirectX10.1 compatible; Intel HD3000 or higher
Notes on how to use the DirectX diagnostic program "DXDiag"
Please first ensure that at least the DirectX version 9c is installed on your PC. For
this purpose open the file DXDiag.exe in the directory "Windows
\System32" (Windows XP), "WinNT\System32" (Windows 2000). Alternatively, it is
sufficient for many Windows installations to insert "dxdiag" (without quotation marks)
in the field "Run..." of the Start menu and then to click on OK.
The DirectX version can be read from the tab "System" of the DirectX diagnostic
program. If a version is displayed, which is lower than version 9c, the current version
of DirectX can be installed from the RehaCom-CD.
Change to the tab "Display". You can find the device properties of your graphics
card in the field "Device". In the field "DirectX functions", the "DirectDraw
acceleration" and the "Direct3D acceleration" must be enabled. In the case that the
DirectX functions are disabled, you have to download and install a new graphics
card driver from the internet. If this function can not be enabled afterwards, a new
graphics card has to be installed in the computer.
The module "Divided Attention 2" does not run without this DirectX
functions. If you have to install a new graphics card, we recommend graphic cards
with a nVidia chipset.
If the module "Divided Attention 2" does not start, a window opens up where different
error messages are displayed indicating why the training could not be activated.
The following messages may appear:
Error message
Error not enough system memory
© 2014 HASOMED GmbH
Troubleshooting
The internal memory is not large enough. The module
"Divided Attention 2" only runs with an internal
memory of at least 256MB RAM. The internal
memory has to be increased.
13
Divided Attention 2
Direct3DCreate9 failed!
Please install DirectX 9c or higher!
An outdated DirectX version is installed on the
computer. Please install DirectX 9c from the
RehaCom-CD.
Your graphic adapter does not support 3D
mode!
The 3D mode is not supported by your graphics card.
Try to download a new graphics card driver from the
internet or install a new graphics card. Please also
refer to the point "Notes on the DirectX diagnostic
program DXDiag".
Direct3D9.CreateDevice failed!
Please install a new graphics card driver.
Device not supports enough Texturewidth/
Textureheight
Your graphics card can't display textures at a
sufficient height and width. Please install a new
graphics card.
Tab. 5: Possible error messages
© 2014 HASOMED GmbH
Theoretical concept
2
Theoretical concept
2.1
Foundations
14
The term Attention comprises functions which guarantee properly arranged external
and internal sequences of objects in terms of contents and time. This enables
conscious, orientated organisms to create a rational picture of life. This is achieved
by a selection and integration of relevant information from different modes of
perception.
Broadbent (1958) wrote in his "Bottleneck - or Filter Theory" of a limited
processing capacity, of incoming sensory information for an organism. That is,
stimuli occurring simultaneously are suppressed as a response to selected stimuli.
From today's point of view, specific input channels of several modalities, where
information is filtered, exist. Sternberg (1969) (cp. Keller & Grömminger, 1993)
distinguishes in his Action-Oriented Attention Model between the following four
phases:
1. Perception,
2. Identification of relevant impulses,
3. Choice of the reaction and
4. Activation of a motor program in reaction to a stimulus.
These processes run partly automatically; with the registration of specific aspects of
situations, active analysis processes are set in operation. Automatic processes
operate parallel and need a smaller capacity. All other processes, however, take
more time because they require a serial manipulation which runs with larger attention
capacities.
The ability of directional attention is a prerequisite for general cognitive
performance skills. A lack of attention and concentration results in a limited
receptiveness and processing capacity, a reduced information processing speed,
an increased fatigue especially under stress, as well as a increased tendency to be
distracted. Thus, patients are restricted when doing intellectual and practical
activities.
Empirical studies have shown that attention is not a uniform construct. In fact, the four
attention aspects are to a large extent independent from each other and can be
distinguished as follows (cf.Fimm, in 1997; cf. Sturm, 1990; .Sturm et al, 1994):
1. periodic activation, Alertness
2. selective attention
3. divided attention
4. tonic activation, Vigilance
Periodic activation is defined as the ability to rapidly increase the activation level
© 2014 HASOMED GmbH
15
Divided Attention 2
of a subsequent reaction situation after a warning stimulus (reflex readiness,
Alertness). Tonic activation, however, is an attention level which stays stable for a
longer period of time.
Selective attention is considered the action of focusing on specific aspects of one
task, meaning it is possible to respond fast to relevant stimuli while ignoring
irrelevant stimuli, at the same time. This ability serves to select and integrate defined
stimuli/objects. "Selective attention" is closely linked to the term "power of
concentration". The latter is defined as a short-term attention span, lasting for
several minutes that allows for recognition of relevant stimuli (cf.Sturm, 1990).
Tasks requiring divided attention abilities have to include at least two stimuli which
have be looked out for, simultaneously. This aims to encourage the patient to
respond both to relevant simultaneous stimuli and to relevant sequential stimuli. One
example of divided attention is a car situation, where the driver has to drive on an
overcrowded street during rush-hour while talking to his/her co-driver. When there
are many stimuli appearing and disappearing fast, they interfere with each other.
Thus, mistakes are likely to be made, and the performance decreases.
Vigilance comprises attention abilities with small stimulus density over long periods
of time. Situations providing a high temporal density of relevant stimuli, are referred
to as continuous attention.
Whether a patient pays attention to relevant environmental stimuli, depends on
internal variables in the organism (physiological status, cognitive processes,
emotions) and external factors (stimulus intensity, contrast, colorfulness, contouring,
spatial relations, etc.).
The patient's attention can be aroused automatically with the help of highly intense
stimuli or new stimuli (containing much information), which cause a natural
orientation reflex. Cognitive processes modulate the current attention status through
thoughts, motivations and interests. In particular, the selectivity of attention is
constantly influenced by emotional associations. Whether or not the selectivity is
maintained, also depends on individual motivation.
Empirical studies, involving experiments with healthy persons, who have lateralized
stimulus material, and split-brain patients, haven proven a particular relevance of the
right hemisphere when it comes to controlling and maintaining elementary activation
processes (cf.Sturm et al., 1994). This concerns all patients with attention deficits,
regardless of individually varying kinds and degrees of those deficits.
After cerebral strokes leading to dysfunctions, the attention system is highly
vulnerable, since it is closely linked to brain fields and brain structures.
In psychological performance diagnostics, especially in diagnostic clinical neuro
psychology, tests for the examination of attention capabilities are essential. The
fields of attention mentioned above differ in their functions. Apart from paper and
pencil tests, test batteries for attention tests of the Vienna test system and the ones
of Zimmermann & Fimm (1989), allow for a different view on impaired brain
© 2014 HASOMED GmbH
Theoretical concept
16
functions.
Children's attention disorders are defined, based on the diagnostic and statistical
manual of psychological disorders (DSM III)
(Lauth & Schlottke, 1988), as a development inadequacy, lack of attention,
impulsiveness and hyper activity.
In diagnostic practice the evaluation of attention is mostly done with the help of
"surface parameters", such as:
the required time,
the number and kind of mistakes,
the development of mistakes depending on time or
the processed amount of submitted material when fulfilling specific tasks.
The advantages of such a diagnostic module lie in the extraction of measurable
variables. Those variables provide for comparisons, both intra-individual (course of
disease, therapy evaluation) and inter-individual (based on values of a standard
group).
Especially in the last decade, efforts to improve adult patients´s attention skills by
doing cognitive brain performance training have skyrocketed, as well (Säring, 1988).
In cases where the cerebral area is damaged, the demand for rehabilitation is
particularly high because 80 percent of all cerebral damages lead to attention and
concentration problems (Poeck, in 1989,Van Zomeren & Brouwer 1994).
For further information, please see the sections Aim of the Training as well as Target
Groups.
2.2
Training aim
More recent results in research have proven a great importance of differential
training methods which allow to specifically treat attention disorders. This is due to
unspecific attention training methods and those methods that are less theoretical,
which often do not lead to an improvement of all brain areas that fulfills attention
tasks (Gray & Robertson, 1989; Sohlberg & Mateer, 1987; Poser et al., 1992; Sturm
et al., 1994; Sturm et al., 1997).
In this RehaCom module, primarily, deficits of divided attention performance are
considered target variables. This module furthermore allows for an improvement of
reaction time, in general. In particular, patients can improve their ability to
simultaneously process both visual and acoustic stimuli while ignoring irrelevant
stimuli. Although, the RehaCom works adaptively, meaning that an increase or a
decrease of the level of difficulty depends on the patient's individual performance,
patients prone to interference are not overwhelmed by too many stimuli at higher
levels of difficulty. At a longer set training time, this module trains, just like all
cognitive exercises, the patient's vigilance, as well.
© 2014 HASOMED GmbH
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Divided Attention 2
When it comes to computer-assisted training of either single or several attention
components, experience has shown, that patients primarily improve during the postacute phase after suffering a stroke.
Working with computers offers a wide range of advantages. By providing systematic
performance feedback, the patient can develop a better self-perception, in order to
use his or her attention capacities in the most efficient way possible.
From a therapist's point of view, it is recommended not only to confront patients with
existing deficits but also to provide information and develop individual Coping and
Compensation Strategies; for instance, by preventing specific stressors or using
external assistance for certain challenges. Relatives are requested to be involved in
this process, as well.
By improving attention capabilities, one can set the basis for training aims of other
cognitive functions. Thus, it plays a key role in treating disturbances of memory
(recording information is crucial for storing information).
On the basis of results of inputs - resp. the progressive diagnostic, it should be
decided if the trainings system Divided Attention (DA) alone or if it should be used
in conjunction with other systems. In most cases it would be considered important
and favourable when a basic training in attention is used at first. (e.g. the RehaCom System Attention and Concentration). In this way, the discussed system can be
seen as specific practice system.
2.3
Target groups
Disturbances in Attention are caused most frequently by neurological
performance deficiencies, after brain damage to different areas or sources in the
organic tissue of the brain (Van Zomeren & Brouwer, 1994). They occur in approx.
80% of patients after strokes, brain/cranium trauma, impairments to the brain of
undetermined origin (e.g. following chronic alcohol abuse or intoxication), as well as
other illnesses which effect the central nervous system.
Conceptually, it is assumed that different functions in attention can be selectively
damaged. Brain damage of undetermined origin after traumatic or hypoxic
aetiology leads to mostly unspecific deficiencies in attention, like rapid fatigue,
increase in the need for sleep, and a general loss of motivation, whilst after localized
strokes, for example of a vascular nature, specific disturbances in attention are often
to be observed. According to the basic principles strokes in the cortex areale can
lead to impairments in attention. After injuries to the brain stem, in the region of the
reticular formation and parietal right sided injuries, problems are very noticeable in
periodic and tonal alertness, as well as in vigilance. On the other hand, left sided
parietal injuries damage the selective attention services earlier; in particular in the
© 2014 HASOMED GmbH
Theoretical concept
18
case of tasks in which decisions must be made between several stimulating or reflex
alternatives (Covert shifts of Attention) (cf.,Sturm1990).
After injuries to the brain patients often report about difficulties to direct their
attention in parallel towards different stimuli or impulses
( Zimmermann & Fimm,1989).
In everyday life, there are numerous situations in which divided attention is required
(budgeting, traffic, social communication situations). Problems with the processing
of parallel information can be seen through a general reflex slow-down, a restriction
of capacity for the processing of a sensory stimulus or lacking in cognitive flexibility.
Also the problems described as interference vulnerability or increased
disturbances in control, which are often to be observed after cerebral damage, may
be evaluated as symptoms of a limited information processing capacity.These
patients complain about a great "flood of information", and often feel disturbed by
different influences and they can only prepare themselves exclusively for one
circumstance or situation.
With this in mind, emotional problems must also be considered and may cause
special strain in social situations as a result of focusing on the attention difficulties.
Having accepted the assumptions of particular deficits of the different aspects of
attention , one should also consider the possibility to train for these particular
functions.
Present module is in particular suitable for difficulties in divided attention.
Using the premise of maximum specificity and to achieve as high as possible
efficiency in the training , one should precede with the preparation of the therapy plan
with computer-assisted procedures, a differentiated singular neuropsychological
diagnostic.
2.4
Bibliography
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ameliorating disorders in basic attention. In Meier, M., Benton, A. & Diller, L. (Ed.).
Neuropsychological rehabilitation. Livingstone, Edinburgh: Churchill.
Brickenkamp, R. & Karl R. (1986): Geräte zur Messung von Aufmerksamkeit,
Konzentration und Vigilanz. In: Brickenkamp, R. (Hrsg.). Handbuch apparativer
Verfahren in der Psychologie. Göttingen: Hogrefe.
Broadbent, D. (1958). Perception and communication. London. Pergamon Press.
Cramon, D. v. (1988). Lern-und Gedächtnisstörungen bei umschriebenen zerebralen
Gewebsläsionen. In: Schönpflug, W. (Hrsg.): Bericht über den 36. Kongreß der
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Divided Attention 2
Deutschen Gesellschaft für Psychologie. Berlin.
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Kerkhoff, G. (Hrsg.): Fallbuch der Klinischen Neuropsychologie. Praxis der
Neurorehabilitation. Göttingen: Hogrefe. S. 25-38.
Gray, J. & Robertson, I.H. (1989): Remediation of attentional difficulties following
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Höschel,K. (1996): Effektivität eines ambulanten neuropsychologischen
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Keller, I. & Grömminger, O. (1993): Aufmerksamkeit. In: Cramon, D.Y. von; Mai, N. &
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Lauth, G. W. (1988): Die Vermittlung handlungsorganisierender und
handlungsregulierender Komponenten in der Therapie von
Aufmerksamkeitsstörungen. In: Schönpflug, W. (Hrsg.). Bericht über den 36.
Kongreß der Deutschen Gesellschaft für Psychologie. Berlin.
Lauth, G. W. & Schlottke, P.F. (1988). Aufmerksamkeitsstörungen. In: Schönpflug,
W. (Hrsg.): Bericht über den 36. Kongreß der Deutschen Gesellschaft für
Psychologie. Berlin.
Niemann, T. & Gauggel, S. (1997): Computergestütztes Aufmerksamkeitstraining. In:
Gauggel, S. & Kerkhoff, G. (Hrsg.): Fallbuch der Klinischen Neuropsychologie.
Praxis der Neurorehabilitation. Göttingen: Hogrefe. S. 48-59.
Poser, U.; Kohler, J.; Sedlmeier, P. & Strätz, A. (1992): Evaluierung eines
neuropsychologischen Funktionstrainings bei Patienten mit kognitiver
Verlangsamung nach Schädelhirntrauma. Zeitschrift für Neuropsychologie, 1, S. 324.
Posner, M. & Rafal, R. (1987): Cognitive theories of attention and the rehabilitation
of attentional deficits. In: Meier, M., Benton, A. & Diller, L. (Ed.). Neuropsychological
rehabilitation. Edinburgh, London: Churchill Livingstone.
Poeck, K. (1989). (Hrsg.). Klinische Neuropsychologie. Stuttgart, New York: ThiemeVerlag.
Puhr, U. (1997): Effektivität der RehaCom-Programme in der neuropsychologischen
Rehabilitation bei Schlaganfall-Patienten. Diplomarbeit an der Universität Wien.
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Regel, H. & Fritsch, A. (1997): Evaluationsstudie zum computergestützten Training
psychischer Basisfunktionen. Abschlussbericht zum geförderten Forschungsprojekt.
Bonn: Kuratorium ZNS.
Regel, H., Krause, A. & Krüger, H. (1981): Konfigurationsfrequenzanalytische
Einschätzung einiger psychometrischer Verfahren zur Hirnschadensdiagnostik.
Psychiatrie, Neurologie, medizinische Psychologie, 33, S. 347.
Saring, W. (1988): Aufmerksamkeit. In: Cramon, D. v. & Zihl, J. (Hrsg.).
Neuropsychologische Rehabilation. Berlin, Heidelberg, New York: Springer Verlag.
Sohlberg, M.M. & Mateer, C.A. 81987): Effectiveness of an Attention Training
Program. Journal of Clinical and Experimental Neuropsychology, 9, S. 117-130.
Sturm, W. (1990): Neuropsychologische Therapie von hirnschädigungsbedingten
Aufmerksamkeitsstörungen. Zeitschrift für Neuropsychologie, 1 (1), S. 23-31.
Sturm, W., Dahmen, W., Hartje, W. & Wilmes, K. (1983). Ergebnisse eines
Trainingsprogramms zur Verbesserung der visuellen Auffassungsschnelligkeit und
Konzentrationsfähigkeit bei Hirngeschädigten, Arch. Psychiatr. Nervenkr., 233, S. 922.
Sturm, W.; Hartje, W.; Orgaß, B. & Willmes, K. (1994): Effektivität eines
computergestützten Trainings von vier Aufmerksamkeitsfunktionen. Zeitschrift für
Neuropsychologie, 1, S. 15-28.
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Specific Training? Neuropsychological Rehabilitation, 7 (2), S. 81-103.
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Erfassung von Aufmerksamkeitsdefiziten. Freiburg: Psychologisches Institut der
Universität.
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Divided Attention 2
Index
-Ffeedback
-A-
-G-
acoustic feedback
5
acoustic information
1
acoustic stimuli
1, 9
acoustic suggestions
9
adaptive
6
additional attention level
9
attention level
6
attention levels
1
average speed
9
-Bbibliography
18
big traffic signs
9
billboards
9
breaks
11
-Cclosed railroad crossings
9
cockpit view
1, 9
crash sound
5
crosswalks with pedestrians
9
green area
1
-Hhouses
6
-Iinstruction series
instructions
1
irrelevant objects
dashboard
1
data analysis
11
default values
9
description
1
determined track
1
distance
11
duration
9
1
1
-Llandscape
1
left-hand driving
level
11
level down
9
level of difficulty
level up
9
9
6, 9
-Mmax. duration
mistakes
5
-D-
9
-Nnumber
11
number of stimuli per route
6
-Oobstacles
1, 6
oil pressure
1
-Eeffec. time
5
11
-Pparameter menu
9
© 2014 HASOMED GmbH
Index
parameters
9
pedestrian crossings
performance feedback
police car
1, 9
1
5
-Rrailroad crossings
red arrow
1
red traffic lights
refueling
1
RehaCom panel
relevant objects
relevant stimuli
route
6
1
9
1
1
9
-Sscenery
1
signs
6
speed limit
1
speed limits
6
speed violation
6
speedometer
1
stimulus interval
6
stop signs
1
stress level
9
structure
6
-Ttherapist menu
9
tolerance
6
traffic lights
1
traffic news
1, 9
traffic sign
1
training parameter
9
training surface
1
training task
1
turning signal
6
Manual release date: 27.09.2015
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