Attention – the wider implications of attention difficulties following a brain injury

Introduction

A change in a person’s ability to focus their attention or to hold that attention for a long period of time is a common problem following a brain injury.  These changes are often temporary and can usually be overcome with help from a specialist who can provide a tailored programme of tasks and activities to improve the affected person’s ability to pay attention.  This is sometimes known as brain training.

It is important for everyone involved in the individual’s recovery to realise that attention difficulties do not simply affect one’s ability to pay attention but rather will most likely impact their other cognitive skills.  Put simply, cognition is the mental action of acquiring knowledge and making sense of the world around us.  The cognitive processes used by the brain to do this include Attention, Memory, Information processing and Executive functioning.  We use these processes all the time to undertake daily tasks.

The hierarchy of cognition

The cognitive processes mentioned above are said to form a hierarchy with the proper functioning of the lower level skills being necessary for the use of the higher level skills.  There are a variety of models but in a typical model of the cognitive hierarchy, attention is at the base of the pyramid with information processing, memory and executive functioning making up the rest of it.

Cognitive skills are located in different parts of the brain therefore a brain injury can cause changes in one skill while not affecting the others.  However, as attention is at the base of the hierarchy and therefore necessary for the functioning of the higher level skills, an individual with attention problems will often struggle with information processing, memory and executive functioning and frustratingly for them, will not realise that this is down to changes in their ability to focus or maintain attention.

It is therefore essential that changes in a person’s ability to pay attention are diagnosed and tackled as early as possible in their recovery.  We will look at these skills and how they interlink below. 

Different types of Attention

With attention fundamentally at the root of so many cognitive processes, it is important to understand the different types so we can better comprehend the range of problems which can be caused.  According to Scholberg and Mateer, there are five distinct categories of attention:

• Focused attention: The brain’s ability to direct its attention to a specific task or thought for any period of time
• Sustained attention: Similar to focused attention but for a longer period of time, this is the ability to focus on an activity or stimulus over an elongated period without getting distracted
• Selective attention: This allows us to select the stimulus that we wish to pay attention to and actively tune out anything irrelevant
• Alternating attention: This refers to the ability of shifting focus from one stimulus to another
• Divided attention: Commonly referred to as one’s ability to multitask, this more complex process is the capacity to maintain focus on multiple stimuli at a given time

The components of attention themselves create a hierarchy, with those unable to engage in focused or sustained attention often being unable to reach the more complex processes of alternating or divided attention.  Likewise, problems with attention will affect the person’s ability of engaging in the next level of the cognitive hierarchy.  For example, if someone cannot focus on new information long enough to absorb it then it is unlikely that they will understand and process this information effectively (information processing) and therefore struggle to remember it (memory) and if they cannot remember information they cannot use this to make informed decisions and organise themselves (executive functioning).

Information processing and attention

Information processing refers to the way we manage and absorb new information and is inextricably linked to all other cognitive functions.  The brain only has capacity to absorb and retain a certain amount of information and when it is damaged, the capacity becomes limited.

As well as the obvious fact that information cannot be taken in without first using attention to focus on it, the skill of paying attention can help the brain when the area responsible for information processing has been damaged.  For example, if the brain is experiencing limited capacity for information processing, it can be prevented from becoming overloaded by using selective attention to focus on relevant information, thus allowing the brain to process only the selected information.

Memory and attention

Problems with memory are common after an injury to the brain and depending on the individual can result in changes to short-term memory, long term memory, remembering new information or difficulties in recognising faces and names.

The importance of addressing problems with attention is paramount in helping someone to understand and overcome their memory problems, especially regarding remembering new information.  For example, problems with sustained attention will mean you cannot focus long enough on the new information to allow the brain to memorise it.  Memory problems are often not simply a problem with memory but rather with the lower level skills of attention and information processing which must be used in order for someone to be able to memorise the information.

Understanding which element of attention someone is struggling with, will help when coming up with strategies to deal with memory problems.  If it is clear that someone struggles with sustained attention for example, they should try to remember new information by spending short amounts of time focusing on it but do this repeatedly rather than in one prolonged period of time.

Executive functioning and attention

Executive functioning describes the many processes our brain uses to enable us to function independently in our everyday lives.  It includes the ability to think, reason and enter into independent self-serving behaviour.  In order to stay focused and make decisions, we are required to maintain attention on a specific thought or a task.  Without the ability to be selective with our attention, we would find seemingly easy tasks and judgements difficult as our brains would be overwhelmed with information.  Furthermore, if unable to divide or alternate our attention from one task to another, multi-tasking will become difficult and many every day activities will be too stressful or dangerous to undertake.  For example, the common daily activity of cooking a meal can be problematic when you are focused on one task such as chopping vegetables and cannot split your attention so as to also focus on taking something out of the oven at a certain time.

Help and advice

If you would like to find out about the different types of specialist’s who can help you or your loved one overcome attention difficulties you can read my blog on this subject.

For more information and advice on the cognitive effects of a brain injury and to discover the resources available to brain injury survivors, visit Headway the brain injury association dedicated to improving life after brain injury.