Reducing attention deficits after stroke using attention process training: a randomized controlled trial.

BACKGROUND AND PURPOSE Impaired attention contributes to poor stroke outcomes. Attention process training (APT) reduces attention deficits after traumatic brain injury. There was no evidence for effectiveness of APT in stroke patients. This trial evaluated effectiveness of APT in improving attention and broader outcomes in stroke survivors 6 months after stroke. METHODS Participants in this prospective, single-blinded, randomized, clinical trial were 78 incident stroke survivors admitted over 18 months and identified via neuropsychological assessment as having attention deficit. Participants were randomly allocated to standard care plus up to 30 hours of APT or standard care alone. Both groups were impaired (z < or = -2.0) across measures of attention at baseline, with the exception of Paced Auditory Serial Addition Test, which was below average (z < or = -1.0). Outcome assessment occurred at 5 weeks and 6 months after randomization. The primary outcome was Integrated Visual Auditory Continuous Performance Test Full-Scale Attention Quotient. RESULTS APT resulted in a significantly greater (P<0.01) improvement on the primary outcome than standard care. Difference in change on the Cognitive Failures Questionnaire approached significance (P=0.07). Differences on other measures of attention and broader outcomes were not significant. CONCLUSION APT is a viable and effective means of improving attention deficits after incident stroke.