Tonic and Phasic Alertness Training For the Treatment of Hemineglect

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DESCRIPTION (provided by applicant): The goal of the current project is to develop and test a computerized attention training program (TAPAT-ATT) to meet the needs of patients with hemispatial neglect following stroke or traumatic brain injury. As a group, these patients tend to have poorer long-term prognosis and are more likely to require managed care than other patient groups with lesions of comparable size. Our recent studies are among the first to demonstrate that brief, tonic and phasic attention training (TAPAT) focused on sustained attention & vigilance can produce lasting benefits that persist for weeks in the absence of additional training. The overall goal of the current work is to reduce the training strategies that we have developed in the lab to practice by optimizing stimulus-delivery parameters and elaborating training in ways expected to increase the range of deficits ameliorated and to prolong and strengthen enduring recovery. Specifically, we will 1) determine the optimal stimulus delivery formats and parameters for maximizing therapeutic training benefits and determine the optimum combinative forms of training and the optimum stimulus sets and task parameters using an iterative program optimization (Agile SCRUM) development process which will rely on outcomes measured from individual program users, and on feedback on user interface designs of training programs recorded by individual trainees and from focus groups. We will also, 2) measure training outcomes as a function of alternative training schedules to further define how to implement and control training schedules that can assure strong and long-lasting recovery. Highly structured progressive attention-skills training modules that allow us to rapidly assess patient performance will be used to evaluate the effects of these new forms of TAPAT training. This ongoing assessment strategy will allow us to quantify learning rates and asymptotic performances achieved within and outside of the neglected field, across several key domains of attention and working memory. Further, our preliminary evidence suggests that this combined training approach (TAPAT followed by attention-skills training modules) may provide synergistic effects, enhancing the effectiveness of both TAPAT and higher-order skills trained. To evaluate this effect, at baseline and after the completion of training, we will measure the generalization of improvements in the training task to untrained standardized measures of attention and working memory. We will also continue to utilize sensitive psychophysical measures of attention and perception to evaluate training outcomes. At the completion of this project we will have outcomes data sufficient for powering a larger randomized controlled study, and training data sufficient for constructing the final form of the 'medical' product model that will be evaluated in the Phase II study.