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Two therapy exercises that target attention: Find the symbols & Find alternating symbols

Constant Therapy | Apr 2, 2020 | Traumatic brain injury, Stroke, Clinician

Staying focused is a skill we take for granted – without attention, it’s tough to get daily activities done, whether it’s grocery shopping, writing an email to an old friend, or just reading a blog. Constant Therapy contains evidence-based therapy exercises that are designed to help people working on strengthening their attention skills. Read on to discover the science behind these tasks.

Difficulty with attention can result from traumatic brain injury or stroke

For survivors, this can be extremely difficult to manage, with attention being necessary for just about everything we do, from the more complex projects we complete at work, to simply having a conversation with a loved one or a friend.

Clinical research has shown us that there are treatment options and compensatory strategies people can use to develop their attention. The Constant Therapy exercises Find the same symbols and Find alternating symbols are two attention-targeting tasks designed for patients looking to strengthen this skill set.

Featured task: Find the same symbols

What is the Find the same symbols exercise?

In this scanning exercise, the user must locate the target symbols in a grid, and select the matching symbols.

How is Find the same symbols leveled?

There are 10 levels, with the number of symbols and the details of the symbols becoming increasingly more challenging.

  • Levels 1-4: Symbols are large and colorful. The number of symbols increases from a 3×3 grid in Level 1 to a 7×7 grid in Level 4.
  • Levels 5-7: Symbols are black-and-white and more detailed. The number of symbols increases from a 4×4 grid in Level 5 to a 7×7 grid in Level 7.
  • Levels 8-10: Symbols are black-and-white, very detailed, and look very similar to each other. The number of symbols increases from a 4×4 grid to a 7×7 grid.

How is Find the same symbols scored?

Scores are calculated in a formula involving the number of errors and the total number of symbols presented. There are two types of errors:

  1. Selecting an incorrect symbol
  2. Not selecting a correct symbol

What skills does Find the same symbols target?

This task is often thought of as one of the common selective attention activities for adults or children, but it addresses other skills as well:

  • Selective Attention: Locating the target symbol and ignoring the distractions.
  • Visual Attention: Attending to visual information instead of auditory. You must scan all quadrants of the screen to locate all the information.
  • Visuospatial skills: Conceptualizing the location of the symbols and their relationship to each other in order to select the correct one.
  • Executive functioning: Self-monitoring whether all of the items have been found.

Featured task: Find alternating symbols

What is the Find alternating symbols exercise?

The user is presented with two target symbols (Symbol 1 and Symbol 2) on the left side of the screen. On the right side of the screen, the user will see an assortment of symbols, which they must tap on, alternating between Symbol 1 and Symbol 2, until all the grid symbols are selected.

How is Find alternating symbols leveled?

There are 8 levels, with the number of symbols, details of the symbols, and a number of distractors becoming increasingly more challenging.

    • Levels 1-3: The number of symbols increases over the course of Level 1 to Level 3. The target symbols look different from each other. Only the two target symbols are present with no other distractors.
    • Levels 4-6: The number of symbols increases over the course of Level 4 to Level 6. The target symbols begin to look more similar to one another. We also introduce other distractor symbols that look visually different from the target symbols.
    • Levels 7-8: The number of symbols increases over the course of Level 7 to Level 8. The target symbols look more similar to each other, and we introduce other distractor symbols that also look similar to the target symbols.

How is Find alternating symbols scored?

Scores are calculated in a formula involving the number of errors and the total number of symbols presented. There are two types of errors:

  1. Selecting an incorrect symbol.
  2. Not selecting a correct symbol.

What skills does Find alternating symbols target?

  • Alternating Attention: Switching between stimulus A and stimulus B.
  • Selective Attention: Attending to the stimulus and ignoring the distractor symbols.
  • Visual Attention: Scanning the entire screen to locate all of the information.
  • Executive functioning: Planning how to start the task and deciding in what order you will select the items. Users must self-monitor performance and assess if they have found all of the items.
  • Visuospatial skills: Understanding the location of the symbols and what their relationship is to each other so that the correct item is selected.
  • Memory: Remembering the sequence of the symbols so that they select the items in the correct order.

BONUS: You can increase the demands on attention by presenting multiple stimuli at one time. For example: a user could complete a higher level of Find alternating symbols while listening to a news clip, then answers questions about the news clip to check for comprehension. Having them partake in two activities simultaneously puts considerable demands on their attention network.

The research behind Constant Therapy’s attention exercises

Research shows that there’s a close link between cognition and language in people with aphasia (Vallila-Rohter and Kiran, 2017). Helm-Estabrooks (2016) discusses the “rather compelling research evidence that attention is a potent factor in the auditory comprehension performance” of people with aphasia (67). One study had people with aphasia participate in a cognitive treatment that targeted attention, memory, numbers, and math, problem-solving, and visuospatial skills. While this treatment did not target language skills, participants showed significant improvements in auditory comprehension post-treatment.

For individuals working on cognitive skills, there is a well-researched paper on scanning tasks that provides a meta-analysis (a grouping of various research on a specific topic) on whether scanning tasks are effective (Berryman et al., 2010). Scanning tasks can help improve visual field loss and visual inattention, specifically deficits affecting attention following stroke or traumatic brain injury.

Attention targeting tasks are especially helpful when presented in a low-stress environment or used in sensory-motor integration. Find the same symbols and Find alternating symbols were designed with this kind of integration in mind. Sensory-motor integration is frequently referenced in treatment for speech, language, and cognitive deficits, and refers to integrating a person’s sensory system (the 5 senses: sight, hearing, taste, touch, and smell) with their motor system (anything requiring muscles).

References:

  • Berryman, A., K. Rasavage, and T. Politzer, Practical clinical treatment strategies for evaluation and treatment of visual field loss and visual inattention. NeuroRehabilitation, 2010. 27(3): p. 261-8.
  • Helm-Estabrooks, N. (2016). Treating attention to improve auditory comprehension deficits associated with aphasia. American Speech-Language-Hearing Association Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 64-71.
  • Sohlberg, M., & Mateer, C. (1987). Effectiveness of an attentional training program. Journal of Clinical Experimental Neuropsychology, 9, 117-30.
  • Sohlberg, M., McLaughlin, K., Pavese, A., Heidrich, A., & Posner, M. (2000). Evaluation of attention process training and brain injury education in persons with acquired brain injury. <i>Journal of Clinical Experimental Neuropsychology</i>, 22, 656-76.
  • Vallila-Rohter, S., & Kiran, S. (2017). Guest Editor’s Column. Perspectives of the ASHA Special Interest Groups, 3-6.
  • Des Roches, C., Balachandran, I., Ascenso, E., Tripodis, Y., & Kiran, S. (2015). Effectiveness of an impairment-based individualized rehabilitation program using an iPad-based software platform. Frontiers in Human Neuroscience, doi.org/10.3389/fnhum.2014.01015.
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