Attention and concentration

 

Attention problems are one of the most common complaints after a brain injury. Attention is an incredibly important cognitive function used in almost everything we do. This demands a considerable amount of attention from the brain.
The amount of attention we can muster is therefore limited:

• in the number of things we can attend to at any given time (our attention span)
• in the time we can sustain our attention.
  

There are therefore different forms of attention.

 

The problems may manifest themselves in these aspects of attention:

 

1. Focused Attention

Focused attention refers to the ability to distinguish relevant from irrelevant information. Focused attention involves suppressing unimportant details to fully focus

on what is important at that moment. An example of focused attention in everyday life is listening to your conversation partner while the radio plays in the background.

 

2. Sustained Attention

Sustained attention is the process of focusing your attention on something for an extended period of time. As time goes by, it becomes more difficult to maintain sustained attention. An everyday example of sustained attention is typing out a long piece of text.

 

3. Shifting Attention

Shifting attention involves shifting what you are focusing on. Focusing on one activity often has to make way for attentively performing another.
Flexibility is therefore crucial when shifting your attention. An example is answering the ringing phone while cooking. Many people with brain injuries can no longer switch quickly from one topic to another. They will therefore find an unexpected phone call very disruptive.

 

4. Divided Attention

Divided attention means focusing your attention on several things simultaneously. Divided attention often involves multitasking. An example from everyday life is driving while listening to the radio.

 

 

 

By brain injury the ability to focus on something or to concentrate may be reduced. This may influence the ability to work, to study or to continue living at home. Sometimes the person in question is not immediately aware of the fact that the ability to concentrate is different than before the injury.

At the outside it is often not noticeable that there is a problem in this area. This often leads to misunderstanding among others who may think that the person is sloppy, paying inadequate attention or has a lack of motivation. This issue is particularly important for children who return to school after a brain injury and are considered indifferent or lazy students. See our special page on this subject.

If a person cannot concentrate on a single subject or a single voice and is unable to ignore the other incentives, this may be caused by overstimulation. Especially with brain injury in the frontal lobes, the brainstem and the cerebellum problems with alertness are reported.

People with brain injury may have the following problems

• Easily distracted. This causes the fact that a person, for example, cannot escape from distracting stimuli like sounds in the environment. Also attending a conversation in a noisy environment is a problem which can lead to overstimulation

• Have trouble keeping track of what is being said or done
• Have difficulty doing more than one task at a time, see our special page on this
• Experience all the information he or she receives as information overload
• Slow in recording and understanding information
• Have difficulty focusing the attention on something (a conversation, an activity, an exercise)
• Have difficulty retaining the attention on to the activity
• Have difficulty dividing attention. If this is difficult, it is almost not possible to perform two things at the same time.  Having a conversation during washing up, for example, does not succeed anymore. Reading a book while the radio is turned on creates a problem. If a person is staying in a noisy environment or living in a family, it can lead to great mutual collisions.

• Have problems with alertness which may vary depending on whether a person can concentrate for a while or is tired

• Concentration problems may make someone appear slightly confused.

   

   

Fatigue, headaches, and dizziness may also lead to lower performance levels.

 

If you experience attention and concentration problems, you will notice that things are better at some times than others.

This can depend on the time of day, whether you have had a busy day or whether you're tired.

Because you need your attention for almost everything in daily life, you may sometimes experience other problems in addition to attention problems.

For example, your memory might function less well because you were less able to focus on what you needed to remember.

So, if you can't pay enough attention to something, it's logical that it won't be remembered as well.

 

Impact on daily life
These problems can affect daily life in the ability to learn and to remember information. It can make a person feel frustrated and be short-tempered. It can give a feeling that everything is too much.

Also, a concentration problem may result in a person to appear confused. It can cause fatigue, headaches and dizziness and performing at lower levels.

A person with an acquired brain injury has an increased risk of cognitive or physical fatigue and headaches, but also on pain in the body caused by the accident and / or neurological pain. With acquired brain injury there is an increased risk of depression and other mental disorders.

 

 

The Post-NAH Effect / BRAIN-ReADAPT Effect

Dutch researchers found that aging individuals who suffered a brain injury earlier in life may experience memory and concentration problems that are not solely attributable to aging.

The symptoms they experience are similar to those experienced immediately after the brain injury.
This is called the post-NAH effect and is also known as the BRAIN-ReADAPT effect.

'NAH' means Niet Aangeboren Hersenletsel, which means Aquired Brain Injury.

 

As people age, their brains function less effectively.

However, the brains of people with brain injuries are less able to counteract this.

 

"This may be because the brains of people with brain injuries have to work extra hard due to this brain damage," states Nikki Thüss (PhD candidate).

 

This may also cause people to become tired more quickly,  get overstimulated, think more slowly, have less overview, have difficulty sustaining attention, have more difficulty with multiple tasks simultaneously, have difficulty seeing things clearly, become more forgetful, become slower in thinking and acting, etc.

 

As you age with brain injury, your brain's reserve capacity is already partially used by the injury.

As a result, it may be less effective as you get older.

If you feel that symptoms from the brain injury are returning, this may be a case of the post-ABI effect.

 

More information on this: 

https://www.kennispleingehandicaptensector.nl/clientgroepen/niet-aangeboren-hersenletsel/het-post-nah-effect-bij-ouder-wordende-mensen

https://www.kennispleingehandicaptensector.nl/tips-tools/tips/het-brain-readapt-effect-bij-ouder-wordende-mensen-met-nah

 

 

Brain areas involved in to attention and concentration

 

The lateral intraparietal cortex (an area in the parietal lobe) monitors and filters what is and is not important to pay attention to at any given moment. This region then stimulates the medial temporal region.

This is where visual information is processed and which visual information receives conscious attention.

 

If the lateral intraparietal cortex is damaged, visual attention can be impaired and lead to problems with concentration.

There is also evidence that the cerebellum is also involved in attention and concentration. Damage to the cerebellum may therefore also lead to problems with concentration.

 

The prefrontal cortex, the cerebral cortex in the frontal lobe,

is important for sustaining attention.

The connections between the frontal lobe and the basal ganglia are also important in this entire process because these nuclei are involved in shifting attention. The thalamus, with its specific nuclei, is involved in switching between stimuli. (Lateral posterior nuclei, lateral geniculate body (CGL), and medial geniculate body (CGM))

 

Because so many brain areas are involved in sustaining attention, shifting attention, filtering, processing auditory stimuli, processing visual stimuli, and processing tactile stimuli, it makes sense that people with injuries in any of these structures have more difficulty with attention and concentration.

 

Neurotransmitters also play a role, such as glutamate (Glu), serotonin (5-HT), and GABA (γ-aminobutyric acid), but even a hormone that acts as a neurotransmitter: dopamine, or 2-(3,4-dihydroxyphenyl) ethanoamine.

The nerve pathways (the connections) between the frontal cortex

and the basal ganglia are sensitive to dopamine.

 

Both an excess and a deficiency may be detrimental to attention,

depending on whether people have thinner or thicker nerve pathways between these brain areas.

How to improve attention / concentration?

Be aware that what happens is affected by your brain injury. Try strategies from the past and note what does work, but if that does not work anymore be aware that brain injury may play a major role.

The following strategies may be helpful

• Reduce any possible distraction coming from the environment

 

• Take regular breaks, take a nap or take a walk

 

• Take a deep breath, look for physical and mental relaxation, for example a coffee break, or a talk to friends

 

• Plan your task in a simple step-by-step approach, and divide large tasks into small, achievable steps

 

• Make notes and keep them in fixed locations

 

• Use a voice recorder from which messages can be periodically played on your smartphone to help you remember

 

• Use a whiteboard to help you organize and plan and store information

 

• If you use medication, put the medication on the table during every meal or ask your pharmacy for a week delivery

 

• Use medication alarms

 

• Maintain a daily routine that gives structure

 

• Aim for variety in the daily grind

 

• Plan demanding tasks at times that your levels of energy and alertness are the highest. This is often early in the morning, but you have to get to know yourself in this. If you are a bad sleeper that is perhaps only after eleven

 

• Eat healthy and try to sleep well

 

• Talk out loud occasionally in order to monitor thoughts and actions

 

• Use a timer or an electronic organizer and set yourself the goal to improve concentration gradually and in small steps

 

• Practice different strategies to determine which is most effective in different situations. Then ask yourself what distracts you and what weakens your attention and make a note of it. Also note what you need to do to make a strategy work or what you should do differently next time

 

Attentional Problems Under Time Pressure

People with traumatic brain injury (TBI) particularly exhibit difficulties with attention tasks that require time pressure (focused and divided attention).
Approximately 40% of people with a stroke exhibit some degree of impairment and limitation in their attentional functions.

 

The feeling that everything is too much

 

These problems can affect the ability to learn and retain information in daily life.

It can make someone feel very frustrated.

It can give the feeling that everything is too much.

A difficulty concentrating may also cause someone to appear slightly confused. It can lead to fatigue, headaches, and dizziness, and to lower performance levels.

 

• Focusing attention on something (a conversation, an activity, an exercise)
• Maintaining attention on the activity
• Dividing attention: if this is difficult, it becomes almost impossible to do two things at once. For example, having a conversation while washing dishes is no longer possible. Following a conversation with multiple people also becomes difficult.
• Video calling is often too difficult because it is a form of multitasking.