Cognitive Rehabilitation

Cognition refers to our ability to attend to, remember, and communicate about the world around us. Disorders of cognition can occur following such disease processes as stroke, traumatic brain injury, and neurodegenerative processes like Alzheimer’s disease. The impact of cognitive disorders can be profound and not only impact the individual but also friends and family. In the following series of posts, Professor Michael Fraas, Ph.D. will elucidate more about cognition, cognitive disorders, and the assessments and treatments that have been found to effectively diagnose and treat these impairments.

What is Cognition?

According to Professor Michael Fraas, cognition is our ability to make sense of and interact with our environment. All human behavior, from the simplest to the most complex, is conducted through a series of cognitive actions or processes. Research has defined and highlighted the components of several specific cognitive domains including attention, memory, executive function, visuospatial function, and social communication (Cicerone et al., 2011; 2019; Eberle & Shapiro, 2022; Sohlberg & Mateer, 2001). These domains are interdependent and are comprised of subservient processes working in concert together to allow us to function effectively in our day-to-day lives. Factors such as our emotional and behavioral state and our physical ability can have a significant influence on our cognitive performance.

Attention

Attention is a foundational skill that underlies and supports all other cognitive abilities (Eberle & Shapiro, 2022). Following injury to the brain, impairments of attention are common and usually are accompanied by deficits in executive function, memory, and learning. There are many subcomponents associated with attention and models have been proposed to define them. Sohlberg and Mateer (2001) proposed a clinical model for the treatment of attention. They divided attention into five components, which are hierarchically organized. These include focused attention, sustained attention, selective attention, alternating attention, and divided attention.

Types of Attention

Focused attention is our ability to direct ourselves toward a stimulus, for example, turning towards an auditory stimulus (e.g., a doorbell or a person’s voice). This basic response requires that we are aroused and alert enough to perceive the stimulus. It is often disrupted in patients with impaired consciousness, as seen in patients emerging from coma. 

Sustained attention is our ability to maintain a consistent behavioral response. Sustained attention requires us to maintain our focus on a continuous activity or task over time. At higher levels of cognitive processing, it involves being able to hold information in your head long enough to perform some mental manipulation to it. This action is referred to as working memory. An example of this would be conducting a continuous task, such as cooking, in a distraction-free environment.

Selective attention is our ability to maintain focus in the face of competing stimuli. The ability to selectively attend allows us to weed out the irrelevant distractions so we can focus on what is most important at that moment in time. Sitting through a lecture while ignoring the lawnmower right outside the window is an example of one’s ability to selectively attend.

Sometimes we are required to shift our attention back and forth between two tasks with different cognitive requirements. Our ability to do so requires that we have efficient alternating attention skills. An example of this would be a secretary who is required to switch between typing documents and answering phones.

Divided attention is our ability to respond to two or more tasks simultaneously. An example might be driving to work while we monitor the road, listen to the news, and simultaneously drink our coffee. The research is unclear about whether divided attention represents a distinct form of attention, or the multitasking is instead an example of rapid alternating attention. As such, Sohlber and Mateer’s (2010) clinical model has been updated to focus more on the executive control of working memory.

More to Come

In subsequent posts, Professor Michael Fraas will summarize other cognitive domains and how they direct our behavior and affect our day-to-day function.

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