title: Impaired auditory selective attention ameliorated by cognitive training with graded exposure to noise in patients with traumatic brain injury.
abstract: Patients who suffer traumatic brain injury frequently report difficulty concentrating on tasks and completing routine activities in noisy and distracting environments. Such impairments can have long-term negative psychosocial consequences. A cognitive control function that may underlie this impairment is the capacity to select a goal-relevant signal for further processing while safeguarding it from irrelevant noise. A paradigmatic investigation of this problem was undertaken using a dichotic listening task (study 1) in which comprehension of a stream of speech to one ear was measured in the context of increasing interference from a second stream of irrelevant speech to the other ear. Controls showed an initial decline in performance in the presence of competing speech but thereafter showed adaptation to increasing audibility of irrelevant speech, even at the highest levels of noise. By contrast, patients showed linear decline in performance with increasing noise. Subsequently attempts were made to ameliorate this deficit (study 2) using a cognitive training procedure based on attention process training (APT) that included graded exposure to irrelevant noise over the course of training. Patients were assigned to adaptive and non-adaptive training schedules or to a no-training control group. Results showed that both types of training drove improvements in the dichotic listening and in naturalistic tasks of performance in noise. Improvements were also seen on measures of selective attention in the visual domain suggesting transfer of training. We also observed augmentation of event-related potentials (ERPs) linked to target processing (P3b) but no change in ERPs evoked by distractor stimuli (P3a) suggesting that training heightened tuning of target signals, as opposed to gating irrelevant noise. No changes in any of the above measures were observed in a no-training control group. Together these findings present an ecologically valid approach to measure selective attention difficulties after brain injury, and provide a means to ameliorate these deficits.
authors.affiliation: Headway Ireland, Blackhall Place, Dublin 7, Ireland; Università di Bologna, Dipartimento di Psichologia, Viale Berti Pichat, 5, Bologna, Italy. Electronic address: neil.dundon2@unibo.it.
authors.forename: Neil M
authors.initials: NM
authors.lastname: Dundon
authors.affiliation: Headway Ireland, Blackhall Place, Dublin 7, Ireland; National Rehabilitation Hospital, Dun Laoghaire, Ireland. Electronic address: Suvi.Dockree@NRH.IE.
authors.forename: Suvi P
authors.initials: SP
authors.lastname: Dockree
authors.affiliation: Headway Ireland, Blackhall Place, Dublin 7, Ireland; Trinity College Institute of Neuroscience, The University of Dublin, Dublin 2, Ireland. Electronic address: buckleyv@headyway.ie.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Buckley
authors.affiliation: Trinity College Institute of Neuroscience, The University of Dublin, Dublin 2, Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: Merriman
authors.affiliation: Headway Ireland, Blackhall Place, Dublin 7, Ireland. Electronic address: mary.carton@gmail.com.
authors.forename: Mary
authors.initials: M
authors.lastname: Carton
authors.affiliation: Headway Ireland, Blackhall Place, Dublin 7, Ireland; Department of Psychology, Beaumont Hospital, Dublin 9, Ireland. Electronic address: sarahclarke2@beaumont.ie.
authors.forename: Sarah
authors.initials: S
authors.lastname: Clarke
authors.affiliation: Department of Psychology, National University of Ireland, Maynooth, Ireland.
authors.forename: Richard A P
authors.initials: RA
authors.lastname: Roche
authors.affiliation: Trinity College Institute of Neuroscience, The University of Dublin, Dublin 2, Ireland. Electronic address: edlalor@tcd.ie.
authors.forename: Edmund C
authors.initials: EC
authors.lastname: Lalor
authors.affiliation: Trinity College Institute of Neuroscience, The University of Dublin, Dublin 2, Ireland. Electronic address: iroberts@tcd.ie.
authors.forename: Ian H
authors.initials: IH
authors.lastname: Robertson
authors.affiliation: Trinity College Institute of Neuroscience, The University of Dublin, Dublin 2, Ireland. Electronic address: dockreep@tcd.ie.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Dockree
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology*; D001308:Auditory Perceptual Disorders / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D001930:Brain Injuries / Q000150:complications*; D002540:Cerebral Cortex / Q000503:physiopathology*; D015928:Cognitive Behavioral Therapy; D004007:Dichotic Listening Tests; D004569:Electroencephalography; D005072:Evoked Potentials, Auditory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009622:Noise; D013067:Speech Perception / Q000502:physiology; D055815:Young Adult