Working with Disruptions

SKILL: Attention

DIFFICULTY: 5/5

LEVELS: 4 based on level of stress

BRIEF RATIONALE: This treatment includes strategies for alternating attention during functional tasks.

In Working with Disruptions, you will complete 5 functional text entry tasks as quickly and accurately as you can . Simulated tasks include:

1. Entering credit card information
2. Adding a new contact
3. Entering shipping information
4. Adding an event to your calendar
5. Sending money transfers

While you are copying the information, you will experience a series of disruptions. These include calls, texts, and emails. You can accept or dismiss the disruption. If you accept the disruption, you must decide if it requires follow-up or not. If you dismiss the disruption, you will have an unread notification. You can access your notifications any time.

The treatment will auto-adjust in difficulty based on performance:

Level 1: no stress; 0 disruptions

Level 2: low stress; 2 disruptions

Level 3: medium stress; 5 disruptions

Level 4: high stress; 8 disruptions

You will learn strategies to help you alternate attention between the main text entry tasks and the disruptions. Strategies include:

• Control the environment: Reduce background noise and visual distractions around you
• Don't multitask: Focus on one thing at a time to improve accuracy and efficiency
• Switch tasks at a logical point: Complete a task or portion of a task before switching your focus
• Block off time: Decide how long you want to spend on one task, and work on only that task during that time
• Read information out loud: Stay focused and listen for errors while reading aloud
• Check before submitting: Look over your work to identify errors before submitting for feedback

FOR THE CLINICIAN: Working with Disruptions is based on the theoretical model for attention. It is meant for patients with impairments in selective and alternating attention. It includes strategy education and reflection because metacognitive strategy training (MST) is recommended for those with mild-moderate attention deficits according to the INCOG 2.0 Guidelines.

There are four levels in this treatment based on the number of disruptions, because repeated practice within a hierarchy encourages new learning. The types of text entry tasks and disruptions were carefully chosen to promote generalization, as these commonly occur in real life.

Selected References:

1. Cicerone, K. D., Dams-O’Connor, K., Eberle, R., Fraas, M., Ganci, K., Langenbahn, D., Shapiro-Rosenbaum, A., Tate, R. L., & Trexler, L. E. (2022). The ACRM Cognitive Rehabilitation Manual & Textbook: Translating Evidence-based recommendations into practice. ACRM Publishing.

2. Ponsford, J., Velikonja, D., Janzen, S., Harnett, A., McIntyre, A., Wiseman-Hakes, C., Togher, L., Teasell, R., Kua, A., Patsakos, E., Welch-West, P., & Bayley, M. T. (2023). INCOG 2.0 guidelines for cognitive rehabilitation following traumatic brain injury, part II: Attention and information processing speed. Journal of Head Trauma Rehabilitation, 38(1), 38–51.