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The Rehabilitation of Attention.
In P.W. Halligan, U. Kischka, & J.C. Marshall (Eds), Oxford Handbook of Clinical Neuropsychology. Oxford: Oxford University Press
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Over the last thirty years there have been considerable developments in how we understand attention. Of most relevance to the clinical field is the view that attention is not a single entity but rather a fractionated set of brain processes that are vulnerable to selective damage. With a clearer idea of what we are looking at, the role of attention in influencing clinical outcome both as a function in its own right and as essential adjunct to the useful expression of other abilities is becoming increasingly apparent. As we will discuss, attention and other ‘central’ functions cannot be observed directly. The scientific inferential techniques of neuropsychology and clinical neuropsychology are essential in determining how these processes operate (and break down) and in making specific assessments. The contribution of a particular impairment to difficulties faced by patients in daily life is not always clear. In the rehabilitation of attention as with any other deficit a broader psychological perspective that takes into account co-existing impairment, pre-morbid factors and the psychosocial context of a patient are vital. Pharmacological interventions for attentional disorders, at least for adults with neurological damage, are at a relatively early stage. Although very useful developments may take place in this respect, the role of the neuropsychologist is careful assessment and targeted rehabilitation is likely to remain crucial in fostering positive outcomes. Here we examine various attempts to enhance the natural recovery of attentional processes or to better manage the consequences of impairment following adult brain injury. The results we review give grounds for cautious optimism. However, rehabilitation is-or should be- about working with patients to achieve functional goals in everyday life. If the promising findings showing changes on neuropsycholigcal tests are to usefully filter through to clinical care, the extent to which these translate into meaningful functional improvements must be evaluated.