Attention and concentration:

Clinical picture:

- Easily distracted
- Difficult with conversations
- Tend to evaluate situations wrong – cannot concentrate enough to understand what is going
on
- Disorganized, short tempered , anxious – inability to participate in PCLs
- Personal appearance –poor
- Poor interest in environment and people
- Problems with problem solving, decision making, activity participation

Pathology/medical conditions:

- Psychosis- Schizophrenia
- Organic brain injuries/dysfunction
o Alzheimer’s Disease and Dementia
o Brain trauma
- Consciousness – coma or semi-comatose state
- Anxieties
- Mood disorders – Anxiety disorders
- Substance abuse / dependency
- Intellectual Impairment

Other reasons:

- Medication
- ECT
- Pain – acute or chronic
- Tiredness
- Temp
- Time of day
- Age, fitness
- Not interested
- Environment
- Too little knowledge, uncertainties, anxiety about issues being discussed
- Haste if in a hurry
- Psychomotor activity – agitated, slowed activity

OT General:

- NB Full Assessment – expectations and grading – to allow planning

- Retraining of concentration often starting point
- Requires repetition
- Bear in mind: Time of day
o Motivation, medication
o Mood and interest
- NB: FIRST HANDLE ANXIETY

General treatment principles:

 - Establish a relationship of trust to reduce anxiety
- Clear and firm regarding expectations: Duration of session / Task completion
- Refocus attention to task: Verbal / Physical
- Positive reinforcement, encouragement, for attempts and successful attempts to
concentrate
- Be sensitive to discomfort, poor endurance, pain – empathy very important
- Keep a record of progress – stay motivated in treatment
- Encourage patient to pay attention to others and objects
- Employ memory strategies – memory and concentration are often linked
- Reassure patient to manage anxiety
- Regular feedback – grade to self-evaluation
- Limit interruptions when patient is concentrating – can be graded so that they can be
successful in the environment where they need to be functional
- Set a realistic goal and upgrade
- Watch for signs of fatigue

Principles for selection of activity:

- Must stimulate and sustain patient’s interest particularly when you want them to
concentrate
- Include elements of accuracy – determine that the person is actually concentrating
- Be gradable – increase demands
- Enjoyment – meaningful and purposeful
- Task satisfaction

Principles for presentation of activity:

- Multi-sensory input
o Looking at basic cognitive skills – if struggling at basic level – keep concrete with
sensory input
- Explain the aim of treatment in language and method that client can understand
- Present one task at a time what the requirements are in concentration and attention
- Clear, brief instructions. Repeat if necessary
- Demonstrate and use visual aids
- Stimulate interest when you are presenting the activity
- Plan treatment for when patient is least tired – highest potential chance of success

Principles for structuring treatment area:

- Position client appropriately – COMFORT

- Start with short sessions with frequent rest periods – grading
- Few external stimuli - grading

Grading:

- Increase duration of session

- Reduce rest periods
- Increase external stimuli
- Simple to complex activities
- Concrete to abstract
- Increase amount of steps
 - Easy to difficult

Precautions:

- Avoid distracting client – talking too much – becoming external stimuli and distraction – do
not talk continuously unless doing it strategically
- Expectations must be appropriate
- Control external distractions – plan for grading
- Manage anxiety and frustration