How do patients with cognitive impairment train their attention and concentration?

Author: Liu Chunyan, deputy chief physician of Aviation General Hospital

Reviewer: Xing Yan, Chief Physician of Aviation General Hospital

Attention is very important for a person because it is the starting point of learning. If the attention cannot be focused on one point, one may not respond to the stimulus and will not be able to learn.

In clinical practice, for example, if a patient with cerebrovascular disease has limb dysfunction, such as hemiplegia, when the therapist is training him, if he cannot listen to the therapist's instructions and cannot focus on the training, the effect of the limb function training will be compromised. This is very clear in clinical practice.

Therefore, we hope that these patients, especially those with stroke, limb dysfunction, or swallowing disorders, should first check their attention to see if their attention is impaired.

① Rehabilitation training for those with poor concentration:

Usually, we pay attention to a thing because it is attractive to us. Therefore, when the patient has poor concentration and cannot focus for a long time, the environment needs to be quiet and simple. If the environment is too noisy, the patient will not be able to concentrate.

For example, in a hospital, the treatment room is usually a large hall with many patients. If the patient's attention is distracted and there is a lot of noise when the therapist talks to the patient, the patient will not be able to concentrate, so the effect of his training here will not be good.

Therefore, if there is a problem with attention, the patient must train in a simple and quiet environment.

In addition, choosing training materials that the patient is interested in can attract his attention, so that the concentration time can be prolonged. As the symptoms improve and the concentration time is prolonged, the patient can be allowed to train in a relatively normal but not particularly complex environment.

Figure 1 Original copyright image, no permission to reprint

All our treatments are designed. We need to know what stage the patient is at, what kind of environment he should be placed in for training, and add some noise at the right time to improve his concentration.

② Rehabilitation training for attention shifting disorder:

Sometimes the patient will focus on a certain question, such as, if you ask him what his name is, he will say he is Wang Yi; if you ask him where he is from, he will say he is Wang Yi; if you ask him who this is, he will still say he is Wang Yi. The patient cannot answer new questions according to the new task. This situation is actually a barrier to the transfer of attention.

Normal people find it easy to shift attention. When communicating with others, we can change the topic at any time. However, in clinical practice, some patients cannot do this. If this happens, they will be given some training to solve this problem.

For example, there are two characters, one black and one red. The black character is written with a red pen, and the red character is written with a black pen. Although they are two characters, they are two systems.

We will give the patient a task, asking him not to read the word, but to read the color of the word. The patient's brain will change, pointing to black words should be read red, and pointing to red words should be read black.

Figure 2 Original copyright image, no permission to reprint

After a period of time, the rules are changed according to the patient's situation, such as asking him to read this word as it is now. Or these two words, this time the black words should be read as black and the red words should be read as red. As the patient progresses, this conversion will become more and more frequent. In fact, from another perspective, it reflects the flexibility of the patient's thinking, whether he can continuously switch according to the task requirements.

③ Cognitive training for stroke and physical training should be carried out simultaneously:

Patients with stroke or brain trauma usually have impaired limb function, and even if they do not have impaired limb function, their reactions will be reduced.

When we didn't have this disease, we would take a walk with friends after dinner, happily chatting while walking, or listen to the radio while cutting vegetables at home, and even talk to others. These were things we often did.

However, patients with impaired limb function can walk and talk, but when you ask them to walk and talk at the same time, they will walk slower or even stop, or stutter when speaking. In fact, this is because their ability to do two things at the same time has been weakened.

So when we are conducting rehabilitation training, if you find that after the patient's limb balance function is established, but his walking is not very stable, it will be a bit difficult for the patient to count while walking, or the speed will decrease, or he may not be able to complete the counting.

Counting is a cognitive process. We have added cognitive elements into it. Therefore, in the rehabilitation process of stroke, physical training should be combined with cognitive training. Only in this way can we truly improve physical function and cognitive function to a state that can be used in daily life.