a b s t r a c t
Patients whosuffertraumaticbraininjuryfrequentlyreportdifficulty concentratingontasksandcom-
pleting routineactivitiesinnoisyanddistractingenvironments.Suchimpairmentscanhavelong-term
negativepsychosocialconsequences.Acognitivecontrolfunctionthatmayunderliethisimpairmentis
the capacitytoselectagoal-relevantsignalforfurtherprocessingwhilesafeguardingitfromirrelevant
noise. Aparadigmaticinvestigationofthisproblemwasundertakenusingadichoticlisteningtask(study
1) inwhichcomprehensionofastreamofspeechtooneearwasmeasuredinthecontextofincreasing
interferencefromasecondstreamofirrelevantspeechtotheotherear.Controlsshowedaninitialde-
cline inperformanceinthepresenceofcompetingspeechbutthereaftershowedadaptationtoin-
creasing audibilityofirrelevantspeech,evenatthehighestlevelsofnoise.Bycontrast,patientsshowed
linear declineinperformancewithincreasingnoise.Subsequentlyattemptsweremadetoamelioratethis
deficit (study2)usingacognitivetrainingprocedurebasedonattentionprocesstraining(APT)that
included gradedexposuretoirrelevantnoiseoverthecourseoftraining.Patientswereassignedto
adaptiveandnon-adaptivetrainingschedulesortoano-trainingcontrolgroup.Resultsshowedthatboth
types oftrainingdroveimprovementsinthedichoticlisteningandinnaturalistictasksofperformancein
noise. Improvementswerealsoseenonmeasuresofselectiveattentioninthevisualdomainsuggesting
transfer oftraining.Wealsoobservedaugmentationofevent-relatedpotentials(ERPs)linkedtotarget
processing (P3b)butnochangeinERPsevokedbydistractorstimuli(P3a)suggestingthattraining
heightened tuningoftargetsignals,asopposedtogatingirrelevantnoise.Nochangesinanyoftheabove
measures wereobservedinano-trainingcontrolgroup.Togetherthese findings presentanecologically
validapproachtomeasureselectiveattentiondifficulties afterbraininjury,andprovideameansto
amelioratethesedeficits