Attention allows us to focus or concentrate on a task, to keep focused over a period of time (sustained attention), and even to seemingly do two things at once (alternating or divided attention). Everyone has experienced times when they just can’t concentrate or when they can’t focus their attention on what they’re supposed to do because there is noise in the background or they are distracted by their own thoughts. Control of attention can be affected after RHD. Some people will have trouble focusing or sustaining attention – they just can’t ignore the distractions around them, or they can start a task but can’t keep their attention focused for the time it takes to complete a task. Someone may start making toast by putting the bread in the toaster and then go to get butter from the fridge; there they see the orange juice and decide they want a drink, so they pour a glass of juice and then sit at the table. They then start watching TV (which is always on in the background) and if they didn’t hear the toast pop up they may forget about it altogether until they start to feel hungry.

Most people believe that they can multitask, or do 2 or more things at once (divided attention). Many people even brag about how well they multitask. In reality, the human brain is not good at this. People can multitask if the 2 things are very different or if one task is pretty automatic – like talking and driving a car. But if the more automatic task (driving) becomes more complex, such as when there is bad weather or lots of traffic, then it is harder to keep up a conversation because more attention is needed to drive safely.

Strokes and other kinds of brain injury can have a big effect on attention. It can be harder to focus attention, to ignore distractors, or to sustain attention long enough to complete a task. It can be much harder to do more than one thing at a time. Another complication is that many tasks that were automatic before the stroke now require thinking and concentration. For example, most adults don’t think about the process of getting dressed – it is automatic. But after RHD people may need to think about the steps needed to dress if one side of the body isn’t working well. They may need to concentrate on doing each step in order so that they don’t end up putting on shoes before their pants. If they get distracted while getting dressed, they may skip a step or two. They may lapse into the automatic routine and then fail, because they old routine doesn’t work anymore.

What you can do

To help someone with attentional deficits, remove distractors by turning off the radio or TV, and don’t have more than one person talking at a time. Break up tasks into steps that don’t take too long, and limit expectations to doing only one thing at a time.Divided Attention