Previous studies have shown that TAPAT enhances sustained attention in patients with severe impairments following acquired brain injury, and that this generalizes to improvements in spatial attention and working memory. Early neuroimaging work has shown an up regulation of acetylcholine post versus pre-training, as measured by the PET acetylcholine ligand [¹⁸F]fluroethoxybenzovesamicol.

Approximately one third of individuals suffering unilateral brain injury exhibit a complex, debilitating array of neurological deficits known as the neglect syndrome. The most apparent problem is failure, or dramatic slowing, of response to stimulation presented to the side of space opposite the lesion. Although less obvious, the severity of non-spatial deficits (e.g., poor intrinsic alertness) is a stronger predictor of the chronicity of spatial neglect in the post-acute phase of recovery than the spatial deficits themselves; thus, these deficits may be fundamental to the neglect disorder. The current training approach was designed to up-regulate both tonic and phasic alertness via a continuous performance “go/no go” computerized task (tonic and phasic alertness training - TAPAT). The objective of the current multi-site RCT was to determine the efficacy of TAPAT to improve spatial attention and functional ability in adults with neglect following acquired brain injury.

Participants (n = 49) completed twelve hours of TAPAT training or an active control activity (casual video games) remotely. The primary outcome (spatial attention) comprised performance on the Posner cueing task and secondary outcomes included functional ability (Catherine Bergego scale). Participants were assessed at baseline, post-training and after a delayed no-contact period.