What SLPs Need to Know:
Attention & Aphasia
7 min read
Aphasia is a loss of language, not a loss of intellect. We know this to be true. But we also know that aphasia is caused by damage to the brain, and that damage can also impair cognitive processes at the same time.
Research suggests that nearly all persons with aphasia have decreased attention abilities compared to those without a brain injury. Attention skills in individuals with aphasia can even predict therapeutic outcomes (Villard, 2017). The good news is that training attention can improve language, and we see the best outcomes when therapy targets both attention and language (Varkanitsa, 2023)!
Peach et al. (2017) reported that people who have both aphasia and attention deficits can have increased difficulty with auditory and reading comprehension as well as with word retrieval, sentence production, and discourse. This is because of the arousal (readiness to receive information), sustained attention (staying focused on the information over time), and selective attention (ignoring distractions) required for these linguistic tasks.
Those with aphasia may also struggle with non-linguistic tasks that require attention when compared to their healthy, age-matched peers. Responses tend to be slower and less accurate. People with aphasia may also experience a spike in the stress hormone cortisol during attention-based tasks (Murray et al, 2004).
Learn more about the fundamentals of attention and how to treat it in our article: “What SLPs Need to Know: Treating Attention in Speech Therapy”
While communication relies on many cognitive skills, it’s attention that deserves the spotlight when it comes to aphasia rehab. Language processing depends on the appropriate distribution of attentional resources, making attention vital for receptive and expressive language. Assessing and treating attention impairments should be on every clinician’s radar.
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Assessing Attention in People with Aphasia
Clinicians can find it challenging to determine whether the difficulties they’re observing stem from attention or language issues—or a combination of both. Most cognitive tests are language-based, so scores may not accurately represent attention abilities given the presence of aphasia.
When using a cognitive test with someone with aphasia, ask yourself these questions to understand the limitations of the assessment:
- Is the test primarily non-verbal or verbal?
- Does the task rely on recognition or require explicit recall?
- What level of comprehension is required?
- How complex is the information presented?
Speech-language pathologists should try to use measures that examine different types of attention, but don’t require significant language processing. Some examples mentioned by Varkanitsa et al. (2023) include:
- Cancellation tasks: crossing out target symbols in a field
- Go-No-Go tasks: responding when they see a “go” signal and not responding to “no-go” signals
- Tone discrimination tasks: deciding if a tone is low or high, for example
- Non-linguistic dual tasks: doing two tasks simultaneously, like discriminating tones while sorting cards
The Cognitive Linguistic Quick Test-Plus (CLQT+) is a standardized measure that assesses five cognitive domains, including attention, with a specific aphasia administration protocol. Subtests related to attention include symbol cancellation, symbol trails, and mazes. Patients receive additional points for auditory comprehension on these subtests.
The Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN) is another standardized test developed by speech-language pathologists to assess both language and cognition. Attention is one of the eight scales in this assessment.
Treating Attention in People with Aphasia
Poor attention can affect a patient’s readiness for rehab, response to treatment, and their ability to adjust to life after stroke. This is why clinicians should consider adding attention treatments when creating a plan of care for a client with aphasia. There are multiple ways speech-language pathologists can treat attention deficits alongside aphasia.
Direct Attention Therapy for Aphasia
Clinicians can include direct attention therapy into the treatment plan along with traditional language interventions. Studies have reported positive outcomes, but the research literature isn’t consistent in these findings (Adjei-Nicol, 2020).
Direct Attention Therapy:
Visual Search
Visual Search is a direct attention training treatment with minimal language requirements. Patients cancel target symbols or letters in increasing fields of distractors.
Try adding background noise or having a conversation while using this treatment to challenge sustained and selective attention.
Visual Search is a cognitive treatment in the Tactus Virtual Rehab Center.
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Use technology to present stimuli of just the right difficulty, provide feedback, adjust complexity, and score the performance – even write the SOAP note! You provide the cues and add to the cognitive load.
Strategy Training for Attention and Aphasia
Attention strategies have been found to be effective in populations such as traumatic brain injury and stroke, but they haven’t been studied specifically in aphasia. There’s no reason to think they can’t work for those with aphasia, but we don’t have empirical data. Implementing strategies in your sessions can improve focus and self-awareness, and is generally a good idea.
Strategies can be divided into the following categories:
- Environmental Modifications: Reduce distractions to help maximize attention. For instance, turning off the television or working in a quiet space can help patients focus on therapeutic activities.
- External Aids: Use tools to compensate for a person’s attention limitations, like ear plugs, noise cancelling headphones, or certain types of microphones.
- Metacognitive Strategy Training: Patients using metacognitive strategies must learn to anticipate attention demands, monitor their concentration, and change their behaviors to maximize performance. Since this involves complex processing, it’s best for those with strong comprehension.
Strategy training can be adapted for people with aphasia. Kersey et al. (2021) used supportive conversation techniques during metacognitive strategy training to include participants with aphasia. Supported conversation methods included white boards, letter boards, picture boards, iPads, simple cues, and multi-modal communication. They found that participants with aphasia benefitted from this adapted instruction to a similar extent as participants without aphasia.
Treat Attention Using Strategies:
Managing Attention
Managing Attention helps patients identify personal and environmental distractors, suggesting strategies and modifications to boost concentration based on their responses.
Use this treatment at the start of each session, printing the PDF results as needed, to set up your patients for success.
Managing Attention is a strategy-based treatment in the Tactus Virtual Rehab Center.
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We know strategies work, so we build them into our treatments & handouts to make your job a little easier.
Final Thoughts About Attention and Aphasia
We know that attention is critical to using language and to success in therapy. We are learning that people with aphasia may have greater difficulty with attention than we first suspected, and that treating attention may not only improve their ability to participate in therapy, but also to communicate.
As speech-language pathologists, we must embrace our role of treating communication and cognition, and do our best to help our patients with aphasia to attend and communicate better. While we don’t yet have the research to show us exactly what we should do, increasing our awareness of the complex relationship between attention and aphasia is a good first step.
Learning More about Attention and Aphasia
We used these references to bring you this information. We recommend reading the sources to learn more:
- Adjei‐Nicol, S., Sacchett, C., & Beeke, S. (2025). Evaluating the effect of a non‐linguistic cognitive intervention on functional communication in global aphasia: A case series study. International Journal of Language & Communication Disorders, 60(1).
- Adjei-Nicol, S. K. (2020). An investigation into the effect of a novel non-linguistic cognitive intervention on functional communication in global aphasia. (Doctoral dissertation, University College London (PDF).
- Helm-Estabrooks, N. (2011). Treating attention to improve auditory comprehension deficits associated with aphasia. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 21(2), 64–71.
- Kersey, J., Evans, W. S., Mullen, K., Askren, A., Cavanaugh, R., Wallace, S. E., Hula, W. D., Walsh Dickey, M., Terhorst, L., & Skidmore, E. (2021). Metacognitive strategy training is feasible for people with aphasia. Occupational Therapy Journal of Research, 41(4), 309–318.
- Kohnert, K. (2004). Cognitive and cognate-based treatments for bilingual aphasia: A case study. Brain and Language, 91(3), 294–302.
- Murray, L. L. (2004). Cognitive treatments for aphasia: Should we and can we help attention and working memory problems? Journal of Medical Speech-Language Pathology, 12 (3), xxv-xi.
- Peach, R. K. (2017). Language-Specific Attention Treatment for aphasia: Description and preliminary findings. Seminars in Speech and Language, 38(1), 5–16.
- Varkanitsa, M., Godecke, E., & Kiran, S. (2023). How much attention do we pay to attention deficits in poststroke aphasia? Stroke, 54(1), 55–66.
- Villard, S. (2017). Potential implications of attention deficits for treatment and recovery in aphasia. Perspectives of the ASHA Special Interest Groups, 2(2), 7–14.
