Mantra Meditation To Improve Chronically Impaired Attention After Stroke: An Ongoing Trial Using Single-Case Research Design

PURPOSE: Attention is often impaired after stroke. There is a lack of high-quality evidence on whether cognitive rehabilitation effectively addresses this problem. The purpose of this study is to investigate whether meditation may improve chronically impaired attention after stroke. Meditation has been categorized as both a restorative occupation and an attentional training technique. It has been shown to modulate attentional substrates and/or improve performance on tests of attention in a variety of populations. This study is the first to investigate the following research question: Will mantra meditation improve attention and related function in daily life measured with neuropsychological and behavioral tests after stroke?

DESIGN: Experimental multiple-baseline across-subjects single-case pilot study with three subjects from ages 18-70 with right-hemisphere stroke at least one year prior to enrollment and no aphasia or neglect at screening. Study site: outpatient occupational therapy research lab in a regional free-standing rehabilitation hospital. Recruitment sources included therapists or other service providers with expertise in rehabilitation or meditation.

METHOD: Each subject took a five-minute attention test on a computer in each session of baseline and intervention phases. The test showed numerals one through nine repeatedly on a computer monitor. Instructions were to press the spacebar each time a numeral appeared, except for the numeral three. Pressing for numeral three was counted as a commission error (primary outcome). Failing to press for any other numeral was an omission error (exploratory outcome). Subjects also rated the impact of attention on daily life (exploratory pre-post outcome). Baseline primary data needed to be stable before the subject began intervention. The intervention phase had three sessions of mantra meditation per week for three weeks. Mantra meditation was operationalized as repetitive intonation of the syllable um for 30 minutes in each session. Each session was private between the principal investigator and one subject at a time. Primary results were graphed and visually analyzed to discern trend, level, and stability of data, including percentage of non-overlapping data between phases. Replication of primary effects across all subjects would indicate a functional relationship between variables.

RESULTS: Three subjects enrolled and completed the trial. All subjects demonstrated baseline stability on primary data. One subject had 100% non-overlapping primary data from baseline to intervention, indicating that mantra meditation had an effect on attention. In contrast, low percentages of non-overlapping data for the other subjects (i.e., 0% and 12.5%, respectively) indicated no effect. Analysis of exploratory outcomes is ongoing.

CONCLUSION: Primary data indicated no functional relationship between variables for two subjects. The other subject had pronounced improvement in attention after intervention. Thus, further research is needed on whether and how mantra meditation may improve impaired attention after stroke. Findings may inform further research on the therapeutic potential of mantra meditation to remediate impaired attention and enhance participation in occupation. In particular, further research is needed to establish what client factors or other variables may influence these outcomes. Such research will lay groundwork for clinical translation studies of this intervention in occupational therapy for stroke or other conditions with pathologically impaired attention.

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