Author ORCID Identifier

https://orcid.org/0000-0001-6832-1116

Date Available

5-25-2023

Year of Publication

2022

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Health Sciences

Department/School/Program

Rehabilitation Sciences

First Advisor

Dr. Dana Howell

Second Advisor

Dr. Richard Andreatta

Abstract

Impairment of attention is common after stroke; is a defining characteristic of attention deficit hyperactivity disorder (ADHD); and has been shown to correlate significantly with difficulties in daily life for individuals with these conditions. More research is needed to establish effective interventions addressing impaired attention in such cases. Meditation is not a standard-of-care intervention for this purpose but may have therapeutic potential. Meditation has been broadly defined as an activity which has self-regulation of attention as its main aim. In other words, it can be considered a training of attention. To shed light on the therapeutic potential of meditation, including its objective effects on impaired attention due to stroke or ADHD, the author of this dissertation conducted three original studies.

Study 1 was a qualitative phenomenological investigation of the experience of meditation after stroke. Participants were individuals aged 18 or older who self-reported that they were in the chronic stage of stroke recovery and had participated in meditation (broadly defined) after stroke. A main utility of the Study 1 findings was to lay groundwork for generating testable hypotheses about how clinical and research protocols may be tailored to afford participation in (or targeted outcomes of) meditation in cases of impaired attention after stroke. Study 1 findings can also serve as an intervention-design resource on meditation after stroke. For example: findings indicated that while participation in meditation after stroke can be afforded by non-traditional elements (e.g., chair seating as opposed to the tradition of sitting cross-legged on the floor), traditions may also enhance participation in meditation after stroke (e.g., candle-lighting; a consistent time for meditation). Findings such as these speak not only to practical feasibility but also tenets of occupational therapy that explicitly designate routines as structures by which life is organized and health may be promoted; and rituals, as meaningful actions that contribute to a client’s identity (American Occupational Therapy Association [AOTA], 2020).

Study 2 used a quantitative, non-concurrent, multiple-baseline, across-subjects, single-case design. The main objective was to test whether mantra meditation would have a therapeutic effect on impaired sustained attention for adults between the ages of 18 and 70 with attention impairment in the chronic stage of recovery after right-hemisphere ischemic stroke. Mantra meditation was operationalized as audible utterance of the syllable um by the subject for 30 consecutive minutes per intervention day. For each subject, the study comprised 11 one-hour days evenly spaced throughout four consecutive weeks, which included time for not only intervention but also testing. Results showed evidence in favor of a therapeutic effect for one out of a total of three enrolled subjects. Thus, further research is recommended to support more than limited clinical use of Study 2’s mantra meditation to target impaired attention after stroke. Practitioners who employ the protocol of Study 2 based on its anecdotal and incidental evidence should monitor attention and related functional status during treatment as well as consider modifying the salience-related aspects of the meditation in keeping with clinical judgement and client preferences.

Study 3 was a phase II, single blind, randomized controlled superiority trial with two arms (active versus comparison). The main objective was to evaluate the effects of mantra meditation on sustained attention impairment for adults with ADHD. Active mantra meditation was operationalized as having the subject say the syllables sa ta ma na out loud at a comfortable pace and volume while touching the thumb to each successive fingertip in time with the syllable’s intonation. Mantra meditation in the comparison condition was designed to be more motorically passive than active mantra meditation. Specifically, subjects in the comparison condition were instructed to sit quietly with thumb touching index fingertip while attentively listening to an audio recording of the continual sound of the syllable om repeated over ambient background sound. For all subjects, the assigned dose was 15 minutes, once per day, for six consecutive days. Because results of Study 3 indicated significant promise that mantra meditation can improve impaired attention in adult ADHD, they support the judicious application of either the active or the comparison protocol as interventions to remediate impaired attention due to adult ADHD.

Overall, findings from this dissertation may be used to inform future research related to meditation, occupation, neuroplasticity, and rehabilitation for adults with pathologically impaired attention. More specifically, future mixed-methods investigation of associations between meaning- or salience-related variables of mantra meditation (e.g., ascribed meaning; complexity of enunciation); neurophysiological and behavioral indices of attention; and functional outcomes for adults with impaired attention due to stroke or ADHD is recommended.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2022.207

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