?The ability to remember is crucial to a person?s sense of self, and its loss is devastating. Memory is the fabric of our lives; it is the ability to recall old information, learn new information and integrate the two. Without the ability to remember information, we experience a loss of control and empowerment?
(Harrell et. al, Cognitive Rehabilitation of Memory, 1992).
?I can?t remember what I forgot? is how Jane (fictitious name) once described the frustration of her memory challenges. The 47-year-old real estate broker was confused and confounded by sudden problems with distractibility, memory and learning that resulted from a car accident. Jane could not remember conversations or appointments, or where she put keys or important documents. Her self-esteem had withered and she doubted her ability to work again.
Two years after her injury, and a year into therapy, memory failure continued to rear its ugly head; but Jane had learned to prevent it from interfering with her independence. She developed compensatory strategies that allowed her to move on with her life, maintain a successful real estate business and regain a sense of personal power.
Help is available:
Jane?s success is not unique. There is help for individuals with memory impairments. Speech-language pathologists can help to make these difficulties less burdensome. This article will provide a brief overview of memory deficits following acquired brain injury and outline key intervention strategies.
Memory Problems are Pervasive:
Memory problems are the most common consequence of traumatic brain injury. One year post-injury, seventy percent of accident survivors will experience significant and ongoing memory difficulties. Many will have residual impairments in learning and retaining new information that will affect all aspects of the rehabilitation process, and will have a profound effect on their lives.
Neuroanatomic Correlates:
Memory function is subserved by various brain structures, including the hippocampus, temporal lobes, thalamus and frontal lobes. The type of memory loss will depend upon the nature of the pathology, and the degree and locus of injury. For instance, damage to the temporal lobes may result in impaired registration and storage of new memories. Damage to the thalamus, particularly the dorsomedial nuclei, may disrupt encoding and integrating of new information. Damage to the frontal lobes may disturb attention processes, the organization of memories and/or time tagging, i.e. the ability to retrieve the temporal order of information from memory. A clinician?s first order of business is to do a thorough evaluation of memory, in order to specify treatment objectives.
Components of Memory:
Memory is viewed as a dynamic, multi-system cognitive activity that involves the following processing levels:
- attention: the ability to hold information in temporary storage
- encoding: the level of analysis that affects one?s ability to recall or recognize information
- storage: the ability to transfer transient information into permanent storage
- consolidation: the ability to integrate new memories within existing cognitive/linguistic schemas
- retrieval: ability to search for or activate memory traces
Memory problems can result from failure at any of these levels. Treatment often targets impairment levels directly.
Rehabilitation
Speech-language pathologists are college- registered professionals who evaluate and treat all areas of communication (reading, writing, speaking, listening) and all areas of cognition that impact upon communication (including attention and memory).
Treatment often involves improving compensatory skills, implementing the use of assistive devices and modifying the environment. Examples of each of these intervention types follow.
Exercises that address memory improvement directly (i.e. memory ?restoration? or ?stimulation? approaches) are not advised, as research has failed to demonstrate memory enhancement for untrained tasks or, more importantly, any impact on functional memory outside the clinic setting. Asking individuals to memorize word lists or listen to paragraphs and answer questions will not, in and of itself, improve defective memory. Rather, treatment should train individuals to store, integrate and retrieve information more efficiently using external and internal coping strategies.
Compensatory Skills Training may involve developing attention processes, teaching verbal rehearsal, improving visual scanning, training the use of mnemonic devises (e.g. ANGER Management: A: anticipate signs of anger, N: never act in anger, G: go through the calming stages, E: evaluate the situation, R: review how you coped), improving organization and categorization skills, teaching note-taking, training active listening, or establishing daily routines to decrease the impact of memory deficits.
Assistive Devices can include tape recorders, key alarms and desk top computers or hand held devices that allow individuals to organize, sort and retrieve significant amounts of information. Prospective memory devices, that remind individuals to perform particular activities at specified future times, include alarms, buzzers, watches and hand held computers like the Palm Pilot that have audible or vibratory alarms.
Environmental Modification may include restructuring the physical environment to decrease the impact of memory impairment, e.g. posting reminders, labeling shelves, alphabetizing cupboards or designing special work settings. It may also include teaching family, friends and coworkers to modify interactions to facilitate recall (e.g. defer important conversations until the individual is rested, focused and ready to listen).
In summary, there are many effective approaches to memory remediation following acquired brain injury. Individuals who are motivated to improve their memory capacity, may benefit from the services of a speech-language pathologist whose practice focuses on acquired brain injury rehabilitation. To access services, consult your physician, case manager or lawyer for a referral.
About the Author:
Kerry Erle is a speech-language pathologist with close to twenty years of clinical experience in acquired brain injury rehabilitation. She is Adjunct Professor at the University of Western Ontario, School of Communication Sciences and Disorders, and
founder of London Speech and Language Centre. The nationally recognized clinic provides acquired brain injury rehabilitation for adults and children across southwestern Ontario.
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