Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 175
10
Memory
OVERVIEW
Memory impairments are common cognitive problems associated with
TBI. As such, myriad cognitive rehabilitation therapy (CRT) interventions
aim to restore or compensate for memory deficits. This chapter presents
descriptions for studies by method of memory strategy (e.g., internal, exter-
nal, or combined). Within these sections, the controlled studies (e.g., RCTs
and nonrandomized, parallel group) are divided by treatment compara-
tor arm (e.g., no treatment, non-CRT treatment, other CRT treatment);
following controlled studies, the noncontrolled studies (e.g., pre-post or
single-subject, multiple baseline experiments) are described. The chapter
closes with the committee’s conclusions for all memory studies reviewed,
drawing out notable findings for mild or moderate-severe traumatic brain
injury (TBI), as possible.
The committee reviewed 13 randomized controlled trials (RCTs) of
treatments intended to improve or compensate for memory deficits. These
trials varied in their intent to restore memory, show improvements in learn-
ing, or train individuals to use external or internal aids to compensate for
poor memory. These trials enrolled a total of 315 study participants, with
the size of the treatment group ranging from 8 to 39. The average age of
participants ranged from early 20s to late 50s. Of the 13 trials, 12 enrolled
participants in the chronic phase of recovery, averaging 4 to 7 years postin-
jury. One RCT enrolled participants who were in the subacute recovery
phase, at 6 to 9 months postinjury (Watanabe et al. 1998).
The committee reviewed two nonrandomized, parallel group controlled
studies of treatments intended to compensate for poor memory by train-
175
OCR for page 176
176 COGNITIVE REHABILITATION THERAPY FOR TBI
ing the use of internal strategies. Goldstein et al. (1996) enrolled 20 par-
ticipants and O’Neil-Pirozzi et al. (2010) enrolled 94 participants. In both
studies participants were considered chronic, averaging 1 to more than 11
years postinjury; the average participant age ranged from the 20s to the
40s. The committee reviewed six pre-post single group design studies and
six single-subject, multiple baseline (SS/MB) designs. Table 10-1 (at the end
of the chapter) presents a summary of all included studies in this review.
INTERNAL MEMORY STRATEGIES
Internal memory strategies may include the use of visual imagery or
other repetitive, drilled practices. The committee reviewed seven RCTs and
two nonrandomized, parallel group studies that used internal memory strat-
egies; comparator arms included no treatment (n = 3), non-CRT treatment
(n = 1), and other CRT treatment (n = 5). The committee also reviewed
one pre-post single group design and five single-subject multiple, baseline
experiments. Table 10-2 presents all internal memory strategy studies by
design, strategy and treatment comparator.
Controlled Studies
Comparator Arm: No Treatment
Tam and Man (2004) conducted a small RCT in which 26 partici-
pants were randomly assigned to four computerized learning conditions:
self-paced practice, stimuli/multi-sensory feedback, personalized training
contents, and visually enhanced presentation. Treatment dosage ranged be-
tween 3 and 5 hours. Performance on drilled content improved significantly
for all treatment groups compared to no treatment, with the feedback
group showing the most gain. On a self-efficacy scale however, the feedback
group demonstrated significant change after treatment, whereas others’ self-
efficacy did not change. None of the groups improved significantly on the
Rivermead Behavioural Test. The group that received stimuli/multi-sensory
feedback appeared to improve memory for drilled content, which also may
be related to their changes in self-efficacy for memory ability. It is unclear
if improvement was related to the treatment, spontaneous neurological
recovery, or other treatment participants were receiving at the time. With
six and seven participants per group, interpretation and generalizability are
limited. Also, specific time since injury was not reported, though individuals
fewer than 3 months from injury were excluded.
Thickpenny-Davis and Barker-Collo (2007) conducted a small RCT
that included moderately and severely injured participants who were more
than 1 year postinjury. The 14 participants were randomly assigned either
OCR for page 177
177
MEMORY
TABLE 10-2 Internal Memory Strategies
Strategy Treatment Comparator
Visual No Non- Other
Study Design Multiple Imagery Treatment CRT CRT
Bourgeois et al. 2007 RCT X X
Dirette et al. 1999 RCT X X
Dou et al. 2006 RCT X X
Ruff et al. 1994 RCT X X
Ryan and Ruff 1988 RCT X X
Tam and Man 2004 RCT X X
Thickpenny-Davis and RCT X X
Barker-Collo 2007
O’Neil-Pirozzi et al. Parallel X X
2010
Goldstein et al. 1996 Parallel X X
Milders et al. 1998 Pre-Post X
Benedict and Wechsler SS/MB X
1992
Ehlhardt et al. 2005 SS/MB X
Hux et al. 2000 SS/MB X
Manasse et al. 2005 SS/MB X
to receive a structured memory program or to join a waitlist. The memory
intervention consisted of educating participants about memory (four parts
of memory: attention, encoding, storage, and retrieval), assisting partici-
pants in understanding their own memory impairment and its effects,
introducing and practicing strategies to aid memory and learning, and
assisting participants in identifying the most appropriate and useful strate-
gies for them. Strategies included didactic teaching, small group activities,
discussions, problem solving and practice implementing memory strategies,
errorless learning, and repetition. Postintervention, the experimental group
as compared to the control group improved in many neuropsychological
measures of memory (California Verbal Learning Test [CVLT]) long de-
layed free recall, Wechsler Memory Scale (WMS) logical memory delayed
recall, and response time on the attention test (Continuous Performance
Test [CPT]). The experimental group also showed increased knowledge of
memory/memory strategies, increased use of memory aids/strategies, and
decreased behaviors indicative of memory impairment. Results were main-
tained at follow-up with the exception of response time on the attention test
OCR for page 178
178 COGNITIVE REHABILITATION THERAPY FOR TBI
and immediate recall of narratives on the WMS. In addition to the initially
small sample sizes, four of the seven participants in the waitlist control
drop dropped out before providing posttreatment and follow-up measures.
O’Neil-Pirozzi et al. (2010), a large nonrandomized, parallel group
study, examined the effects of memory training on individuals with mild,
moderate, and severe injuries. Of the 94 enrolled participants, 54 received
memory intervention and 40 received no specific intervention. Memory
intervention, called I-MEMS focused on memory education and teaching
individuals to use internal memory strategies, particularly “semantic asso-
ciation (i.e., categorization and clustering); semantic elaboration/chaining
and imagery were emphasized secondarily” (O’Neil-Pirozzi et al. 2010).
The memory intervention included 12 group sessions, 90 minutes each, held
twice each week for 6 weeks, totaling 18 hours. Primary outcome measures
were memory performance on the Hopkins Verbal Learning Test–Revised
and the Rivermead Behavioural Memory Test II. Additional standardized
tests of memory and executive functions were included. The treatment
group demonstrated significant improvement on T-tests after treatment.
Over time, these improvements went beyond changes in the control group.
Regressions were used to determine if performance could be predicted
after treatment (or second testing of control group). Consistent with the
hypothesis, treatment predicted performance on both primary outcome
measures at the second testing. Participants who received memory inter-
vention improved more than those who did not. Furthermore, mild and
moderately injured participants improved beyond those severely injured,
even though the severely injured participants still improved beyond severely
injured participants who received no treatment. At 1 month posttreatment,
no significant changes were seen in memory performance. Aside from the
limitation of not being completely randomized, the pre-post study design
provides some evidence that the instruction of internal memory strategies
has positive treatments effects when compared to no treatment, even for
individuals who are at least 1 year postinjury.
Comparator Arm: Non-CRT Treatment
Ryan and Ruff (1988), a small RCT, enrolled 20 mildly to moderately
injured participants who averaged 5 to 6 years postinjury. Participants were
randomly assigned to the memory strategies arm or to the control arm. The
memory strategies arm included training to use internal memory strategies
such as associational tasks, chaining, rehearsal, visual imagery, and ritual-
ized recall. The control group received psychosocial support and played
cognitive games. Each group received 48 hours of treatment over 6 weeks.
On neuropsychological measures of memory, both groups improved after
treatment; however. those who were mildly injured and received strategy
OCR for page 179
179
MEMORY
training improved significantly more than moderately injured participants
in both groups, as well as mildly injured participants in the psycho-
social support group. Participants were not available for follow-up and no
patient-centered measures were included. This study’s limitations include its
small number of participants and data analysis by severity post hoc, even
though it makes sense scientifically to examine treatment effects by injury
severity. It should be noted however, that this was one of the earliest studies
in memory intervention to find a severity effect.
Comparator Arm: Other CRT Treatment
Bourgeois et al. (2007), another modest-sized RCT, involved adults
(average age 42) with persisting memory problems several years after a
documented closed head injury. Participants also needed a family member
willing to participate. Participant-caregiver pairs were assigned to either
spaced retrieval training or a didactic control therapy that consisted of
strategy education. Assignments were made using stratified pairing based
on race and sex (quasi-experimental). Both interventions were delivered
via telephone by clinician trainers. After initial face-to-face assessments of
cognitive difficulties and social participation (Community Integration Ques-
tionnaire), the trainer discussed treatment goals with the patient and care-
giver, and the group selected three specific goals. The trainer then provided
memory logs and asked patients and caregivers to record the frequency with
which each problem occurred over the next week. The trainer called the
participant the following day to make sure instructions and data collection
methods were understood. The trainer then called participants four to five
times weekly for 30-minute sessions. Participants in the spaced retrieval
group received an instructional technique focused on selected goals. During
sessions, the therapist modeled correct responses to questions related to the
goals and instructed the participants not to struggle to retrieve responses,
but to respond immediately. Participants in the control arm received the
same total amount of therapy time in sessions that included discussion
about memory strategies such as association, verbal rehearsal, imagery,
and written reminders. Outcomes included goals mastered, generalization,
the frequency of reported memory problems, cognitive difficulties scale,
and community integration. Immediately and at 1 month posttraining, the
space retrieval group (and their caregivers) reported more treatment goal
mastery and use than the didactic instruction group (and their caregivers).
Both groups reported some generalization to other nontargeted behaviors,
but the difference between these improvements among groups was not
statistically significant. There were no reported important or statistically
significant improvements in quality of life between or within groups on
these measures. One limitation was that data about “objective, observable
OCR for page 180
180 COGNITIVE REHABILITATION THERAPY FOR TBI
behaviors” related to selected goals was obtained from memory logs, and
these data were sometimes incomplete or not turned in. Of the 51 pairs
that agreed to participate, only 38 completed the study: 22 spaced retrieval
training pairs and 16 didactic control pairs.
Dirette et al. (1999), a small RCT, included 30 participants, the vast
majority of whom had mild, moderate, or severe TBI. Injury severity was
distributed equally across two treatment arms: one in which internal com-
pensatory strategies (verbalization, chunking, pacing) were taught and one
in which remedial computer work involving visual processing was provided.
Both treatments were delivered via a computer for a total of 3 hours, in four
45-minute sessions, once per week for 4 weeks. The compensatory strate-
gies came from a program called “IQ Builder,” which included “memory
for numbers” and “memory for letters.” Outcomes included weekly mea-
surement of working memory using the PASAT and two pre-post measures
of computer-based visual processing for data entry and reading. Following
treatment, both groups improved significantly on weekly and posttreatment
measures, although performance did not differ by group, i.e., there was no
treatment effect for learning internal compensatory strategies. Demographic
variables, including injury severity and time since injury, did not account
for participants’ performance either. Post hoc analyses of self-report and
observations of strategy use indicated that about 80 percent of all partici-
pants, regardless of which treatment they participated in, used compensa-
tory strategies. Unfortunately, treatment dosage was very low; there was no
description of the instruction of the strategies. Furthermore, only F statistics
and p-values were presented, which limits the applicability of these results
to inform future research and interpretation.
Ruff et al. (1994) conducted a small RCT that involved 15 participants
with severe TBI. Participants were randomized into two groups, in which
the order of receiving restorative attention therapy and compensatory mem-
ory therapy was counterbalanced; i.e., both groups received both kinds of
therapy in a crossover design. Participants received 20 hours of therapy
via a computer program called “THINKable.” Outcomes were computer
scores, neuropsychological tests of attention and memory, and behavioral
assessments. After intervention, the computer scores showed significant
improvement in attention but no significant improvement in memory. Re-
sults of the neuropsychological measures were mixed: immediate memory
improved while delayed memory did not; only one attention measure im-
proved. Self and other behavioral assessments of memory-based behavior
did change after intervention, but only observer rating of attention-related
behavior showed significant change after intervention. Thus, this study
provides nonspecific, limited evidence on the efficacy of internal compensa-
tory memory training (versus attention training) in that although subjective
OCR for page 181
181
MEMORY
ratings showed improved memory, improvement on computerized memory
scores and neuropsychological test scores was inconsistent.
Dou et al. (2006), a small RCT, involved 30 participants with TBI who
were several months post neurosurgery. Exclusion criteria include a history
of psychiatric problems or computer phobia. Participants were randomly
assigned to three groups: computer assisted memory training, therapist as-
sisted memory training, and a control group that did not receive any specific
memory training. In the computer assisted training, participants were asked
to identify or define the information to be learned with computerized as-
sistance. This decontextualized training consisted of instruction in internal,
compensatory memory strategies aimed at memory and management of
typical daily activities. The computer then provided the necessary informa-
tion for the participants to generate correct decisions through an errorless
approach. Participants were not encouraged to engage in guesswork, to
avoid mistakes, and were told to consider alternatives to and consequences
of an intended action. The therapist assisted training covered the same
content but converted the instruction into a picture album; therapists gave
directions face to face. The 15 hours of training were delivered in 20 ses-
sions occurring 6 days a week, with each session lasting about 45 minutes.
Immediately after treatment, both groups improved on multiple standard-
ized measures of memory (Neurobehavioural Cognitive Status Examina-
tion, Rivermead Behavioural Memory Test) compared to the no-treatment
group, although not on every measure. The treatment groups performed
similarly in comparison to each other. Performance was the same at 1
month posttreatment. Thus, there appears to be some benefit to those at a
chronic recovery stage to learning to use to internal, compensatory memory
strategies; the delivery (therapist versus computer) does not appear to mat-
ter. Estimates and effect sizes were not provided, so the results cannot be
used to inform the design of future studies.
Goldstein et al. (1996), a small nonrandomized, parallel group study,
enrolled 20 participants with TBI and persistent amnesia who were pro-
vided with computerized instructions on how to create stories from word
lists (“The Ridiculously Imaged Story” technique). Of the 20 participants,
10 received the computerized presentation on how to make associations
between names and faces, as well as additional initial coaching and in-
struction about the cues the computer would provide for the list-story
task. The other participants were instructed to make these associations
using the original therapist delivery mode (Goldstein et al. 1988). Both
groups were trained in these imagery techniques using roughly equivalent
procedures. Data from 10 participants in a previous study that used thera-
pist delivery were included as a comparison group. The number of words
recalled from lists appeared to improve during generalization trials, though
OCR for page 182
182 COGNITIVE REHABILITATION THERAPY FOR TBI
no individual trials were significantly different between computerized and
the noncomputerized comparison group (from original data in Goldstein
et al. 1988). After treatment, both groups recalled significantly more from
examiner-provided lists when compared to pretraining, and the computer-
ized group appeared to improve slightly more. On participant-provided
lists, pretreatment to posttreatment recall improved significantly, though
the computerized group lost its advantage. On the name-face learning task,
the computerized group had a clear advantage over the original method
group, both in learning trials and pre- and posttreatment comparisons; in
fact, the therapist delivery group did not recall significantly more names
after treatment. Authors stated that the decontextualized methods did not
provide evidence of long-term use of learned strategies to improve memory,
though there was no long-term follow-up.
Other Study Designs
Benedict and Wechsler (1992), a single-subject, multiple baseline study,
examines the effects of teaching the method of loci (MOL, for word list
learning) and Preview, Question, Repeat, State, and Test (PQRST, for para-
graph learning). Two individuals participated in the study—one with mod-
erate TBI and moderate memory impairment and the other with severe TBI
and severe memory impairment. They received 27 and 34 weeks of training,
respectively, in which the order of MOL and PQRST were counterbalanced.
Results revealed that the moderately impaired participant’s memory for
word lists benefitted from the MOL training, but the participants’ para-
graph learning did not benefit from PQRST training. The severely impaired
participant’s performance was highly variable throughout, resulting in little
change in recall from word lists or paragraphs.
Ehlhardt et al. (2005) investigated the efficacy of instructing adults
with severe TBI to use recall and e-mail in a multiple-baseline-across-
subjects-designed study. All five participants were many years postinjury
and all demonstrated severely impaired memory and executive functions
on standard neuropsychological measures. Treatment included the TEACH-
M approach, which entails seven steps and learning principles of errorless
learning; distributed practice and metacognitive instruction were empha-
sized. Training was delivered four to five times weekly, ranging from 7 to 15
weeks (as many as required to reach criteria). Four of the five participants
completed the training and three of these four participants maintained
these steps at 1 month after treatment ended, and all four participants
maintained implementation of of the e-mail steps when “altered interface
and/or a computer game with no shared features” was added (Ehlhardt et
al. 2005). Interviews revealed that all four participants who completed the
training endorsed the training. Inter-rater reliability and procedural fidelity
OCR for page 183
183
MEMORY
were reportedly strong: baselines were adequate prior to the start of treat-
ment; therefore within-subject experimental control was clearly established.
Hux et al. (2000) examined the efficacy of internal memory strategies
(mnemonics and visual imagery) to improve face-name recall in seven indi-
viduals with TBI who ranged from 2 to 26 years postinjury. Participants’
memory impairment ranged from nonexistent to severe. Intervention was
delivered via training sessions that occurred five times per day in one phase,
one time per day in another phase, and two times per week in yet another
phase using within-participant comparisons. Face-name recall improved
more after the intervention was provided one time per day or two times per
week as opposed to five times per day, however results were highly variable
across individual participants. Authors also reported frequent participant
behavior problems.
Manasse et al. (2005) examined the efficacy and effectiveness of a
sequential treatment approach that consisted of visual imagery for face-
names, followed by real-word training that involved three cuing strate-
gies: name restating, phonemic cuing, and visual imagery. There were five
participants with chronic, severe TBI, ranging from more than 1 to 29.5
years postinjury. Treatment was provided in 9 sessions of visual imagery
and 30 sessions of real-world intervention. All participants improved in
name-face recall after intervention regardless of the kind of cuing, and four
of five participants demonstrated more spontaneous use (effectiveness) of
therapists’ names.
Milders et al. (1998), a pre-post single group study, involved 13 adults
with memory problems following closed head injuries and 13 healthy
controls matched on age and level of education. Most patients had been
discharged from a nearby rehabilitation center. The mean time from injury
was about 4 to 5 years, and the mean length of posttraumatic amnesia
(PTA) they had suffered was reported as 36 days. The healthy controls
were friends or relatives of the patients. Patients were taught strategies to
improve the learning of new names and the retrieval of familiar people’s
names. Strategies were taught in eight, 1-hour sessions delivered one on
one over a 4-month period. The importance of applying the strategies
in everyday life was repeatedly stressed and homework exercises were
encouraged. Pre-post assessments in both groups included the following:
three target evaluation tasks that had items not presented in the training
(i.e., Name Learning Test, Name-Occupation-Town Learning Test, Famous
Faces Naming Test); and two memory tests assumed insensitive or unrelated
to the strategies practiced during training (i.e., Digit Span Forwards and
Auditory Verbal Learning Task). Performance on two of the three target
tasks improved with training compared to controls, but performance on
the Name Learning Test did not change in either group. Both groups had
similar improvement in the two control memory tests. Limitations included
OCR for page 184
184 COGNITIVE REHABILITATION THERAPY FOR TBI
the small selected sample, an unclear history of the severity and sequelae of
TBI in some patients, and narrowly focused outcome measures.
EXTERNAL MEMORY STRATEGIES
External memory strategies may include the use of notebook or other
tool to enhance memory abilities. The committee reviewed four RCTs and
no nonrandomized, parallel group studies that used external memory strate-
gies; comparator arms included no treatment (n = 1), non-CRT treatment
(n = 1), and other CRT treatment (n = 2). The committee also reviewed
three pre-post single group designs and one single-subject, multiple baseline
experiment. Table 10-3 presents all external memory strategy studies by
design, strategy, and treatment comparator.
Controlled Studies
Bergquist et al. (2010) and Bergquist et al. (2009), a small randomized
crossover study, enrolled 20 volunteers who had moderate-severe TBI and
were more than 1 year postinjury. Participants with a history of ongoing
TABLE 10-3 External Memory Strategies
Strategy Treatment Comparator
Notebook, External
Diary, Cuing,
Calendar, PROMpting No Non- Other
Study Design Other Device(s) Treatment CRT CRT
Bergquist et al. RCT X X
2009, 2010
Ownsworth and RCT X X
McFarland 1999
Schmitter- RCT X X
Edgecombe
et al. 1995
Watanabe et al. RCT X X
1998
Bergman 2000 Pre-Post X
Gentry et al. Pre-Post X
2008
Hart et al. 2002 Pre-Post X
Zenicus et al. SS/MB X
1991
OCR for page 185
185
MEMORY
psychiatric symptoms were included as long as symptoms were not severe
(e.g., psychotic symptoms) and did not interfere with study participation.
Participants also had to have reliable access to the Internet, as the trial
compared two Internet-based interventions: an active calendar treatment
intervention and a control diary condition. The calendar intervention,
which involved an online therapist, focused on developing calendar skills to
address difficulties with memory in everyday life and strategies to improve
memory functioning. Participants in the diary control condition spent an
equivalent amount of time interacting with a therapist online but simply
used their calendar to record day-to-day events and not as a compensatory
tool. Only 14 of the 20 participants completed the study; 6 of 8 assigned
to the calendar intervention, and 2 of 8 assigned to the diary. Outcome
measures included self-reported measures that assessed use of compensation
strategies (Compensation Techniques Questionnaire) and satisfaction (four
questions—satisfaction with therapist, satisfaction with therapy received,
emotional distress during therapy, and willingness to receive such therapy
again), as well as measures completed by family members (Neurobehavioral
Functioning Inventory [NFI] and Compensation Integration Questionnaires
[CIQ]). Analytic methods were not well described, particularly regarding
missing data for patients who did not complete the trial. Most participants
in both groups were satisfied with the Internet-based interventions. No
statistically significant differences between groups were found for the four
satisfaction questions. Also, no statistically significant differences in func-
tional change between groups were reported after 30 sessions (NFI, CIQ
outcomes).
Ownsworth and McFarland (1999) conducted a small RCT in which
20 participants with TBI who were many years postinjury were provided
with a diary. Severity of brain injury was not described. Participants were
randomized to either use a procedural worksheet during diary use (Di-
ary and Self-Instructional Training) or to use the diary without this self-
instruction (diary only), which required the use of higher cognitive skills
of self-awareness and self-regulation. The diary-only participants were
taught a behavioral sequence to use the diary. During the Diary and Self-
Instructional Training session subjects learned how to compensate for ev-
eryday memory problems using a small notebook, as an internal strategy to
mediate diary use. Some instructions for daily memory checklists were given
verbally over the phone (in one session), but the 4-week intervention period
mainly involved self-use of diaries. At the end of the intervention period,
groups did not differ in mean number of diary entries; however, the diary-
plus-self-instruction group maintained their use of the diary strategy to a
greater extent than the diary-only group. Using daily checklists, the diary-
plus-self-instruction group self-reported these strategies as more helpful and
reported less confusion on a questionnaire. Thus, support is provided for
OCR for page 202
TABLE 10-1 Continued
202
TBI
Severity
Study N Level Brief Narrative Comparator Outcome Measures Findings
Ownsworth 20 NR The aim of this study Y • RBMT Compared to the Diary Only
and was to investigate • WMS-R (DO) group, the Diary and
McFarland the remediation and No Content: Self-Instructional Training
1999 assessment of everyday Control group (DSIT) group made diary
memory problems, using instructed entries more consistently,
the RBMT and WMS-R to use the reported fewer memory
to measure global memory diary, without problems, and made more
performance in 20 treatment positive ratings associated
subjects. with treatment efficacy.
On the computer scores
Ruff et al. 15 Severe Two groups received Y • 2+7 Selective Attn Test
after intervention, there was
1994 two counterbalanced • Behavioral assessments
significant improvement
treatments, attention Other CRT • Continuous Performance
in attention, whereas no
training compared or Content: Test
significant improvement for
memory training, delivered Attention • Corsi Block Learning
memory. On neuropsycho-
via a computer-based and memory Test
logical measures, the results
multi-media program training, • Rey Auditory Verbal
were mixed: immediate
called THINKable. delivered to Learning Test
memory improved while
both groups in a • WAIS-R
delayed memory did not;
crossover design
only one attention measure
improved. Self- and other
behavioral assessment of
memory-based behavior did
change after intervention,
whereas only observer rating
of attention-related behavior
reached significance after
intervention.
OCR for page 203
Ryan and 20 Mild- Memory retraining with Y • Benton Visual Retention On neuropsychological
Ruff 1988 Moderate visuospatial and verbal Test (BVRT) measures of memory, both
representations, using Non-CRT • Rey-Osterrieth Complex groups improved after
multiple strategies: Content: Figure Test (CFT) treatment; however, those
associational tasks, Psychosocial • Ruff-Light Trail who were mildly injured
chaining, rehearsal, activities with no Learning Test (TLT) improved significantly more
visual imagery, multiple feedback from • Selective Reminding Test than moderately injured
associations, ritualized therapist • Taylor Complex Figure participants who had received
recall. • Wechsler Memory strategy training, moderately
Scale (WMS), Logical injured participants in the
Memory Subtest psychosocial support group,
or mildly injured participants
in the psychosocial support
group.
Schmitter- 8 Severe The purpose of this Y • Everyday Memory The notebook training group
Edgecombe study was to evaluate Questionnaire (EMQ) reported significantly fewer
et al. 1995 the effectiveness of a Non-CRT • Global Severity Index everyday memory failures
9-week memory notebook Content: from the Symptom (EMFs) on a daily checklist
treatment for patients with Supportive Checklist 90–Revised measure than the supportive
known memory deficits. group therapy • Logical Memory 1 and therapy group; at follow-up,
2 scales this finding was no longer
• Notebook training significant. For the lab-
• RBMT based memory measures, no
• Visual Reproduction 1 significant treatment effects
and 2 scales were found at posttreatment
• Weekly learning or follow-up.
activities packets (LAPs)
• WMS-R
203
continued
OCR for page 204
TABLE 10-1 Continued
204
TBI
Severity
Study N Level Brief Narrative Comparator Outcome Measures Findings
Y
Tam and 26 NR The goal of this study • Built-up computer Though all four memory
Man 2004 was to gain understanding performance records training methods showed non-
No Content:
of computer-assisted • RBMT statistically significant positive
Unspecified; the
training effects, using four results compared with the
• Self-efficacy rating scale
study indicated
theoretically different no-treatment control, clinical
treatment was
memory retraining improvement was found in all
not provided
strategies, for the four methods, and the Feed-
treatment of posttraumatic back group showed significant
amnesia. improvement in self-efficacy
compared to the other groups.
Y
Moderate- This study aimed to
Thickpenny- 14 • Behavioral indicators Compared to the control, the
Severe evaluate the effect of an
Davis and of memory impairment experimental group improved
eight-session structured No Content:
Barker- checklist in many neuropsychological
group format memory Waitlist control
Collo 2007 • California Verbal measures of memory (CVLT
rehabilitation program on Learning Test (CVLT) long delayed free recall, WMS
memory function deficits. • Integrated Visual and logical memory delayed recall,
Auditory Continuous and response time on the
Performance Test attention test [CPT]), also
(IVA-CPT) showing increased knowledge
• Memory in Everyday of memory/memory strategies,
Life and Use of Aids and increased self/observer (sig-
Strategies Questionnaire nificant other) use of memory
• “Memory quiz” (Extent aids/strategies and decreased
of participants’ knowl- self/observer behaviors indica-
edge about memory and tive of memory impairment.
Results were maintained at
memory strategies)
• Visual paired associates follow-up, with the exception
(VPA) of response time on the atten-
• Wechsler Memory Scale tion test and immediate recall
(WMS) Logical Memory of narratives on the WMS.
Subtest, revised
OCR for page 205
Watanabe et 30 NR This study compared the Y Temporal Orientation Test Results indicated that
al. 1998 effect of the presence (TOT) measuring day, the presence of a wall
or absence of a wall Other CRT date, month, year calendar and corresponding
calendar in participants’ Content: orientation therapy had no
hospital room on temporal Control received effect on orientation; only
orientation. nonspecific the emergence out of PTA
cognitive corresponded to orientation.
rehabilitation,
with no calendar
in room
Nonrandomized, Parallel Controlled Group
O’Neil- 94 Mild, This study examined the Y • Hopkins Verbal Memory group intervention
Pirozzi et al. Moderate, effects of memory training Learning Test–Revised participants showed improved
2010 Severe focused on internal No Content: (HVLT-R) memory performance
strategy use for memory Control received • Rivermead Behavioral immediately postintervention
impairment. no specific Memory Test II (RBMT as well as one month
intervention II) postintervention. Mild
and moderately injured
participants improved beyond
those who were severely
injured, even though the
severely injured participants
still improved beyond severely
injured participants who
received no treatment.
205
continued
OCR for page 206
TABLE 10-1 Continued
206
TBI
Severity
Study N Level Brief Narrative Comparator Outcome Measures Findings
Goldstein et 30 NR This study replicated Y • Free recall of patient- After treatment, both groups
al. 1996 earlier work that provided list recalled significantly more
demonstrated the efficacy Other CRT • Number of words from examiner-provided
of two methods of memory Content: recalled on a selective lists when compared
training using imagery Parallel groups, reminding task to pretraining, and the
mnemonics. with one • Scoring on RIS and computerized group appeared
receiving (partly) FNM tasks to improve slightly more. On
computerized participant-provided lists,
intervention, one pretreatment to posttreatment
receiving non- recall improved significantly,
computerized though the computerized
intervention group lost its advantage.
On name-face learning task,
the computerized group had
a clear advantage over the
original method group both
in learning trials and pre- and
posttreatment comparisons;
the therapist delivery group
did not recall significantly
more names after treatment.
Pre-Post Single Group
Bergman 41 NR This study examined the N • Appointment Scheduling Thirty-six of the 41
2000 effect of orientation to a • Check Writing participants achieved mastery
cognitive orthosis (CO); • Directory of four or more activity
subjects were progressed • Journal modules and 36 demonstrated
on specific tasks until they • Savings Deposit/ rapid achievement of success
could perform without Withdrawal on initial assigned tasks.
assistance (mastery). • Telephone Log
OCR for page 207
Freeman et 12 NR This study compared N Identification of key ideas There was a statistically
al. 1992 the efficacy of memory in a paragraph read to the significant difference between
remediation treatment, subject treatment and control post-
which consisted of test memory scores that
compensatory and favored the treatment group.
executive training skills
delivered over a 2.5-week
period, with no treatment.
Gentry et al. 23 Severe This study examined the N • Canadian Occupational Self-ratings of occupational
2008 efficacy of personal digital Performance Measure performance and satisfaction
assistants (PDAs) as a (COPM) with occupational
compensatory cognitive • Craig Handicap performance (COPM),
aid, used by subjects Assessment and Rating as well as self-rating of
for 8 weeks after three Technique-Revised participation (CHART-R),
to six in-home training (CHART-R) showed statistically significant
sessions conducted by an improvement.
occupational therapist.
Hart et al. 10 Moderate- This study investigated the N Number of goals (recorded Subjects recalled recorded
2002 Severe usefulness of a portable and nonrecorded) that goals more often than goals
voice organizer in helping were remembered that were not recorded;
people recall therapy furthermore, recorded goals
goals and plans previously seemed to be correlated
discussed with their case with better awareness or
managers. follow-through with therapy
objectives.
207
continued
OCR for page 208
TABLE 10-1 Continued
208
TBI
Severity
Study N Level Brief Narrative Comparator Outcome Measures Findings
Milders 26 Severe In this training study, N • Digit Span Forwards Performance on two of the
et al. 1998 patients were taught • Dutch version of Rey’s three target tasks improved
strategies to improve the auditory verbal learning with training compared to
learning of new names and task controls but performance on
the retrieval of familiar • Famous Faces Naming the Name Learning Test did
people’s names. Test not change in either group.
• Name Learning Test Both groups had similar
• Name-Occupation-Town improvements in the two
Test control memory tests.
Raskin and 8 Mild, Prospective memory N • Boston Diagnostic Subjects showed improvement
Sohlberg Moderate, training delivered to eight Aphasia Examination, on prospective memory
2009 Severe subjects in a within- animal naming time and tasks after 2
subjects crossover design. • Consonant Trigrams minutes, but not at the
Subjects were expected to Test longer delay of 10 minutes.
perform a specific task, • Controlled Oral Word On neuropsychological
tested at 2 and 10 minutes, Association Test measures immediately post
with and without external • PASAT treatment, subjects improved
cues. In addition, half of • Randt Memory Test, in attention and executive
the subjects were tested on story recall and picture functions. Generalization
retrospective memory. recognition to everyday memory
• Revised Attention performance also improved,
Process Test as measured by a memory
• RBMT questionnaire and diaries.
• Trail Making Test Maintenance of prospective
memory improvements was
demonstrated at one year post-
treatment. None of the subjects
showed improvement for
retrospective memory drills.
OCR for page 209
Single Subject, Multiple Baseline Experiment Design
Benedict and 2 Mild and The study examined the N Scores on word-list recall The moderately impaired
Wechsler Moderate efficacy of long-term and paragraph recall participant’s memory for
1992 memory retraining in two word lists benefitted from the
adults using two training MOL training, but paragraph
strategies: method of loci learning did not benefit
(MOL) and the PQRST from PQRST training. The
verbal strategy. severely impaired participant’s
performance was highly
variable throughout, resulting
in little change in recall form
word lists or paragraphs.
Ehlhardt et 4 Severe The TEACH-M program, N • Number of correct All four participants replicated
al. 2005 which facilitates learning e-mail steps in sequence treatment effects immediately
and retention of multi- (out of 7) posttreatment and 30 days
step procedures, was • Number of correct steps thereafter; generalization
administered to assess regardless of sequence and social validity data also
participants’ ability to • Number of training supported the effectiveness of
learn multi-step procedures sessions needed for TEACH-M.
utilizing specific cognitive mastery
rehabilitation principles.
Hux et al. 7 NR This study examined the N • Number of faces Sessions held daily and twice
2000 efficacy of internal memory correctly identified a week were found to be
strategies, specifically • Number of training more effective than those held
mnemonics and visual sessions needed to five times a day. Mnemonics
imagery, to improve reliably identify subset and visual imagery strategies
face-name recall in seven of faces were effective for four of the
subjects ranging from 2 to participants, irrespective of
26 years postinjury. session frequency.
209
continued
OCR for page 210
TABLE 10-1 Continued
210
TBI
Severity
Study N Level Brief Narrative Comparator Outcome Measures Findings
Manasse et 5 Severe The study examined three N Number of names All participants improved
al. 2005 cueing strategies (name mastered (name use, name in name-face recall after
restating, phonemic cueing, knowledge seen in each intervention regardless of the
and visual imagery) in cueing condition) kind of cuing and four of five
a real-world context to participants demonstrated
increase mastery and use of more spontaneous use
face-name associations in (effectiveness) of therapists’
five chronic participants. names when given the same
number of opportunities.
Raskin and 2 NR This study was an N • Performance on Memory for future actions
Sohlberg investigation of prospective criterion standard improved more after
1996 memory training using neuropsychological prospective memory training
two different types of measures than after repetitive drill,
intervention: prospective • Performance on although generalization to
and repetitive memory prospective memory real world remembering was
drill. screening test variable across participants
(Perspective Memory and type of training. Both
Screening, or PROMS) participants validated their
• Probes of everyday preference for prospective
prospective memory memory training during
interviews.
Zencius et al. 4 NR In this study, the usefulness N Number of homework After notebook training,
1991 of memory notebook assignment components three of the four participants
training for completing completed correctly: improved in completing the
homework assignments • Meeting a specified number of components to the
was examined for four person at a certain place homework assignments.
adults, who were also and time
receiving interdisciplinary • Turning in a completed
rehabilitation services. written homework
assignment
OCR for page 211
211
MEMORY
REFERENCES
Benedict, R. H., and F. S. Wechsler. 1992. Evaluation of memory retraining in patients with
traumatic brain injury: Two single-case experimental designs. Journal of Head Trauma
Rehabilitation 7(4):83–92.
Berg, I. J., M. Koning-Haanstra, and B. G. Deelman. 1991. Long-term effects of memory
rehabilitation: A controlled study. Neuropsychological Rehabilitation 1(2):97–111.
Bergman, M. M. 2000. Successful mastery with a cognitive orthotic in people with traumatic
brain injury. Applied Neuropsychology 7(2):76–82.
Bergquist, T., C. Gehl, J. Mandrekar, S. Lepore, S. Hanna, A. Osten, and W. Beaulieu. 2009.
The effect of Internet-based cognitive rehabilitation in persons with memory impairments
after severe traumatic brain injury. Brain Injury 23(10):790–799.
Bergquist, T., K. Thompson, C. Gehl, and J. M. Pineda. 2010. Satisfaction ratings after receiv-
ing Internet-based cognitive rehabilitation in persons with memory impairments after
severe acquired brain injury. Telemedicine and eHealth 16(4):417–423.
Bourgeois, M. S., K. Lenius, L. Turkstra, and C. Camp. 2007. The effects of cognitive tele-
therapy on reported everyday memory behaviours of persons with chronic traumatic
brain injury. Brain Injury 21(12):1245–1257.
Dirette, D. K., J. Hinojosa, and G. J. Carnevale. 1999. Comparison of remedial and compen-
satory interventions for adults with acquired brain injuries. Journal of Head Trauma
Rehabilitation 14(6):595–601.
Dou, Z. L. D. W. K. Man, H. N. Ou, J. L. Zheng, and S. F. Tam. 2006. Computerized errorless
learning-based memory rehabilitation for Chinese patients with brain injury: A prelimi-
nary quasi-exerimental clincial design study. Brain Injury 20(3):219–225.
Ehlhardt, L. A., M. M. Sohlberg, A. Glang, and R. Albin. 2005. TEACH-M: A pilot study
evaluating an instructional sequence for persons with impaired memory and executive
functions. Brain Injury 19(8):569–583.
Freeman, M. R., W. Mittenberg, M. Dicowden, and M. Bat-Ami. 1992. Executive and com-
pensatory memory retraining in traumatic brain injury. Brain Injury 6(1):65–70.
Gentry, T., J. Wallace, C. Kvarfordt, and K. B. Lynch. 2008. Personal digital assistants as
cognitive aids for individuals with severe traumatic brain injury: A community-based
trial. Brain Injury 22 (1):19–24.
Goldstein, G., M. McCue, S. M. Turner, C. Spanier, J. A. Malec, and C. Shelly. 1988. An
efficacy study of memory training for patients with closed head injury. Clinical Neuro-
psychologist (2):251–56.
Goldstein, G., S. R. Beers, S. Longmore, and M. McCue. 1996. Efficacy of memory training:
A technological extension and replication. Clinical Neuropsychologist 10(1):66–72.
Hart, T., K. Hawkey, and J. Whyte. 2002. Use of a portable voice organizer to remember
therapy goals in traumatic brain injury rehabilitation: A within-subjects trial. Journal of
Head Trauma Rehabilitation 17(6):556–570.
Hux, K., N. Manasse, S. Wright, and J. Snell. 2000. Effect of training frequency on face-name
recall by adults with traumatic brain injury. Brain Injury 14 (10):907–920.
Kaschel, R., S. Della Sala, A. Cantagallo, A. Fahlbock, R. Laaksonen, and M. Kazen. 2002.
Imagery mnemonics for the rehabilitation of memory: A randomised group controlled
trial. Neuropsychological Rehabilitation 12(2):127–153.
Manasse, N. J., K. Hux, and J. Snell. 2005. Teaching face-name associations to survivors of
traumatic brain injury: A sequential treatment approach. Brain Injury 19(8):633–641.
Milders, M. V., I. J. Berg, and B. G. Deelman. 1995. Four-year follow-up of a controlled
memory training study in closed head injured patients. Neuropsychological Rehabilita-
tion 5(3):223–238.
OCR for page 212
212 COGNITIVE REHABILITATION THERAPY FOR TBI
Milders, M., B. Deelman, and I. Berg. 1998. Rehabilitation of memory for people’s names.
Memory 6(1):21–36.
O’Neil-Pirozzi, T. M., G. E. Strangman, R. Goldstein, D. I. Katz, C. R. Savage, K. Kelkar, C.
Supelana, D. Burke, S. L. Rauch, and M. B. Glenn. 2010. A controlled treatment study of
internal memory strategies (I-MEMS) following traumatic brain injury. Journal of Head
Trauma Rehabilitation 25(1):43–51.
Ownsworth, T. L., and K. McFarland. 1999. Memory remediation in long-term acquired brain
injury: Two approaches in diary training. Brain Injury 13(8):605–626.
Raskin, S. A., and M. M. Sohlberg. 1996. The efficacy of prospective memory training in two
adults with brain injury. Journal of Head Trauma Rehabilitation 11(3):32–51.
———. 2009. Prospective memory intervention: A review and evaluation of a pilot restorative
intervention. Brain Impairment 11(1):76–86.
Ruff, R. M., R. Mahaffey, J. Engel, C. Farrow, D. Cox, and P. Karzmark. 1994. Efficacy study
of THINKable in the attention and memory retraining of traumatically head-injured
patients. Brain Injury 8(1):3–14.
Ryan, T. V., and R. M. Ruff 1988. The efficacy of structured memory retraining in a group com-
parison of head trauma patients. Archives of Clinical Neuropsychology 3(2):165–179.
Schmitter-Edgecombe, M., J. F. Fahy, J. P. Whelan, and C. J. Long. 1995. Memory remediation
after severe closed head injury: Notebook training versus supportive therapy. Journal of
Consulting & Clinical Psychology 63(3):484–489.
Tam, S., and W. Man. 2004. Evaluating computer-assisted memory retraining programmes for
people with post-head injury amnesia. Brain Injury 18(5):461–470.
Thickpenny-Davis, K. L., and S. L. Barker-Collo. 2007. Evaluation of a structured group for-
mat memory rehabilitation program for adults following brain injury. Journal of Head
Trauma Rehabilitation 22(5):303–313.
Watanabe, T. K., K. L. Black, R. D. Zafonte, S. R. Millis, and N. R. Mann. 1998. Do calendars
enhance posttraumatic temporal orientation? A pilot study. Brain Injury 12(1):81–85.
Zencius, A., M. D. Wesolowski, T. Krankowski, and W. H. Burke. 1991. Memory notebook
training with traumatically brain-injured clients. Brain Injury 5(3):321–325.
