the use of internal strategies. Goldstein et al. (1996) enrolled 20 participants 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 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 strategies; 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 participants 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 between 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

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