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 association (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 intervention 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 ritualized 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