Rehabilitation of memory for people's names

The effectiveness of memory remediation strategies after traumatic brain injury: Systematic review and meta-analysis

BACKGROUND

Traumatic brain injury (TBI) is a steadily rising health concern associated with significant risk of emotional, behavioral and cognitive impairments. Cognitive memory impairment is one of the most concerning outcomes after TBI, affecting a wide range of everyday activities, social interactions and employment. Several comparative and comprehensive reviews on the effects of cognitive interventions in individuals with TBI have been conducted but usually with a qualitative rather than quantitative approach. Thus, evidence synthesis of the effects of TBI interventions on memory difficulties is limited.

OBJECTIVE

In this meta-analysis, we examined the memory-remediating effects of internal and external interventions, injury severity and the interaction of both factors for patients with TBI.

METHODS

Data were extracted from studies published between 1980 and 2020 that used objective memory measures (computerized or pencil-and-paper), and multiple meta-analyses were conducted to compare effectiveness across these interventions. Publication bias was assessed, as was quality of evidence using the Cochrane Risk of Bias tool for randomized controlled studies. Our final meta-analysis included 16 studies of 17 interventions classified into 3 categories: internal, external and mixed.

RESULTS

Mixed interventions demonstrated the highest average effect size for memory difficulties (Morris d=0.79). An evaluation of injury severity yielded 2 categories: mild-moderate and moderate-severe. Analyses demonstrated a homogenous medium effect size of improvement across injury severity, with moderate-severe injury with the largest average effect size (Morris d=0.65). Further evaluation of injury severity interaction with intervention type revealed a mediating effect for both factors, demonstrating the largest effect size for mixed interventions with moderate-severe injury (Morris d=0.81).

CONCLUSION

This study highlights the effectiveness of memory remediation interventions on memory impairment after TBI. A wide range of interventions are more effective because they address individual variability for severity and memory deficits. The study further supports and expands existing intervention standards and guidelines.

The application of Strategy-based Training to Enhance Memory (STEM) in multiple sclerosis: A pilot RCT

New learning and memory (NLM) impairments are common in multiple sclerosis (MS), negatively impacting daily life. Few studies seek to remediate these deficits to improve everyday functioning. Self-generation, spaced learning and retrieval practice have been shown to improve NLM in healthy persons and have been incorporated into an 8-session treatment protocol, Strategy-based Training to Enhance Memory (STEM). STEM teaches participants about each of the techniques, how to apply them in daily life and provides practice. Participants are taught to restructure a memory-demanding situation to optimize self-generation, spaced learning and retrieval practice. This pilot double-blind, placebo-controlled, randomized clinical trial (RCT) tested the efficacy of STEM in 20 learning-impaired participants with clinically definite MS (9 treatment, 11 control). Significant treatment effects were noted on self-report measures of daily functioning (primary outcome). Objective neuropsychological testing approached significance, showing a medium-large effect on verbal NLM. Results suggest that STEM may improve everyday functioning in individuals with MS. A full-scale RCT is warranted to validate findings in a larger sample so that findings may be generalized to the broader MS community.

Everyday memory errors in older adults

Despite concern about cognitive decline in old age, few studies document the types and frequency of memory errors older adults make in everyday life. In the present study, 105 healthy older adults completed the Everyday Memory Questionnaire (EMQ; Sunderland, Harris, & Baddeley, 1983 , Journal of Verbal Learning and Verbal Behavior, 22, 341), indicating what memory errors they had experienced in the last 24 hours, the Memory Self-Efficacy Questionnaire (MSEQ; West, Thorn, & Bagwell, 2003 , Psychology and Aging, 18, 111), and other neuropsychological and cognitive tasks. EMQ and MSEQ scores were unrelated and made separate contributions to variance on the Mini Mental State Exam (MMSE; Folstein, Folstein, & McHugh, 1975 , Journal of Psychiatric Research, 12, 189), suggesting separate constructs. Tip-of-the-tongue errors were the most commonly reported, and the EMQ Faces/Places and New Things subscales were most strongly related to MMSE. These findings may help training programs target memory errors commonly experienced by older adults, and suggest which types of memory errors could indicate cognitive declines of clinical concern.

Ecologically-oriented neurorehabilitation of memory: robustness of outcome across diagnosis and severity

PRIMARY OBJECTIVE

The current study looked for a differential response to memory rehabilitation, testing the hypotheses that outcome would vary significantly as a function of patient diagnosis and severity of memory impairment.

RESEARCH DESIGN

Unblinded, open-label, pre/post-treatment comparison of memory rehabilitation in patients stratified by diagnosis (brain injury, n = 15; stroke, n = 12; other neurological condition, n = 6) and memory impairment severity.

METHODS AND PROCEDURES

Patients underwent an ecologically-oriented, strategy-based intervention for memory impairment and were evaluated pre- and post-treatment on seven simulations (four with alternate forms, randomized to the pre- or post-test) of everyday declarative or prospective memory tasks.

MAIN OUTCOMES AND RESULTS

Patients at all levels of severity and in all three diagnostic groups showed equivalent, statistically significant improvement in memory performance. Neither practice effects from repeat test administration nor spontaneous recovery accounted for the improvement in memory performance.

CONCLUSIONS

The current study provided evidence of improved performance in everyday memory content domains with compensatory-based cognitive rehabilitation. Comparable improvement was seen across diagnostic groups and severity ranges. Additional case series and randomized clinical trials are needed to evaluate further the efficacy of compensation-based approaches to cognitive rehabilitation.

How name descriptiveness impacts proper name learning in young and older adults

To elucidate the impact of name descriptiveness and aging on learning new names, 26 young and 26 healthy older participants learned visibly-descriptive (e.g., Lengthy for a giraffe), psychologically-descriptive (e.g., Classy), and non-descriptive (e.g., Sam) proper names for previously-unknown cartoon characters. More visibly-descriptive names were learned than psychologically- or non-descriptive names, which did not differ from each other. There was also a differential benefit for older adults when the name was visibly-descriptive of the referent, such that older adults learned visibly-descriptive names as well as young adults but there were substantial age-related deficits in learning psychologically- and non-descriptive names.

Diagnostik und Therapie von Gedächtnisstörungen

Die wichtigsten Empfehlungen auf einen Blick

Diagnostik: Die Untersuchung von Gedächtnisstörungen erfordert mindestens ein Verfahren zur Erfassung der Gedächtnisspanne und des Arbeitsgedächtnisses sowie je ein Verfahren zur Untersuchung der unmittelbaren und verzögerten Reproduktion verbaler und figuraler Informationen. Darüber hinaus wird eine Untersuchung des Lernprozesses im Rahmen eines Lernparadigmas (z. B. Wortlisten-Lernen) empfohlen (A). Für die Untersuchung des für den Alltag so relevanten prospektiven Gedächtnisses sind vor allem die Verhaltensbeobachtung und die systematische Befragung z. B. mit Hilfe von Fragebögen von Bedeutung (B). Therapie: (1) Am Anfang der Therapie in der Frühphase steht häufig das Orientierungstraining. (2) Bei Patienten, bei denen die Diagnostik Hinweise auf eine erhaltene Konsolidierung gibt und bei denen der Rehabilitationsverlauf noch offen ist, wird empfohlen, internale Gedächtnisstrategien intensiv zu üben, um die Enkodierungsleistung zu verbessern (A). Für die Wirkung eines übenden Funktionstrainings, bei dem möglichst viele Informationen «auswendig gelernt» werden müssen, gibt es hingegen keine Evidenz. (3) Darüber hinaus ist die Behandlung der Gedächtnisstörung an den Alltagsanforderungen des Patienten zu orientieren und für spezifische gedächtnisrelevante Situationen sind Kompensationsstrategien zu erarbeiten (A). Ob die Patienten lediglich lernen können, auf externe Hilfen, die sie von Angehörigen oder Pflegepersonen erhalten, adäquat zu reagieren, oder ob sie diese selbstständig nutzen können, muss im Einzelfall im Therapieverlauf entschieden werden.

A developmental framework for memory rehabilitation in children

Memory difficulties in adults with acquired brain injuries have been reported in the literature for some time. In recent years, the consequences of memory difficulties from acquired and neurodevelopmental disorders in children have also been investigated. Initial studies have suggested that, like adults, children can experience severe and specific memory deficits. However, there are important developmental differences, both in terms of the nature of cognitive difficulties experienced, and the subsequent consequences for learning, educational attainment and everyday living. Despite the advances made in developmental memory studies, as yet, there appears to be scant literature to guide effective rehabilitation specifically targeted at children. As a starting point, it may be appropriate to consider adaptation of adult rehabilitation strategies to address memory problems in children. This paper describes some of the common principles and practices of adult rehabilitation strategies and then considers the validity of such strategies against developmental models of the memory system and child's learning environment. In particular, four important areas are highlighted: the development of normal memory functions in children, the range of cognitive deficits that can occur in a developing brain, the interaction of memory deficits with other immature cognitive skills and the context of the psycho-social environment in which rehabilitation may take place.

Cognitive interventions post acquired brain injury

OBJECTIVE

Cognitive rehabilitation represents a substantial portion of rehabilitative efforts put forth in increasing independence following an acquired brain injury.

MAIN OUTCOMES AND RESULTS

This review examined four major areas of cognitive therapy including: attention/concentration, learning and memory, executive functioning, and general cognitive rehabilitation approaches. In total, 64 studies were evaluated throughout the four major areas, which provided the evidence-base for 18 conclusions. The majority of the conclusions were based on moderate and limited evidence, however three strong and one conflicting conclusions were made.

CONCLUSIONS

Future research should explore functional outcome measures and long-term effects of treatment interventions through follow-up.

Training patients in Time Pressure Management, a cognitive strategy for mental slowness

Purpose: To provide clinical practitioners with a framework for teaching patients Time Pressure Management, a cognitive strategy that aims to reduce disabilities arising from mental slowness due to acquired brain injury. Time Pressure Management provides patients with compensatory strategies to deal with time pressure in daily life. Application of the training in clinical practice is illustrated using two case examples from a randomized controlled trial on the effectiveness of Time Pressure Management for patients with stroke.

Rationale: The Time Pressure Management approach is based on Michon's task analysis, describing levels of decision-making in complex cognitive tasks. Decisions with little or no time pressure are not impaired by mental slowness. Therefore, patients should try to transfer actions from situations with high time pressure to situations where the preserved decision levels with little or no time pressure can work.

Theory into practice: Several factors are required to teach patients to use Time Pressure Management. First, sufficient awareness is needed to recognize that there is a deficit and behavioural change is necessary. Sufficient awareness is also required to recognize and anticipate time pressure situations and to realize that the strategy is helpful and might also be useful in new and more difficult circumstances. Second, adequate motivation is needed to learn the strategy. And finally, the training should be adjusted to the patient's individual learning abilities and cognitive skills.

Efficacy of traumatic brain injury rehabilitation: interventions of QEEG-guided biofeedback, computers, strategies, and medications

The onset of cognitive rehabilitation brought with it a hope for an effective treatment for the traumatic brain injured subject. This paper reviews the empirical reports of changes in cognitive functioning after treatment and compares the relative effectiveness of several treatments including computer interventions, cognitive strategies, EEG biofeedback, and medications. The cognitive functions that are reviewed include auditory memory, attention and problem solving. The significance of the change in cognitive function is assessed in two ways that include effect size and longevity of effect. These analyses complement the previously published meta-reviews by adding these two criteria and include reports of EEG biofeedback, which is shown to be an effective intervention for auditory memory.

An investigation of errorless learning in memory-impaired patients: improving the technique and clarifying theory

In rehabilitating individuals who demonstrate severe memory impairment, errorless learning techniques have proven particularly effective. Prevention of errors during acquisition of information leads to better memory than does learning under errorful conditions. This paper presents results of a study investigating errorless learning in three patient groups: those demonstrating mild, moderate, and severe memory impairments. The first goal of the study was to trial a new version of errorless learning, one encouraging more active participation in learning by patients via the use of elaboration and self-generation. This technique led to significantly better memory performance than seen under standard errorless conditions. This finding highlights the value of encouraging active and meaningful involvement by patients in errorless learning, to build upon the benefits flowing from error prevention. A second goal of the study was to clarify the mechanisms underlying errorless learning. Memory performance under errorless and errorful conditions was compared within and across each group of patients, to facilitate theoretical insight into the memory processes underlying performance. The pattern of results observed was equivocal. The data most strongly supported the hypothesis that the benefits seen under errorless learning reflect the operation of residual explicit memory processes, however a concurrent role for implicit memory processes was not ruled out.

The improved name game: better use of expanding retrieval practice

Morris and Fritz (2000) demonstrated the effectiveness of the name game as a retrieval-practice based technique for learning the names of group members. We hypothesised that a reversed version of the name game would be even more effective. Performance was contrasted with a no-retrieval condition that mimicked the name game in every way except for the retrieval of the names, allowing an estimate of the specific contribution of retrieval practice. The benefit of a few refresher rounds of the game after 2 weeks was also examined. The reversed name game was superior to the original name game and the refresher rounds benefited all groups. The very considerable superiority of the name game over the no-retrieval condition demonstrated the magnitude of the benefit of expanding retrieval practice.

The effectiveness of cognitive rehabilitation for attention deficits in focal seizures: a randomized controlled study

PURPOSE

Cognitive deficits are one of the major limiting factors in the everyday life functioning of patients with focal seizures. Although cognitive rehabilitation methods have been successfully applied to patients with other central nervous system (CNS) lesions, these methods have not yet been evaluated in cognitively impaired patients with epilepsy. The present study evaluated the effectiveness of two commonly used methods for attention deficits: (a) the Retraining Method, aimed at retraining impaired cognitive functions; and (b) the Compensation Method, aimed at teaching compensatory strategies while taking neuronal loss for granted.

METHODS

Fifty adult outpatients with focal seizures and attention impairments receiving carbamazepine (CBZ) monotherapy were randomly assigned to the Retraining Method, the Compensation Method, or to a waiting-list control group. Established and self-reported neuropsychological outcomes and self-reported quality of life of these groups were evaluated at pretraining, posttraining, and at a 6-month follow-up measurement point and were completed by 44 patients.

RESULTS

Neuropsychological outcomes related to training, self-reported neuropsychological outcomes, and quality of life at the 6-month follow-up measurement point improved both in the Retraining Method group (n = 19) and the Compensation Method group (n = 17) relative to the waiting-list control group (n = 8). The Compensation Method was more effective in improving self-reported neuropsychological outcomes and quality of life, especially for patients with less education. The patients with active epilepsy benefited more from both methods than did the seizure-free patients.

CONCLUSIONS

These data show that cognitive rehabilitation programs are effective for patients with focal seizures and attention deficits and should, therefore, be incorporated into comprehensive care programs.

The influence of learning style and cognitive ability on recall of names and faces in an older population

The present study examined whether, for older adults, a verbal or imagery cognitive style is associated with recall of names and faces learned in an experimental condition. Cognitive abilities that are represented in current models of face recognition and name recall were also examined. Those abilities included picture naming, verbal fluency (i.e., naming items within a given category), vocabulary comprehension, visual memory, and the learning of unassociated word pairs. Fifty older adults attempted to learn first and last names of 20 student actors and actresses pictured on videotapes (40 names total). On average, participants learned the most first names, followed by last names, and the fewest full names. The greater the number of responses on a questionnaire associated with an imagery cognitive style, the more the names of faces were correctly identified by participants. There was no significant relationship between a verbal cognitive style and the number of names and faces recalled. As for cognitive abilities, all of the abilities measured--with the exception of vocabulary comprehension--were significantly associated with the number of names and faces learned. A regression analysis indicated that the best predictor of successful name-face learning was the participants' ability to learn and recall 5 unrelated word pairs. When that cognitive measure was deleted from the regression analysis, delayed visual memory and verbal fluency were the next best predictors of the older adults' ability to learn names and faces.

Evidence-based cognitive rehabilitation: recommendations for clinical practice

OBJECTIVE

To establish evidence-based recommendations for the clinical practice of cognitive rehabilitation, derived from a methodical review of the scientific literature concerning the effectiveness of cognitive rehabilitation for persons with traumatic brain injury (TBI) or stroke.

DATA SOURCES

A MEDLINE literature search using combinations of these key words as search terms: attention, awareness, cognition, communication, executive, language, memory, perception, problem solving, reasoning, rehabilitation, remediation, and training. Reference lists from identified articles also were reviewed; a total bibliography of 655 published articles was compiled.

STUDY SELECTION

Studies were initially reviewed according to the following exclusion criteria: nonintervention studies; theoretical, descriptive, or review papers; papers without adequate specification of interventions; subjects other than persons with TBI or stroke; pediatric subjects; pharmacologic interventions; and non-English language papers. After screening, 232 articles were eligible for inclusion. After detailed review, 61 of these were excluded as single case reports without data, subjects other than TBI and stroke, and nontreatment studies. This screening yielded 171 articles to be evaluated.

DATA EXTRACTION

Articles were assigned to 1 of 7 categories according to their primary area of intervention: attention, visual perception and constructional abilities, language and communication, memory, problem solving and executive functioning, multi-modal interventions, and comprehensive-holistic cognitive rehabilitation. All articles were independently reviewed by at least 2 committee members and abstracted according to specified criteria. The 171 studies that passed initial review were classified according to the strength of their methods. Class I studies were defined as prospective, randomized controlled trials. Class II studies were defined as prospective cohort studies, retrospective case-control studies, or clinical series with well-designed controls. Class III studies were defined as clinical series without concurrent controls, or studies with appropriate single-subject methodology.

DATA SYNTHESIS

Of the 171 studies evaluated, 29 were rated as Class I, 35 as Class II, and 107 as Class III. The overall evidence within each predefined area of intervention was then synthesized and recommendations were derived based on consideration of the relative strengths of the evidence. The resulting practice parameters were organized into 3 types of recommendations: Practice Standards, Practice Guidelines, and Practice Options.

CONCLUSIONS

Overall, support exists for the effectiveness of several forms of cognitive rehabilitation for persons with stroke and TBI. Specific recommendations can be made for remediation of language and perception after left and right hemisphere stroke, respectively, and for the remediation of attention, memory, functional communication, and executive functioning after TBI. These recommendations may help to establish parameters of effective treatment, which should be of assistance to practicing clinicians.