The effectiveness of an electronic memory aid for a memory-impaired adult of normal intelligence

Do memory aids help everyday memory? A controlled trial of a Memory Aids Service

There is a growing body of knowledge about the use of compensatory memory aids in memory rehabilitation, but relatively few controlled trials on how to train the use of such aids. This study investigated the effects of systematic training in the use of compensatory memory aids on everyday memory functioning within a Memory Aids Service. In a controlled clinical trial, a comparison was made between treatment participants and waiting list controls. Participants had everyday memory problems secondary to progressive or non-progressive neurological conditions. Following baseline assessment and goal setting, treatment participants underwent three training sessions, in which memory aids were matched to goals, across a six week period, with a follow-up assessment 12 weeks later. Outcome was measured by a goal attainment diary, neuropsychological test performance, psychosocial questionnaires and a problem solving inventory. There was a significant treatment effect of training on the goal attainment diary but only at 12 weeks follow-up. A post-hoc analysis indicated that treatment was effective for participants with a non-progressive condition but not for participants with a progressive condition. We conclude that a Memory Aids Service can be beneficial for patients with a non-progressive neurological condition, and make suggestions that might inform future applications of memory aids with those who have a progressive neurological disorder.

Efficacy of electronic portable assistive devices for people with acquired brain injury: a systematic review

A systematic review was conducted to evaluate the efficacy of electronic portable assistive devices (EPADs) for people with acquired brain injury. A systematic database search (OVID, CINAHL) found 541 citations published between 1989 and the end of 2012. A total of 23 reports met the inclusion/exclusion criteria, namely intervention studies (group, n-of-1) testing the efficacy of EPADs as compensatory devices for cognitive impairment for people with acquired brain injury aged 16-65 years. Study quality was rated by the PEDro (Physiotherapy Evidence Database) scale, (randomised controlled trials), the Downes and Black tool (other group intervention studies), and the Single Case Experimental Design tool (single participant studies). Levels of evidence were determined using five levels of classification based on the Spinal Cord Injury Rehabilitation Evidence table. Results found no Level 1 studies (RCTs with PEDro score ≥ 6), four Level 2 studies and 10 Level 3 studies. There was insufficient evidence to recommend any practice standards, but sufficient evidence to recommend the use of electronic reminder systems in supporting the everyday functioning of people with acquired brain injury as a practice guideline. Higher quality studies are required to support a broader range of compensatory roles that EPADs have the potential to play in neurorehabilitation and the long-term support of people with acquired brain injury.

Comparison of remedial and compensatory approaches in memory dysfunction: a comprehensive literature review

ABSTRACT Memory is a cognitive process of information storage and retrieval that is essential to performing daily functional activities efficiently. Occupational therapists regularly help individuals with memory impairment to manage their memory deficits. The purpose of this paper was to review the main memory strategies and instructional methods used to improve or manage memory. Studies were identified by searching for the relevant literature published between 1980 and 2007 through the use of several databases with the inclusion criteria that the study must identify at least one specific memory rehabilitation method with an outcome measure representative of the specific method. The reviewed studies included three reviews, 10 randomized control trials, 17 quasi-experimental studies, and five single subjects' designs. The results suggest that there is empirical evidence to support the effectiveness of certain remedial and compensatory memory rehabilitation methods with healthy populations, but weaker evidence can be identified for the memory-impaired populations. In general, remedial methods are effective in lab settings with primarily healthy populations, yet effectiveness in daily activities is less clear. Compensatory methods are generally more efficient than remedial ones and more easily generalized to daily activities, even with memory-impaired populations.

Long-term benefits of the Memory-Link programme in a case of amnesia

Objective:

To systematically evaluate the maintenance of clinical gains from a structured memory intervention programme. Efficacy of the programme was initially demonstrated in RR, a woman with moderate-to-severe memory impairment following colloid cyst removal. In the current study (Svoboda and Richards, 2009), we examined RR’s day-to-day memory functioning 18 months after completion of the intervention programme.

Design:

Within-subject A1B1A2B2B3 single-case experimental design.

Setting:

Outpatient memory rehabilitation clinic.

Intervention:

A theory-driven training programme in the use of commercially available smartphones for individuals with moderate-to-severe memory impairment.

Main measures:

A phone call task was used as an objective measure of prospective memory function. Self-report, ecologically valid questionnaires were also completed to further assess generalization of smartphone use to day-to-day memory function.

Results:

Eighteen months after intervention, RR completed 80% of scheduled calls using the smartphone, a rate significantly higher than at baseline (40%) and comparable to her success rate immediately following intervention (90%) and at the four-month follow-up (90%). Responses to questionnaires indicated that RR felt more confident in her ability to handle memory-demanding situations and was making fewer memory mistakes. This favourable outcome was not found with the use of another smartphone brand for which training was not received.

Conclusions:

Results from ecologically valid measures of memory functioning demonstrated robust maintenance of independent commercial smartphone use over an 18-month period, with increases observed in independence, confidence and real-life memory functioning. The findings further suggest poor cross-device generalizability.

Cognitive function and assistive technology for cognition: a systematic review

The relationship between assistive technology for cognition (ATC) and cognitive function was examined using a systematic review. A literature search identified 89 publications reporting 91 studies of an ATC intervention in a clinical population. The WHO International Classification of Functioning, Disability and Health (ICF) was used to categorize the cognitive domains being assisted and the tasks being performed. Results show that ATC have been used to effectively support cognitive functions relating to attention, calculation, emotion, experience of self, higher level cognitive functions (planning and time management) and memory. The review makes three contributions: (1) It reviews existing ATC in terms of cognitive function, thus providing a framework for ATC prescription on the basis of a profile of cognitive deficits, (2) it introduces a new classification of ATC based on cognitive function, and (3) it identifies areas for future ATC research and development.

Efficacy and usability of assistive technology for patients with cognitive deficits: a systematic review

Objective: To determine the efficacy of portable electronic aids such as personal digital assistants (PDAs), pagers or mobile phones for patients with cognitive deficits by means of a systematic review. The usability of these aids is also briefly discussed.

Data sources: PubMed, CINAHL, PsychINFO, EMBASE and MEDLINE were searched up to February 2009. The references of identified and relevant articles were scanned to find additional relevant titles.

Review methods: Papers referring to ‘electronic aids’, ‘cognition’ and ‘brain injury’ were included. The population had to be adult and have cognitive impairments as a result of acquired brain injury. Outcome measures were change in cognitive or occupational performance or the level of participation in daily life. The criteria of Cicerone et al. were used to evaluate the quality of the retrieved studies.

Results: Twenty-eight papers presenting 25 studies were reviewed. The total number of participants was 423. Most identified papers described case reports or non-randomized clinical trials. Only one randomized controlled trial was identified, in which the NeuroPage proved effective in supporting prospective memory. Other kinds of assistive technology such as PDAs and voice recorders showed positive results in supporting retrospective and prospective memory.

Conclusion: The efficacy of assistive technology in general is not yet sufficiently studied in randomized controlled trials, although promising results has been reported. Furthermore, several survey studies established that both potential users and clinicians have optimistic expectations about the usability of assistive technology.

Improvement patterns among survivors of brain injury:Three case examples documenting the effectiveness of memory compensation strategies

Three case examples illustrate possible patterns of improved functioning that may emerge as survivors of traumatic brain injury (TBI) attempt compensation for persistent memory deficits impeding independent living. The task selected for report was independence in remembering to take regularly-prescribed medications. Strategies applied to promote learning included use of written reminders and use of two assistive technology (AT) devices-a wristwatch alarm (WatchMinder) and a digital voice recorder and alarm system (Voice Craft ). With participation in the intervention programme, two of the three individuals demonstrated increased independence in remembering to take medications; the third did not. The case examples illustrate varying responses of people with TBI to intervention using compensatory strategies and AT devices. Professionals and caretakers working with survivors must recognize the uniqueness of each survivor, must adjust intervention programmes accordingly and must be willing to persist in trying to increase functional independence repeatedly for many years post-injury.

Successful guidance by automatic output of music and verbal messages for daily behavioural disturbances of three individuals with dementia

There have been no previous reports of daily home activities of individuals with dementia being guided by the combination of music and verbal messages. This study evaluated the effectiveness for three individuals of music and messages which were automatically output by an IC recorder. After music was presented, messages instructed the participants to go to a day care centre, behave more peacefully and eat more at meals, respectively. These stimuli were highly effective for guiding the above activities. This study suggests that automatic output of music and messages has potential as a strategy for guiding individuals with dementia at their home. For the third individual, the music and messages were output through a doll. The implications of using a doll are also discussed.

Clinician expectations for portable electronic devices as cognitive-behavioural orthoses in traumatic brain injury rehabilitation

OBJECTIVE

To ascertain experiences and expectations of clinicians as to uses of portable electronic devices such as hand-held computers as cognitive-behavioural orthoses in TBI rehabilitation.

DESIGN

Survey study.

PROCEDURES

A survey developed and piloted with the input of clinician focus groups was completed by 81 TBI clinicians from a variety of disciplines and work settings.

RESULTS

About half of the respondents reported prior exposure to clients with TBI who had used portable electronic aids. Of 10 key cognitive/behavioural areas, respondents saw most potential for devices in the areas of learning/memory, planning/organization and initiation; less potential was seen for social/interpersonal or behavioural difficulties. However, many respondents also identified learning and memory abilities as essential client characteristics for successful use of portable electronics. Cost was identified as a significant barrier to use of portable devices in rehabilitation. Respondents expressed low confidence overall in their ability to guide clients in use of devices; those who reported personal use were significantly more confident than those who did not.

CONCLUSION

Clinicians believe that new electronic devices have potential for treatment of some cognitive impairments, but clinical experimentation may be limited by costs of technology and low clinician confidence.

Use of a portable voice organizer to remember therapy goals in traumatic brain injury rehabilitation: a within-subjects trial

OBJECTIVE

To test the efficacy of a portable voice organizer in helping people with traumatic brain injury (TBI) to recall therapy goals and plans discussed with their clinical case managers.

DESIGN

Prospective within-subjects trial, in which individualized therapy goals were randomly assigned to intervention or no intervention.

SETTING

Comprehensive postacute TBI rehabilitation program.

PARTICIPANTS

Ten people with moderate to severe TBI enrolled from 3 months to 18 years after injury.

OUTCOME MEASURE

Memory for therapy goals. Clinicians generated statements describing six current therapy goals, half of which were randomly assigned to be recorded on a voice organizer during the next case management session. Participants selected three times per day to listen to the recorded goals, prompted by an alarm. One-week recall was tested using both free- and cued-recall formats.

RESULTS

Recorded goals were recalled better than unrecorded goals and appeared to be associated with better awareness or follow-through with therapy objectives.

CONCLUSION

Portable electronic devices have the potential to assist with treatment areas beyond tasks involving prospective memory.

Using talking lights to assist brain-injured patients with daily inpatient therapeutic schedule

OBJECTIVES

To test the ability of patients with brain injury to use a patient locator and minder (PLAM) system to assist in their adherence to therapy schedules.

PARTICIPANTS

Five patients with acquired brain injury who were inpatients on an acute rehabilitation floor of a rehabilitation hospital.

MEASURES

The number of human prompts necessary to direct a patient to, and ensure arrival at, a scheduled therapy destination and the proportion of therapy sessions requiring no prompting was measured both before and after the introduction of the PLAM system.

RESULTS

With the PLAM system, the average number of human prompts dropped by more than 50%, and the number of sessions requiring no prompting increased from 7% to 44%.

CONCLUSION

The PLAM system described in this article seems feasible and useful for patients with acquired brain injury in assisting them with arrival at their therapy destinations without the assistance of staff.

Evaluation of an electronic memory aid in the neuropsychological rehabilitation of prospective memory deficits

Five subjects with acquired memory impairment were trained to use a new electronic memory aid, the Voice Organizer, to manage prospective memory errors. Performance was assessed on two measures analogous to everyday memory tasks; a Message-Passing task requiring prospective recall after a delay of 9 hours, and a Domestic Task measure which involved the recall of household chores following a delay of 1-6 days. All subjects benefited from the introduction of the aid on the Message-Passing task and all but one improved their prospective recall on the Domestic Task measure. These results suggest that the Voice Organizer may be a useful aid in the neuropsychological rehabilitation of prospective memory impairment.

Electronic memory aids for outpatient brain injury: follow-up findings

The introduction of highly portable computers extends the range of tools potentially useful to persons with functional impairments of prospective memory resulting from brain injury. This study reviews the experience of 12 patients with brain injury undergoing outpatient treatment using palmtop computers to assist with memory dependent activities in their everyday lives. During the initial supervised trial period, each was provided a palmtop computer based memory aid capable of generating audible and visible reminder cues. Subsequently, patients were contacted for follow-up between 2 months and 4 years after initial trial usage, and surveyed as to the utility of the computer. Nine patients found palmtop computers were useful during supervised trials. Seven of nine patients actually continued to use such devices after the usage trials had ended. Experience with this technology has shown it to be useful in a high proportion of patients for assisting with memory dependent functions.

Utility of a microcomputer as an external memory aid for a memory-impaired head injury patient during in-patient rehabilitation

Memory deficit is one of the most frequent cognitive complications encountered after brain injury. It is recognized as difficult to treat. Over the past decades, various strategies of memory remediation have been used. Among them, prosthetic devices, such as notebooks and alarms, have shown some benefit. This study describes the case of a 22-year-old man who demonstrated deficits in memory and executive function. In an in-patient rehabilitation setting, a microcomputer was introduced as an external memory aid. With this intervention, the patient demonstrated an immediate improvement in the ability to attend every therapy and ask for every medication on his schedule. This case study demonstrates the usefulness of a microcomputer as an external memory aid for a memory-impaired head injury survivor.

Use of a comprehensive programme of external cueing to enhance procedural memory in a patient with dense amnesia

This case study describes rehabilitation efforts with a 24-year-old woman who exhibited dense amnesia secondary to status epilepticus following a motor vehicle accident. She was 20 months post-injury upon entry into our day treatment programme. The functional severity of her amnesia was reflected in numerous ways, including no recall of what she wore from day to day and an inability to find the toilet after 2 weeks in the programme. A multidisciplinary comprehensive programme of external cueing was established to exploit her preserved procedural memory. Objective measures of functional compliance were gathered over time and contrasted with both standard neuropsychological test scores and early levels of functioning in rehabilitation. Results demonstrated enhanced functioning via utilization of procedural memory. In addition, the patient actually demonstrated increased independent generalization of strategies and techniques over time. Practical treatment implications are reviewed and discussed.

Assessing learning capabilities during cognitive and perceptual evaluations for adults with traumatic brain injury

Occupational therapists (OTs) typically identify cognitive and perceptual deficits in adults with Traumatic Brain Injury (TBI) through a combination of Activity of Daily Living (ADL) evaluations and cognitive/perceptual skill evaluations which provide information about clients' occupational performance and cognitive/ perceptual skill levels, respectively. These evaluations do not provide information about clients' abilities to learn new approaches to tasks or to transfer learning from one task to another. Since learning ability is an important determinant of clients' response to treatment, OTs need to evaluate that ability as part of their routine ADL and cognitive/perceptual evaluations. This paper presents a learning process approach to cognitive/perceptual evaluation that identifies ways OTs can evaluate clients' learning abilities with only slight modification of current evaluation practices.