Cognitive Rehabilitation Therapy for Traumatic Brain Injury Evaluating the Evidence (2011) / Chapter Skim
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10 Memory
10 Memory
Pages 175-212
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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)
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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)
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Postintervention, the experimental group as compared to the control group improved in many neuropsychological measures of memory (California Verbal Learning Test [CVLT]
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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.
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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.
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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 compensatory memory training (versus attention training)
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Exclusion criteria include a history of psychiatric problems or computer phobia. Participants were randomly assigned to three groups: computer assisted memory training, therapist assisted memory training, and a control group that did not receive any specific memory training.
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. Two individuals participated in the study -- one with moderate TBI and moderate memory impairment and the other with severe TBI and severe memory impairment.
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(2000) examined the efficacy of internal memory strategies (mnemonics and visual imagery)
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Table 10-3 presents all external memory strategy studies by design, strategy, and treatment comparator. Controlled Studies Bergquist et al.
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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.
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. The primary outcome measures were laboratory-based measures (recall, everyday memory failures [EMFs]
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Limitations included the absence of a control group, narrowly focused or restricted outcome measures, and an unclear history of the severity and sequelae of TBI in some patients. Gentry et al.
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, a single-subject, multiple baseline experiment, studied the efficacy of prospective memory training with two adults with severe TBI who were, respectively, 11 and 12 years postinjury. Two types of intervention were provided: prospective memory training and repetitive memory drill.
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1995) enrolled 39 severely injured participants in a small RCT in which they compared the efficacy of a memory strategy program that consisted of instructing two control groups TABLE 10-4 Combined Memory Strategies Strategy Treatment Comparator No Non- Other Design Internal External Treatment CRT CRT Berg et al.
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Participants were randomly assigned to receive visual imagery to improve memory or to receive a typical memory rehabilitation program, which emphasized a combination of compensatory internal strategies and external compensatory strategies. There were 30 treatment sessions in total.
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RESTORATIVE STRATEGIES Restorative memory strategies aim to reestablish memory functioning following brain injury. The committee reviewed two RCTs that included repetitive drill as a treatment arm; comparator groups were both no treatment and have been previously described in this chapter (see Berg et al.
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provided both prospective memory training and retrospective memory drills to adults with brain injury and healthy adults. Eight adults with brain injury received 1-hour training sessions, twice each week for 6 months.
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The committee found limited evidence that the ability to recall new information improves in patients with chronic, mild TBI when they learn to use internal memory strategies such as visual imagery and other encoding strategies. This benefit was short term or immediate as measured by standard memory tests (O'Neil-Pirozzi et al.
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The literature suggests that there is limited evidence of a differential benefit of internal memory strategies to patients with mild TBI over those with moderate or severe TBI. Two studies, one RCT and one nonrandomized, parallel group design (O'Neil-Pirozzi et al.
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. The efficacy of using internal memory strategies to immediately improve memory performance in individuals with moderate-severe TBI on standard memory tests has been shown in several RCTs and a nonrandomized, parallel group design when compared to no treatment or non-CRT treatment (Dou et al.
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2010) demonstrated improvement in learning and memory for those who received internal memory strategy training when compared to a no treatment control group.
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(2002) attempted to investigate the active ingredient of visual imagery from matched participants who were receiving memory rehabilitation involving both external memory compensatory aids and other internal memory strategies.
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There is modest evidence from three RCTs of the effectiveness of external memory aids to reduce everyday memory failures for patients with moderate-severe injuries in three small to modest-sized RCTs (Bergquist et al. 2009, 2010; Ownsworth and McFarland 1999; Schmitter-Edgecombe et al.
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Berg et al. 39 Severe "Memory strategy Y • Control tasks At 4-month follow-up both 1991 training" with several ▪ Distraction-Reaction groups of trainees saw memory tasks chosen by No Content Time Task significant, subjective effects Milders participant with following and Other CRT ▪ Reaction Time Task of therapy on their everyday et al.
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, Didactic problems; furthermore, the delivered via telephone, memory strategy differences between the two in improving everyday instruction from pre-assessment remained, memory problems. but were still not significant.
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, including Learning Test (HKLLT) a comparison between post training outcome measures and follow-up results, patients in both groups performed better than the Control Group (CG)
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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.
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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.
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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.
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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)
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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.
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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)
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• 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.
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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.
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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.
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2009. The effect of Internet-based cognitive rehabilitation in persons with memory impairments after severe traumatic brain injury.
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1996. The efficacy of prospective memory training in two adults with brain injury.
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