Improving Memory in Outpatients with Neurological Disorders Using a Group-Based Training Program

Abstract

Memory problems are common in patients with a range of neurological conditions, but there have been few attempts to provide and evaluate the usefulness of memory training for groups of neurological outpatients. We used a waitlist-controlled trial design to assess the effectiveness of a newly created, 6-session intervention, which involved training in the use of compensatory strategies as well as education regarding memory function, neurological damage, sleep and lifestyle factors that have an impact on memory. Fifty-six patients with neurological conditions (e.g., stroke, epilepsy) and memory complaints completed the training and assessments. Outcomes were evaluated in terms of reported strategy use as well as objective and subjective measures of anterograde and prospective memory. Training resulted in significant improvements on number of strategies used, scores on the Rey Auditory Verbal Learning Test (total learning and delayed recall) and self-report on the Comprehensive Assessment of Prospective Memory. Improvements were stable at 3-month follow-up. Better individual outcomes were related to lower baseline memory scores, fewer symptoms of depression and greater self-awareness of memory function. Overall the study provides encouraging results to indicate that patients with neurological conditions such as stroke and epilepsy can show improvements in memory after a relatively short group-based intervention.

Testing the effectiveness of group-based memory rehabilitation in chronic stroke patients

“…For mixed groups of neurological patients and/or patients with epilepsy, greater memory treatment gains have been associated with younger age (e.g., Fleming, Shum, Strong, & Lightbody, 2005;Wilson & Moffat, 1992), longer time since injury/onset (Fleming et al, 2005;Malec, Goldstein, & McCue, 1991), lower level of education (Engelberts et al, 2002;Jennett & Lincoln, 1991;Radford et al, 2011b), less depression (Radford, Lah, Thayer, Say, & Miller, 2012) and mild to moderate range of memory impairment rather than very severe impairment (Cicerone et al, 2000(Cicerone et al, , 2005Malec et al, 1991;Rees, Marshall, Hartridge, Mackie, & Weiser, 2007;Richardson, 1995). In the Fish et al (2008) study mentioned above, group differences in rehabilitation gains (TBI better than stroke) were attributed to differences in executive functioning, but it is important to note that the stroke patients were also older and had a shorter interval post-injury.…”

“…Recently, we found that patients with epilepsy (Radford et al, 2011b) or of mixed neurological aetiology (Radford et al, 2012) benefited from a manualised group-based memory training programme (Radford, Say, Thayer, & Miller, 2010) that involved educational components, strategy training and homework. In those studies, baseline memory performance, age, level of depression and level of education helped to predict outcome.…”

Descriptions of memory rehabilitation group interventions for neurological conditions: a systematic review

“…Of these five studies, four of the trials (8,14,16,19) provided a reference to the original programme, from which the intervention was developed or adapted. One study (18) had two intervention groups that were compared to a control, where one of the experimental interventions was a novel programme designed for the trial whilst the other was a previously developed programme, for which a reference was provided.…”

“…Four of the studies (13,15,18,19) reported that theirs was a manual-based programme, but only two of these manuals (15,18) were accessible. Three of the four studies using a manual (13,15,18) reported how the manual was developed.…”

“…Three of the four studies using a manual (13,15,18) reported how the manual was developed. Although a manual was not used, or not readily accessible, three of the studies (11,12,19) gave session-bysession content, i.e., these three studies gave a clear indication of the topics covered in each group session.…”