Internal Memory Rehabilitation Strategies in the Context of Post-acute Brain Injury: A Pilot Study

Abstract

Memory impairments are one of the most common consequences of acquired brain injury. Poor memory can have a severe impact on a person's daily functioning and his/her quality of life. While research provides some support for using external, compensatory strategies (e.g. diaries, lists, visual or electronic reminders), empirical evidence in favor of internal, restorative strategies (i.e. learning and training strategies that utilize less impaired or healthy cognitive resources to restore function) is much sparser. This study investigates the effects of a rehabilitation treatment comprised of internal strategies on the memory functioning of 11 participants with acquired brain injury associated memory impairments. The interventions utilized in this study included practicing visualization, first letter mnemonics, semantic clustering, elaborative encoding, and completing worksheets from Workbook of Activities for Language and Cognition (WALC 10 Memory). The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used for the pre-and post-treatment assessment of memory functioning. Treatment gains as measured by pre-post therapy RBANS differences suggested large memory improvements of a magnitude to suggest clinically meaningful gains. This study was limited by its sample size, absence of a control group, and use of only one outcome measure. Keywords: Rehabilitation; Brain injury; Memory Internal Memory Rehabilitation Strategies in the Context of Post-Acute Brain InjuryMemory impairment is a common consequence of acquired brain injury that often causes functional and long-term disability [1]. Memory impairment can be caused by many types of brain injury. By some estimates, in individuals with severe traumatic brain injury (TBI) the prevalence of memory impairment ranges between 40% and 84% [2]. Within the overall TBI population, the percentage of people suffering from some form of memory impairment ranges from 20% to 79%, depending on the severity of the closed-head trauma, the timing of assessment, and the instruments used. Even after one year, 4% to 25% of TBI patients show some form of memory impairment [3]. The prevalence of memory dysfunction post-stroke varies from 23% to 55% in the first 3 months and at one year post-stroke, declines to between 11% and 31% percent [4,5].Memory impairment can be an obstacle to successful return to work and may even interfere with successful rehabilitation [6]. Individuals with TBI and their family members report post-injury memory deficits as one of the most persistent problems following a TBI [7]. Memory impairments can interfere with independence in activities of daily living, as well as return to work, social participation and the overall quality of life [8]. The long-term persistence of memory impairments and the risk that these impairments will affect functional activities often cause clinicians to target the memory issues as a therapy goal. Cognitive rehabilitation providers report learning and memory as primary post-injury target of rehabilit...

Memory rehabilitation: Restorative, specific knowledge acquisition, compensatory, and holistic approaches

“…These involve the mental manipulation of information such as via imagery or associations to improve retrieval at a later time (das Nair & Lincoln, 2012;Lewinsohn et al, 1977;O'Neil-Pirozzi et al, 2010;Perna & Perkey, 2016;Wilson, 1982). Internal aids include mnemonics such as chunking, rhyming, acronyms, visualization, first letter mnemonics, and chaining (Crovitz, 1979;das Nair et al, 2016;Harris, 1992;Lewinsohn et al, 1977).…”

“…Across internal aids, mnemonic strategies with imagery components are among those that show the most promising results (Censori et al, 1996;Patten, 1972;Pino, 2015). Internal aids are often used as part of memory rehabilitation or training rather than as standalone memory aids (das Nair & Lincoln, 2012;Lewinsohn et al, 1977;O'Neil-Pirozzi et al, 2010;Perna & Perkey, 2016).…”

Perspective of application of nonlinear stimulation therapy in the treatment of traumatic brain injuries and maintenance of cognitive functions in the elderly

“…Результаты исследований поддерживают компьютерную когнитивную тренировку как эффективный метод улучшения рабочей памяти после ЧМТ [5]. Однако исследователи сходятся во мнении, что, несмотря на определенное подтверждение поддержки памяти с помощью когнитивных тренировок и других реституционных подходов, необходимо более тщательное изучение эффективности внутренних стратегий в когнитивной реабилитации и поиск новых технологий нейрокогнитивных воздействий [51,58]. В недавней публикации [21] дан критический анализ существующих представлений о морфологических и функциональных модификациях в головном мозге, происходящих при выполнении реабилитационных программ у пациентов с его хроническим травматическим повреждением.…”

“…При закрытой травме, в зависимости от ее тяжести, периода, прошедшего после эпизода и методов исследования, признаки нарушения памяти отмечали у 20% -79% пострадавших (цит. по [51]). Некоторое нарушение памяти остается даже спустя год после ЧМТ у 4% -25% пациентов [10], что может препятствовать их социальной и профессиональной реабилитации.…”

“…К методам внешней помощи относится, например, ведение дневников, использование электронных органайзеров, а к внутренним стратегиям -повторяющиеся тренировки, обучение когнитивным методам сохранения информации [14]. До недавнего времени большее внимание уделялось методам внешней компенсации, однако достижения в исследованиях нейропластичности вновь активизировали поиск потенциально эффективных внутренних (реституционных) стратегий [37,51]. Одним из перспективных способов ослабления последствий ЧМТ считается когнитивная реабилитация, основанная на принципах нейропластичности [21].…”