Memory Rehabilitation

in Occupational Therapy

byIris Lazaro

Hricha RakshitEugenia Wong

(MSc. OT Candidates)University of Toronto

Memory Rehabilitation

What is Rehabilitation? Types of Memory Disorders Memory Rehabilitation Strategies

Restorative Compensatory

Things to Consider: About a Client As a Therapist

What is Rehabilitation?

Cognitive rehabilitation is described as any intervention strategy or technique which enables clients and their caregivers to live with, manage, by-pass, reduce or come to terms with cognitive deficits precipitated by injury to the brain (Wilson, 1999).

Memory Disorders(in close head injuries)

Post Traumatic Amnesia confused and disoriented stage have difficulty in keeping track of ongoing

activities (i.e. know where they are or remembering materials presented to them)

Retrograde Amnesiadifficulty in remembering events prior to

onset of memory problem with recent memories more affected than earlier years

shrinking usually occurs

Memory Disorders(in close head injuries)

Anterograde Amnesiainability to remember events after the onset of

memory problemproblems in ongoing memory and new learning

Material Specific Amnesiaverbal (letters, names, words) vs. non verbal

materials (figures, faces, spatial positions)

Prospective Memory AmnesiaCannot remember intended actions

Memory Disorders(in close head injuries)

Alzheimer’s diseaseprogressive dementia: development of

plaque and neuro-fibrillary tangles in braindifficulty in free recall deficit in working memoryCombination of amnesic syndrome and

disturbances in the Central Executive System

Memory Rehabilitation Strategies

RestorativeMemory Training

CompensatoryInternal Strategies External Strategies Environmental Modifications

Assumption – memory responds like a mental muscle

Improvement may occur on particular training task

Examples – party games (Kim’s game) and laboratory tasks (list learning)

Little evidence to prove that memory drills improve memory

Memory Practice Drills

Ericsson, Chase, Faloon (1980)

Subject – an undergraduate with average memory abilities

Method – subject was read random digits at rate of one digit per second, then recalled the sequence

Results – digit span of subject improved from 7 to 80 digits

He constructed mnemonic associations based on running times, ages, and dates

Ericsson, Chase, Faloon (1980)

For examples – 3492 was recoded as “3 minutes and 49 points 2 seconds”

When sequences present could not be associated with running time categories, his performance would decrease

The practice did not transfer to letter span task Conclusion

Extended practice was not able to increase capacity of short-term memory

Increase in memory span was due to use of mnemonic associations

Compensatory Strategies

Based on theory of functional adaptation

Assumes that clients need to develop alternative ways to cope with deficits rather than work on damaged area or restoring said area

Utilize another memory system to compensate or the use of external aids

Compensatory Strategies

Internal Strategies MnemonicsMethod of Vanishing Cues Expanded Rehearsal

External StrategyMemory Book Electronic Devices (Neuropage)

Environmental Modifications

Mnemonics

Principle Association of unknown material

with something familiar to the individual

Relieve burden on short-term memory

Two main groups – verbal and visual techniques

Verbal Mnemonics Alphabetical searching

To retrieve a particular name, work through the alphabet until correct letter is recognized

The letter may act as retrieval cue for full name

Helpful when considerable information about the word is available

Limited studies investigated its effectiveness in people with memory impairment

Verbal Mnemonics

First-letter cueing Uses initial letters to act as retrieval cues Example

used for learning names of cranial nerves “On Old Olympus Towering Tops, A Finn And German Viewed Some Hops” (older and cleaner version)

for remembering colors of rainbow “Richard Of York Gives Battle In Vain”

Likely used when material remembered is well known but difficult to recall in a correct order

Verbal Mnemonics

Story Method Words are embedded in a story

with each word chained on to the next

Used with both individuals with and without brain damage

“bizarreness” is not a crucial feature in using this method

Visual Mnemonics

Remembering by pictures that may be mental images or actual drawings

Examples – Peg method and method of loci

Visual Mnemonics Peg Method

Procedure – a standard set of peg words such as tea, bun, tree are learned and items to be remembered are linked to the pegs by means of visual imagery

Best-known system is rhyming-peg method, whereby the numbers 1 to 10 are associated with rhymes (one-bun, two-shoe, three-tree)

Visual Mnemonics

First item to be remembered is linked with a bun, the second with a shoe

To recall items, pegs are elicited first, then attempts are made to retrieve the mental images linked to the pegs

Pegs system may help people with mild head injuries

No satisfactory evidence this method was successfully applied to everyday problem

Visual Mnemonics

Method of Loci Visually linking items to be recalled with

specific locations such as locations in a house, body parts

Locations would trigger the recall of information

For example – when the words to be remembered are read, the individual would imagine each word in a different place in the house

Visual Mnemonics

• Peg method and method of loci have very limited practical applications to everyday living for people with impaired memory

• Effectiveness of the methods is related to severity of memory impairment

• Magnitude of improvement inversely related to severity of amnesia

Visual Mnemonics

Individuals with brain damage have problems in spontaneous use of mental imagery

Patients with memory impairment may benefit more when images are provided by others

They need to be prompted at the time of recall so they can use mental imagery to learn critical material

Wilson (1987)

Comparison of four mnemonic strategies – first-letter cueing, method of loci, visual imagery, story method

Purpose To determine which strategy most

effective for immediate recall and which for delayed recall

To determine if individuals with brain damage and without brain damage would benefit from same strategy

Wilson (1987) Subjects – 20 with brain damage and 20 controls

Method – five lists of 10 words were read to subjects and they were asked to recall words with different strategy, one strategy for one list of words

Results Immediate recall – controls Story method superior than all other strategies No difference between first-letter cueing and

no strategy

Wilson (1987)

Results Immediate recall – subjects with brain damage No method superior to the no strategy

condition

Delayed recall – control Story method significantly better than any

other methods

Delayed recall – subjects with brain damage All strategies significantly better than no

strategy, story method helped most of all

Wilson (1987)

Results Percentage retained scores Controls found story, method of loci, visual

imagery better than no strategy Subjects with brain damage found story,

method of loci, first-letter cueing better than no strategy

Wilson (1987)

Discussions In control subjects, first-letter cueing not

significantly more helpful than no strategy In individuals with brain damage, first-letter

cueing is better than no strategy, it may be a good strategy for amnesic patients

In delayed recall, both groups found story method better than other strategies

Story method combines both visual and verbal methods

Method of Vanishing Cues

Is a process where a client is given cues (i.e. stem words) and the cues are systematically withdrawn as the client learns

Aims: to teach domain specific knowledge or simple procedures

Theory: to utilize intact ability to respond to partial cues of items presented before

Method of Vanishing Cues

Method: (1) Initial Trial: client is presented with ascending amount of cues to elicit the target response (2) Subsequent Trials: cues are withdrawn gradually (usually one less than the last time client was correct) to produce the same response

Method of Vanishing Cues

• A sequence of characters enclosed in quotation marks is called a ________. (answer: STRING)

• 1st trial hints required: S, T, R, I, N • 2nd trial hints given: STRI• 3rd trial hints given: STR • 4th trial hints given: ST• 5th trial hints given: S• 6th trial hints given: none

Method of Vanishing Cues

Target behaviour is to have no cue needed to produce behaviour when prompted

Successfully taught domain-specific skills for the work environment: word processing, data entry and database management (Glisky et al., 1988, 1989)

Method of Vanishing CuesVC vs. SA (Hunkin and Parkin, 1995)

- Subjects:16 memory impaired: CHI and

encephalitis- Material:

32 computer related words with definitions (MOUSE – a small hand held device) = divided in half for each VC and SA method-Measure: test: present definition

pre-session test (measures progressive learning from session to session)

post-session test (learning after training session)

VC vs. SA

SA (rote learning) Teaching Method(1) given= definition and required= type word in 15 sec (2) No cues are given : if wrong, post the answer(3) Proceed to next item (the definition)

VC vs. SA

VC Teaching Method• First trial (ea. session):

given = definition + four letters A small hand held device? MOUS_ (10 sec)

time elapsed or wrong = given the next letterA small hand held device? MOUSE

VC vs. SA

• 2ND TO 8TH TRAILS given: definition + string of the letters (LESS THAN 1 LETTER FROM PREVIOUS TRIAL NEEDED TO COMPLETE THE ANSWER)

Trial 3 : A small hand held device? MOU respond: SE (10 sec)

Trial 4: A small hand held device? MO

response of client:?

VC vs. SA• Maintenance: 6 week delay• Transfer test = to assess flexibility of

what is learned: MODALITY /WORDING Results: SA teaching method appears to be

more effective during the initial phase of training = but disappears after 12 sessions (when quick learning is not a factor anymore)

VC vs. SA6 weeks delay: pre test of the last training

sessions vs. pre test of delay session forgetting of info across the delay greater forgetting in the SA than VC

Transfer (flexibility) poorer performance on transfer test on both method and there is no difference Rewording of the question was the major factor that contributed to performance

VC vs. SA

• Why is SA better initially than VC?• This possibly suggest that more mildly

impaired learned better with SA. While more severely impaired learned better with VC

• Correlation between “VC-SA difference scores” and verbal IQ, attention, verbal memory , and frontal lobe dysfunction

• Results of correlation revealed that clients with low verbal IQ, with more severe memory deficit, and with more compromised fontal lobe functioning are those who gain benefit form VC procedure

Method of Vanishing Cues Limitations

(1) Takes a long time to train and learn(2) Takes a lot of effort(3) Hyper specific = only elicit response if the format of prompt is the same as training and can not transfer to other circumstances(4) Errorful learning can be learned and strengthen = especially on the initial trial(5) Implicit memory likely to occur when there is already an existing trace of association

Spaced Retrieval Is a process where a client is taught to recall

information over increasingly longer periods of time.

Aims: to teach client to retain and produce target info/behaviour when prompted

Theory: rely on intact ability to respond to prompted behaviours due to previous exposure and practice

Employs errorless learning (client is not allowed to respond in error)

It requires little effort and improves with practice without necessarily remembering that they have preformed the task.

Spaced Retrieval

Theory of Errorless Learningthe basic assumption is that errors that are produced during learning interfere with the correct responsesimplicit memory does not have the capacity to distinguish between responses = acts on the strongest response that has been trained Normally, the errors are corrected by explicit memory processes, but since it is impaired in amnesic clients, errors may be actually consolidated

Spaced Retrieval

Method(1) Clients are given specific information to

remember. (2) Immediate recall is solicited. (3) If the recall attempt is successful, the

next trial interval is expanded systematically (e.g., 5, 10, 20, 40, and 60 s)

4)If the recall is wrong or no response is given, the therapist immediately gives the correct respond and ask the client for immediate recall (usually clients are instructed to not respond if they are not sure of their answer = errorless)

Spaced Retrieval

(5) Then the interval for the next recall will be the same as the last time the client gave the correct response

(6) Each trial must end with a correct recall

Spaced Retrieval

Previous studies with efficacious results(1) Brush and Camp (1998a) reported the use of SR to reach clinical goals involving strategies: teaching the client to use a schedule or date book, teaching the client to use a voice amplifier and make eye contact when speaking, etc(2) In a case study, Brush and Camp (1998b) used SR to train a person with dementia a strategy for remembering to take a sip of liquid after each bite of solid food as a treatment for dysphagia.

Spaced Retrieval

• Bourgeois et al. (2003)- compared SR with Cueing Hierarchy (CH) in training clients with dementia to achieve various goals they would like to achieve

Goals (use external memory aids): memory books, reminder cards, activity lists, and ADL task analyses- Subject: 25 dementia patients (possible AD)

SR vs. CH

SR Training(1) Introduction to the goal and procedures:

‘‘I understand that sometimes you have trouble remembering what activities there are to do here. If you want to know what activity you should do today, you can look at this list of activities. What can you do to know what activity you should do?’’ (2) Expected response:

‘‘I look at my activity list.’’

SR vs. CH(3) The correct response was given immediately, the therapist replied:

‘‘That’s right. And I’ll be asking you to remember that in a little while,’’

(4) The interval will increase in double value as long as the client respond correctly

(5) Talk about an unrelated topic or do some therapeutic activities for the designated interval

(0, 1, 2, 4, 8, 16 sec …etc)(6) If the client did not respond or responded incorrectly = clinician modeled the correctresponse and ask the client to repeat it(7) The next interval to prompt the client is going to be the same as the last interval with a successful response

SR vs. CH

CH training(1) Introduction to the goal and procedures:

‘‘I understand that sometimes you have trouble remembering what activities there are to do here. If you want to know what activity you should do today, you can look at this list of activities. What can you do to know what activity you should do?’’ (2) Expected response:

‘‘I look at my activity list.’’

SR vs. CH

(3) If the client did not respond immediately or responded incorrectly = provided a hierarchy of cues (in order)

(a) Semantic (‘‘Something to look at’’),

(b) Phonemic (‘‘/qk/’’ first syllable)(c) Visual (point to list), (d) Tactile (touch/hold list),

(e) Imitation (‘‘I look at my activity list.’’)

SR vs. CH

Criterion to stop training:- correct response was given to the

first prompt of the next three sessions, with a minimum 24-h interval between each session.

Maintenance:- One week and four months post-

goal mastery participants were given the goal prompt to assess goal maintenance.

SR vs. CH

Results:(1) Number of goals mastered

- SR = 23/25- CH = 18/25- SR and CH both goals mastered

= 18/25- No participants mastered a CH

goal without also mastering a SR goal

- 5 participants mastered a SR goal without mastering a CH goal

SR vs. CH

(2) Goal Maintenance(a) One week delay - SR = 16/23 maintained their

goal - CH = 9/18 maintained their goal(b) 4 Month delay

- SR = 5/11 maintained their goal

- CH = 1/11 maintained their goal

Expanded Rehearsal (SR)Rules to Remember in SR training

(1) Effortless(2) Errorless(3) Procedure or info is concrete(4) 1 piece of info taught at a time(5) If clients can not recall correctly after 6 min interval after 6 sessions, this method might not be the best one

Barriers(1) Domain Specific (transferability problem)(2) Spontaneously use when prompt is not available(3) Passive Learning

Compensatory StrategiesGlitsky, E. L., & Schacter, D. L. (1986).

Classifications of external aids: • (i) Storage devices: such as diaries, memory

notebooks, calculators and computers. • (ii) Cuing devices: such as alarm watches,

pagers, memory notebooks and bell timers.

(iii) Modifying the environment: e.g. Labelling cupboards and drawers.

Most of the external aids that are currently in use in rehabilitation are cuing devices

Compensatory Strategies

Characteristic features of cuing devices• They should be administered close to the

time of the required action• Active vs. passive cues eg. Using pagers

and alarm clocks vs. a reminder in a book.• Cues should be specific The cuing devices that will be discussed

today are memory books and neuropagers.

Compensatory StrategiesMemory Books: (SOHLBERG, M. M. and MATEER, C. A,

1989)• Sohlberg and Mateer’s protocol includes three

training phases:• Acquisition: teaches patients to to use the journal by outlining the

name, and purpose of each section of the book using a question and answer format.

Examples of sections in the book are: Orientation, Memory log, Calendar, Things To Do, Transportation to be used on a specific day, Feelings Log, Names and Today at Work

Memory Books:• Application: phase involves teaching patients to record in the

appropriate journal sections through engagement in role playing exercises.

• Adaptation: phase involves teaching patients to use the journal in

naturalistic settings.

Compensatory Strategies(Burke, J.M, Danick, J.A., Bemis, B. & Durgin, C.

J., 1994)

Barriers to memory book training:• Physical: loss of dominant arm and/ or fine motor

coordination, visual impairments, decreased mobility

• Cognitive: linguistic and attention deficits, decreased language comprehension, reduced problem solving skills and so on.

• Emotional: fear of stigma associated with using memory aids, level of social support from family and friends

Clients weaknesses emerging from all three domains will hinder their ability to use the notebook

Compensatory Strategies

Challenges of memory book training:• Gaining clients’ compliance to use

the memory book after therapy sessions.

• Clients are not aware of the severity of their neurological and cognitive deficits.

• Fear of stigmatization

Compensatory Strategies

How is the memory book training initiated?Step 1: Awareness training• This is implemented when clients show

unawareness of their cognitive deficits or do not acknowledge the benefits of using external memory aids.

• Purpose: the client becomes aware of how their memory deficits impedes their functioning in daily activities that are important to them.

• the therapists conducts reality testing of their memory functioning skills without using the tool or external cues.

Compensatory Strategies

Awareness training (cont’d)• Tests include aspects of client life including ADL, work,

family and entertainment.• Clients are assigned to remember specific information

without provision of any cues. E.g. watching favourite upcoming television events.

• The clinician simultaneously documents this interview.• When the event occurs the clinician questions the client

about their participation in the activity.• When client is unable to recall ever participating in the

event clinician makes reference to notation made in previous session.

• This allows clients to recognize the severity of their cognitive impairments. After this clients are more likely to acquiesce using external memory aids.

Compensatory Strategies

Awareness training: • clients gain assurance that these memory aids will

enable them to fulfill their goals more efficiently.• It may be made clear to the clients that by learning

to use the book independently they do not have to rely on others to remind them of important tasks.

• Remind the clients of where their skills lie in order to encourage them continue in their pursuits of using the notebook and offer them positive feedback on their progress.

Compensatory Strategies

Step 2: Selection and design of tool:• Client and therapist collaborate together to design the tool• Assess clients’ needs and take special note of the barriers

imposed by the client’s physical, and cognitive limitations and also consider client’s psychosocial issues.

• Typically a standard day planner is used as: It is already designed for making notation of future events

Appointment books are used by the general public. Planners differ with respect to style, special features

such as calculators, a blank memo or “to do” list on each page, an expense report for each month, blank pages to make notes and so on.

Additional features can be introduced into the planner. E.g. page for phone numbers and addresses, maps and directions to specific destinations.

Compensatory Strategies

Step 3: Memory book trainingThe training procedure is comprised of four processes: Orientation:• Identifying the different features of the book.• Learning the function of each feature.Develop a system to keep the book close to client.• Carrying book in purse, handbag or briefcase.• Attaching the book to clothing with a clip or Velcro straps Learning to write info that is meaningful to client:• This process occurs through trial and error.• It begins with clients writing down their schedules in their logbook for a

specific day.• Information should be framed in such a manner that it will convey meaning

to them at a later time. E.g. Vocational therapy at 2:00 p.m in room 102 on Tuesday” as opposed to writing “Voc at 2:00 on Tuesday”

• Meaningful Abbreviations may be used if clients find writing lengthy notes tedious

Compensatory StrategiesLearning to write information that is meaningful to client

(cont’d):• This aspect of memory training requires a lot of practice.• Treatment team guide clients in assessing the amount of

informative detail they need. – Keep chart of successful entries that act as a standard to refer

to.– recoding synopsis of the various day activities during specific

intervals of the day.Development of consistent referral to the book:• Purpose: repeated efforts of this action of referral will

eventually become a natural habit for the client • Can be accomplished by drawing up a schedule of specific

times to review the book. E.g. in the morning, at lunchtime and in the evening

• use active reminders such as alarm systems that are programmed to ring at prescribed times of the day.

Compensatory StrategiesDevelopment of consistent referral to the book:• Every time the clients refer the book they keep themselves

up to date with recent, current and upcoming events. This incorporates retrospective and prospective reviews.

• Reward clients with positive feedback for every successful attempt in following their schedules from their book.

• Applicability of their memory log books should be expanded to other domains client’s life. E.g. remembering to call relatives on their birthday could be recorded in memory book.

• Helpful to incorporate personal aspects of clients’ life. This would increase applicability of the memory notebook to client’s social interactions. E.g. client will be offered positive reinforcement for recording details about bringing pictures of family and actually remembering to complete this task.

Compensatory Strategies

Generalizability of the memory book:• This is accomplished by training clients’ families and friends

they become acquainted with the application of the notebook more likely to offer support and positive feedback More equipped in assisting the client to generalize the notebook to other aspects of client’s life through cues to write down information for future reference.

Using the book at home may include recording when bills are due, repairs that need to be completed, household chores and medications.

At work the book may be used to record times of meetings, daily job tasks, assignments to be completed by specific due dates and so on.

Compensatory Strategies

Benefits of using memory books:(Fluharty, G. & Priddy, D., 1993).• Helps clients in recalling important events, keeping

appointments, running errands, and remembering to complete household chores.

• Effective in compensating for prospective memory deficits.(Harrel, M., Parente, F., Bellingrath,E., G. & Lisicia, K., A.,

1992 ).• Makes a client a more active listener because you are writing info

down. • Facilitates encoding process via multisensory modalities. such as

hearing the info, seeing it written down, and using motor functions to write it down

• It also avoids repetition of info, reducing boredom and potential distraction.

Compensatory StrategiesLimitations of using memory Books:Glitsky, E. L., & Schacter, D. L. (1986). • Passive cues as opposed to active• Notebook has to be constantly referred to. • learning or remembering to use them (Donaughy, S. & Williams, W., 1998).• Using memory notebooks require extensive training. • Acquisition phase entails client having to acquire new

semantic information. This is difficult for brain injury patients.

• Patients are not happy with the requirement of having to flip frequently between sections of Calendar, Things to Do, and Memory Log for each referral.

Compensatory StrategiesNeuropagers: B. A., Evans,J. J., Emslie, H. & Malinek, V. (1997).• Portable paging system with a screen that is attached to

the waist belt. • Connected to an array of microcomputers that is linked to a

paging company via a conventional computer memory and by telephone

• Scheduling of cues or reminders for each individual are keyed into the computer.

• At a specified date and time the reminder is transmitted to the individual.

• Purpose of pagers is to offer assistance to patients with prospective memory deficits. The practice of using pagers enables patients to follow a routine consistently. As they practice using the same routine on a day to day basis, eventually the patients commit this routine to procedural memory.

Compensatory StrategiesEfficacy of neuropagers:B. A., Evans,J. J., Emslie, H. & Malinek, V. (1997). Evaluation of

NeuroPage: a new memory aid. Journal of Neurology, Neurosurgery and Psychiatry, 63, 113-115

Purpose: to evaluate the efficacy of neuropagersPopulation: Selected 15 participants with organic memory

impairments. Most (12) subjects were living at home with their families, one subject was living alone, one was in long term residential care, and one in an acute hospital at the start of the trial, and living alone after discharge. None of the subjects were in paid employment. All the participants displayed memory problems with respect to performance in daily activities during the baseline phase of the study

Compensatory StrategiesEfficacy of neuropagers (cont’d):

Procedure:• An ABA design to evaluate the success of NeuroPage. The first A

phase was the baseline, the B phase signified the treatment, and the second A phase was the post-treatment baseline.

• The programmed reminders that were commonly used by all patients were:– good morning, it is (day, date)– take your medication now; – fill in your diary; – don't forget to take your (keys/bag/stick/folders, etc), – make your packed lunch.

Compensatory Strategies

Procedure (cont’d):During the first two to six weeks baseline

data clients’ abilities to remember different tasks was collected.

The nature of the baselines depended on the particular problem. So, for example, remembering to take medication was usually recorded as "number of minutes late"; remembering to attend a clinic was recorded as "yes" or "no"; and remembering to switch off a number of appliances every day was recorded as "percentage of appliances remembered".

Compensatory Strategies

Procedure (cont’d):B phase:(treatment) data were collected for 12 weeksfor each

subject. Reminders for the targeted problems were sent out at

times specified by the subject. Success or failure was recorded in the same way as the

baseline phase.Post-baseline (second A phase): Lasted for three weeks the pager was removed and recordings were taken to

determine whether the participants’ performance reached their initial baseline levels or not.

Compensatory StrategiesResults:All the participants showed improvement in their performance. The mean success rate for all participants was 37.08 (SD 24.86) and the

mean success in the treatment phase was 85.56( SD 18.58)For some subjects there was rapid improvement from total failure to complete success.

For other subjects performance was still considered to be poor

even when it though it was above baseline performance. The mean % success in the post-treatment phase was 74.46. The group has a whole displayed more

success in remembering to do tasks without the

assistance of memory aids in the posttreatment phase.

Compensatory Strategies

Results (cont’d):Variation were reported in the posttreatment performance.Some subjects did not exhibit any decline in their performance Some subjects’ performance fell drastically to pretreatment

levels. Discussion:Specified length of time to use the neuropager is debatable. The researchers suspect that the efficacy of nueropagers is

reliant on the presence or absence of executive deficits.Further research is suggested

Compensatory StrategiesBenefits of using neuropagers: (Wilson,B. A., Evans,J. J., Emslie,

H. & Malinek, V., 1997) • Apart from initial programming, no other commands or

programs have to be computed.• Very easy to use.• It is small and portable so it avoids problems of existing

aids such as cumbersome computers.• Possess option of an audible alarm that can be modified to

vibrate coupled with a verbal message displaying on the screen.

• They are used typically when other memory interventions fail.

• Have the potential to enhance independence and employability, speed discharge from acute and rehabilitation services, and reduce stress.

• NeuroPage is also likely to be cost effective for health services.

Critical review of all three interventions

Glitsky, E. L., & Schacter, D. L. (1986)Practice Drills:• No empirical evidence suggested that rehearsal and

repetitive practice would eventually restore impaired memory.

• No evidence suggests that this technique is generalizable to other tasks, and situations.

• Even with the advent of microcomputers, it has not shown to augment overall memory functioning.

Mnemonic training:• Several studies have demonstrated that these techniques

are not generalizable to any situation even in the laboratory setting

• Outside the laboratory setting there are very few opportunities for implementing this strategy.

• Imagery mnemonics are reported to be difficult to learn

Critical review of all three interventions

• Glitsky and Schacter claim amongst most patients, external aids seem to be a more popular tool of memory intervention than drills and mnemonic strategy.

• Compensatory strategies are seen to be more effectual and simpler in expanding memory capacity as they have internal stores.

• Many people prefer memory aids even after training. • Many neurologically intact people rely on external memory

aids such as lists, appointment books. • The training required to train patients to use the aids are

far simpler than mnemonic training. • Individuals are trained to use these in everyday situations,

they find it easier to generalize it to other situations

Things to Consider

About the Client(1) Dimension, type, severity, and chronicity of memory impairment (2) Age, Education(3) Pre-morbid knowledge and skills(4) Other difficulties (physical, behavioural, cognitive)(5) Current daily routine(6) Context where the client will do his/her

occupations(7) Awareness of own difficulties

Things to Consider

As a Therapist(1) Sensitive to client’s wishes on which memory aid to use(2) Educate clients (3) Caregivers need to be closely involved in the process (4) Teach meta-memory and problem solving skills(5) Utilize the external environment and everyday routines to anchor strategies(6) Help make it meaningful to the client

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