Transcript Memory Interventions

Memory Intervention
Presented by:
Lauren Hershfield
Ahuva Katzman
Shira Tenenbaum
Melanie Teplinsky
Presentation Outline
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Introduction to memory
Memory interventions
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Restorative approach
Domain specific approach
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Errorless learning
External Aids
Making the most of our memory
Tips for teaching memory
Choosing the best intervention
Memory
Human memory can most broadly
be defined as a function of the
brain that gives us our ability to
store and retrieve information.
(Wilson, 1991)
Processing Stages of Memory
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Analogous to a computer system
Input stage: Information must be fed into
the system. (attention and encoding)
Storage stage: Maintaining information in
memory over time.
Retrieval Stage: Recovering information
from memory stores.
(Pinel, 2003, Sohlberg & Mateer, 2001)
Short Term Memory
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Storage of limited information for a
restricted period of time.
Temporary holding information.
3-5 items, for up to a few minutes.
Long Term Memory
Preserving information for anything ranging from
minutes to years.
1. Declarative/Explicit Memory
Conscious knowledge base: “Learning That…”
a)
Semantic knowledge for the meanings of words
and how to apply them.
b)
Episodic memory: Unique knowledge of
personal experiences, tagged in time and place.
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(Sohlberg & Mateer, 2001; Reisberg, 1997)
Long Term Memory Cont’d…
2. Non Declarative
Memory/Procedural
• Occurs without conscious awareness:
“Learning How…”
• Memory storage of skills and
procedures
• Implicit knowledge
(Sohlberg & Mateer, 2001)
Memory Disorders
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Focal/Multi-focal:
 Gun shot.
Diffuse:
 Hypoxia/Ischemia (stroke,
cardiac/respiratory arrest)
 Korsakoff syndrome
 Alzheimers disease
 Non-penetrating head injuries (concussionpost traumatic amnesia)
Memory Interventions
Any intervention strategy or technique which
enables patients/clients and their families or
caregivers to live with, manage, by-pass,
reduce or come to terms with cognitive
deficits precipitated by injury in the brain
(Wilson, 1991)
Domains of Memory
Intervention
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Sohlberg and Mateer (2001) classify methods
of memory intervention into two main
categories
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Restorative/Generalized Memory Intervention
Domain-Specific Memory Intervention
A third domain for memory intervention
employs external aids, but this domain does
not fit clearly into either of the two
aforementioned domains
Types of Memory Intervention
Restorative/Generalized
1.
Memory Practice Drills
2.
Mnemonic Strategy
Training
3.
Metamemory Training
4.
Prospective Memory
Training
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4.
Domain-Specific
Mnemonic Strategy
Training (for specific
information)
Preserved Priming (i.e.,
Vanishing Cues)
Creating a Personal
History
Expanded Rehearsal
Time/Spaced Retrieval
Restorative Memory
Interventions
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Methods that aim to restore/improve
memory across various tasks and
contexts.
Memory Practice Drills
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Not much empirical support for this approach
Commonly used in clinical practice
Visible improvements may actually be due to
increases in attention ability rather than
memory ability
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Clients could complain of memory problems that
are actually secondary to attention deficits
Attention processes respond more favorably
to drills than memory functioning
Mnemonic Strategy Training
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Teaching clients to use this strategy was a
focus of early memory intervention literature
Examples include
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Visual imagery (most popular)
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Verbal organization strategies (e.g.,
forming acronyms; making paired
associations with target words)
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Semantic elaboration (e.g., linking target
words or ideas in a story)
Metamemory Training
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An intervention that uses the concept of
understanding ones own memory problems
Used for those who are not aware of their
memory deficits
One type of training method consists of
prediction exercises
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These involve helping clients compare predictions
with actual performance
Schlund (1999) showed that provision of feedback
on accuracy of predicted recall reduced variability
between self-reports and recall performance
Metamemory Training
Cont’d…
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Another method of metamemory training
involves teaching people self-instructional or
self-monitoring routines that will help them to
improve memory functioning
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Clients are taught to regulate behaviour via selftalk
Strategies can be used to help them review
material to be remembered in a way that will
increase the likelihood of recall
Metamemory Training
Cont’d…
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Self Monitoring techniques usually involve
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Providing external feedback on errors and
successes, with clients recording errors
Comparing performance across trials
Asking clients to verbalize their impressions
Some clients have shown great difficulty
generalizing these strategies and thus more
research is needed to improve these
techniques (Moffat, 1992)
Prospective Memory Training
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Prospective Memory Process Training (PROMPT)
 Clinician asks client to remember to carry out
target task in specified number of minutes
 Number of minutes increased after client
demonstrates repeated success at particular time
interval
 Over course of training clinician systematically
lengthens amount of time client can remember
and act on assigned task
Within this particular method of training there are a
number of variables that could possibly be altered
Prospective Memory Training
Cont’d…
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Task variables that may be altered include
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Type of prospective memory task (e.g., one-step
motor command vs. multistep)
Time delay (i.e., number of minutes between task
administration and execution)
Distracter task during time delay (e.g., sit quietly
vs. math sheet)
Associated prompts to initiate task (e.g., alarm vs.
requirement to monitor time independently)
Prospective Memory Training
Cont’d…
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To effectively employ PROMPT it is important
to follow these stages
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Alter only one task variable at a time
Observe the effects, and then
Wait for stable improvement before altering
another variable
Overall goal is to increase intervening delay
systematically as client’s prospective memory
lengthens
Prospective Memory Training
Cont’d…
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Most common method is to teach people to
use appointment books
Initial experiments suggest effects appear to
generalize across contexts and tasks
This technique is beneficial for clients with
severe memory disturbances who can encode
information but do not hold on to it, and who
have preserved procedural learning
Critical Review of Prospective
Memory Training
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Schmidt I. W., Berg I. J. and Deelman B. G. (2001). Prospective
Memory Training in Older Adults.
Study evaluates the results of a training program for
prospective remembering.
The goal of the study was to improve prospective
memory by associating cues from the retrieval
situation with the to be remembered information
At three month interval, control group had reached
same level of trained group
As well, training effects did not generalize to other
memory tasks or control measures.
Critical Review of Prospective
Memory Training
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Furst (1986); Sohlberg, White, Evans & Mateer,
(1992)
Found that effects of prospective memory training
were generalizable to real-world tasks and related
neuropsychological tests.
Controversy in the literature: Does prospective
memory training simply teach a behavior or skill or is
there is improvement in the underlying processes
that mediate acting on future intentions?
Domain-Specific Memory
Intervention
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Also referred to as compensatory strategies
Goal – to reduce problems associated with
memory impairment rather than restore
memory processes
Information learned has practical value
Purpose – to teach clients procedures so
they can access information independently
Examples of Domain Specific
Tasks
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Procedures for operating computer
Names of people or objects
Operating a wheelchair
Medication schedule
Types of Memory Intervention
Restorative/Generalized
1.
Memory Practice Drills
2.
Mnemonic Strategy
Training
3.
Metamemory Training
4.
Prospective Memory
Training
1.
2.
3.
4.
Domain-Specific
Mnemonic Strategy
Training (for specific
information)
Preserved Priming (i.e.,
Vanishing Cues)
Creating a Personal
History
Expanded Rehearsal
Time (i.e., Spaced
Retrieval)
Preserved Priming
Cues that prompt accurate recall
Example:
 500 University Ave  all of this
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information is initially presented
5_ _ _ _ _ _ _ _ _ _ _ _ _ _ _  1st
letter presented (if fail to produce
response, next letter added)
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50_ _ _ _ _ _ _ _ _ _ _ _ _ _
Preserved Priming Cont’d…
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An example of priming includes the “method
of vanishing cues”
Can be used to teach knowledge/behaviours
that might be used in everyday life
Client is provided with enough information to
give correct response and then parts of
information are gradually withdrawn
PRINT  PRIN  PRI  PR  P 
Creation of Personal History
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Used for clients with retrograde amnesia (loss
of events prior to injury)
Creation of autobiography using items such
as
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Written life history
Video composite of important people
Photographic life essay
Helps clients to relearn aspects of their
personal history
Expanded Rehearsal/Spaced
Retrieval
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Client practices recalling information
over increasingly longer periods of time
Spaced retrieval (SR) has been used to
teach clients to remember names of
common objects, to remember to
perform a future action, etc.
Advantages of SR
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(Camp & Stevens 1996)
Easily used by professionals and caregivers
Intervals between trials can easily be
incorporated into treatment sessions
Intervals between trials can be filled with
conversation or other tasks enjoyed by client
Participant receives a high degree of success
during each session
Errorless Learning
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Method of instruction that reduces errors in the
acquisition phase
Been suggested that if clients prevented from
committing errors during initial process, they will
learn more quickly and less likely to repeat their
errors
For example people with amnesia often remember
their own mistakes better than they remember the
corrections to their mistakes
The theory is that if the person is not given the
opportunity to make a mistake then there are no
mistakes to be remembered
Errorless Learning Controversy
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Baddeley and Wilson (1994) suggested
that EL enhances implicit memory
Tailby and Haslam (2003) showed that
it may actually employ explicit learning
Making Use of Compensatory
Strategies (Oddy & Cogan, 2004)
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Nature of original injury
Confabulation
Awareness of deficit and mood
Premorbid characteristics
The strategies
The family
Critical Appraisal of
Compensatory Training
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Jennetta & Lincoln (1991) argue that teaching
memory compensation strategies is time
consuming and benefits minimally compared
with the effort
In contrast, Wilson (1991) found evidence of
increased use of memory aids and
compensations by patients 5-10 years post
cerebral insult.
External Aids
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Favored mode of compensation across
non-disabled and disabled population
Means to reduce load on memory or
executive functioning so person can
carry out a task and get around
cognitive impairment
Involves teaching sets of behaviours
rather than retraining a process
Selecting an External Aid
1.
Clinician, client and other involved
parties must perform a needs
assessment which usually focuses on
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2.
Organic Factors
Personal Factors
Situational Factors
Clinician should have an appreciation
of available options for external aids
External Aid Options
Generic Aids
Written
Electronic
Computer Systems
Task Specific Aids Key finders
Car memo pads
Refrigerator pads,
grocery lists
Pill box reminders
Written Memory Aids
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Day Planners
Notebook divided into sections
Calendars
Appointment books
Memory books
Memory Books
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Facts about a person’s life they can share with others
and use to remember important events
Includes information on client history, family,
appointments, schedules, medications, daily meal
planners, telephone numbers.
Can reduce caregiver burden, as it provides a source
for individuals to obtain answers to questions
Andrews-Salvia, Roy, and Cameron (2003) study
supports the use of memory books for individuals
with dementia.
Electronic Memory Aids
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Watches
Dictaphone
Voice Organizer
Mobile Phones
Palm Pilots
“Blackberry”
Computerized Memory Aid
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Word processor
Telephone dialing software
Timex Data Link Watch
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Uses USB link and custom software
Schedule, phone/address, contacts (and it
also tells the time!)
Approx. $130
What do People use Currently?
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Evans, Wilson, Needham and Brentnall (2003)
Survey of 94 people with memory
impairment.
Most commonly used:
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Wall Calendar (72%)
Notebook (63.8%)
Lists (62%)
Diary (54.3%)
Asking others to remind (48.9%)
Only 7 out of 94 were using an electronic
device.
External Aids
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Benefits
Non Technological aids
 Easy to use and
teach
Technological Aids
 Alerting function
 Storage space
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Limitations
Non Technological aids
 Lack alerting
function
 Only work when
looking at them
Technological Aids
 Complex and may be
unfamiliar so
learning demands
are high
Making the Most of Our Memory
(CAOT)
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Keep a date book or calendar. Write down everything
that you have to remember to do.
Give yourself a visual cue to remember things
whenever possible
Use written “to do lists”. Keep the list in the same
spot all the time, and check it every day.
Keep your home organized and uncluttered
Have a routine way of doing certain activities to help
you remember everything that needs to be done
THE REALITY
INTERVENTIONS ARE NOT
CURE ALL!!
Tips for Teaching Memory
Strategies
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Teaching should be done one step at a time
It is better to draw images then to rely on
mental images.
Materials to be learned should be realistic and
relevant to the needs of the patient.
Therapists should also recognize that
individual patients have individual styles and
preferences when it comes to learning.
(Wilson, 1992)
Tips for Teaching Memory
Strategies Cont’d…
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Goals should be small and specific: ex: “ To
teach Mrs. A to check her notebook every half
hour.”
Measure the deficit in order to obtain a
satisfactory baseline
SIMPLIFY information
REDUCE amount of information
LINK new information to existing information
or schemas.
Case Study – A.B.
(Adapted from Kime, Lamb, & Wilson, 1996)
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24 year old woman with orthopaedic injuries following MVA
Requires assistance for clothing selection,cues to carry out
personal hygiene tasks, and direct supervision to assure
compliance with medication regime
Entered day hospital with goal of improving ability to
independently complete self-care and home-management tasks
Upon admission tests showed borderline range of ability on
immediate recall of narrative passages and simple designs
Ability to learn list of 16 words severely impaired
Showing signs of amnesia
Unable to remember where toilets located, names of various
therapists, purposes of different sessions, or having participated
in programme activities from day to day
Treatment Strategies Employed by
Kime, Lamb, and Wilson (1996)
1)
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Mnemonic Cues
Associated with photos of staff and patients
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She linked PT with her job (“Heather is healthy”)
Sometimes rhymed names (“Dennis plays
tennis”)
Each cue was written on cue card that
included her own associate drawings
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Practiced linking cues with names and was tested
daily
Treatment Strategies Employed by
Kime, Lamb, and Wilson (1996)
2) Creation of Personal History
 Collected photos in an album and
labeled them to mark events in which
she participated since her accident
Treatment Strategies Employed by
Kime, Lamb, and Wilson (1996)
3) External Aids
 Purchase of date-book and watch alarm
that chimed hourly to remind her to
refer to the date-book
 Written procedures were developed for
every multi-step task
 An eraser board with information for
tracking self-care and home duties
Questions and Discussion