Rebuilding Your Memory: Memory Notebooks & Other

StrategiesKaleena Valente, M.A., CCC/SLP

MetroHealth Rehabilitation Institute of OhioCleveland, Ohio

November 1, 2010

Common memory problems after TBI Short term and recent memory

– Names and faces– Details and sequences during the day– Information that someone told you

Declarative memory– Knowledge base (storage of events, facts, words)

Prospective memory– Remembering to complete a task in the near future– Future appointments

The memory process

Attention Encoding

– It can be described as “understanding” the information

Storage– Transferring of information to a specific area

of the brain Retrieval

– Searching for existing memory traces

The memory process

Memory failure– Can be attributed to one of these processes

• Encoding• Storage • Retrieval

Types of memory– Procedural—implicit, nondeclarative, automatic

(routines)– Semantic—explicit, declarative, encyclopedic

knowledge (facts)– Episodic—explicit, declarative, you remember the

event

Brain Injury and memory

One or more of these areas of memory and attention are often affected following a brain injury

Using compensatory strategies such as a memory book, planner, self-talk, mnemonics, etc can be very effective in targeting these different stages of the memory process.

Common Memory Problems After a Brain Injury

Difficulty recalling: – Names– Items – Events– Personal information– Phone calls– Conversations

Evidence based practice of external memory aids (Sohlberg et al, 2007)

19 studies with 270 subjects (Mostly young adults)

Every study showed a positive treatment effect

Evidence did not show: – Which strategies worked for which patients– How to best assess and train people in use of

strategies

Evidence-based practice for memory aids Clinical recommendation from researchers noted

that external memory aids may be considered a practice guideline for individuals with TBI.

Kennedy, 2007

Technical reports from ASHA for several treatment modules are near completion that include the reports on training external memory aids.

ASHA, 2008

External memory strategies

Compensatory (versus restorative) strategy.

Can be used for one domain (one specific use) or can be used for a set of tasks.

Goal: Rely on preserved memory processes (non declarative memory) to learn a new procedure such as using memory aids.

Considerations when selecting an external memory aid

Needs assessment– Organic factors

• Severity of cognitive or memory deficits• Physical profile (are there physical limitations…

such as visual or motor difficulties?)

– Personal factors• Have they used a planner before? What kind?• What is their preference?• What is their goal? (manage daily activities, return

to school or work)

Examples of external memory aids Written planning systems (planners, notebooks,

calendars) Electronic planners (PDA, Blackberry, cell

phone) Computer based planning systems (Outlook) Task specific aids:

– Memo pads– Post-it notes– Pill box– Key finder– Bulletin boards/Dry erase boards– Grocery lists

Memory Notebook System

Improves orientation Helps with recall of past, present and

future information Improves planning of tasks Can be tailored to the individual

Sample pageMonday, November 1, 2010

Appointments/Scheduled Activities: 9:15am—Brain Injury Conference 5:00pm—Hair cut 6:00pm—Dinner at Applebee's with Barb

To Do: Call about water bill Schedule cable TV installation

Log:Saw a very old friend of mine at the Conference today (Barb

Smith). She lives in Dayton (phone #: 937-555-1234). On my way home from dinner I was pulled over by a state

trooper because one of my headlights is burned out. I’ll have to schedule an appointment to get it fixed tomorrow!

Tips for using a daily memory notebook system

Put the book in a high traffic area so you’ll be more likely to use it or look at it.

Check the book frequently—plan on looking at the book at least 3 times per day.

Family members can help with cues and reminders.

Set an alarm (watch, cell phone, kitchen timer) as a reminder to check notebook.

More tips for using a daily memory notebook system

Clinicians: start with orientation goals and progress towards higher level tasks (think errorless learning!)

Clinicians: a questionnaire can be used to check understanding of planner usage.

Electronic aids

BlackBerry’s, PDAs, even iPods. These devices often have calendars, to-

do lists and note features.

Blackberry iPod touch PDA

Electronic aids

Even cell phones can have alarm and calendar features.

Many of these electronic devices can be hooked up with your computer, making it even easier to manage your calendar, appointments, to-dos, etc.

Through gmail, you can set up a calendar and have reminders text messaged to your phone.

Other Electronic Resources

Voice Organizers– Record goals, set alarms to

remind you of goals

Timers

Smart Pens– Will record pen strokes and audio

More Electronic Resources

Reminder Watches

Timex USB Data Link Watchminder 2 Fossil Palm CasioWrist PDA Databank

Specialized Devices

The Jogger– www.thejogger.com

Pocket Endeavor

PEAT– www.brainaid.com

Other memory aids

Pill reminder boxes (can also be purchased with alarms)

Appliances and lights with automatic shut-off features

Beeping key chains Key hooks by the door Post-it notes Mail Sorters Calendars Large dry erase boards

Beyond memory notebooks

Utilizing other strategies to assist with our memories.

Strategies for recalling:– Names– Items– Events– Phone calls

Recalling Names

When meeting someone new, repeat the person’s name as soon as it’s said.

Ask the person to spell his or her first or last name, even if it’s easy to spell.

When you leave a situation when you’ve just met someone, end the conversation by saying the person’s name

Recalling Names

As soon as you leave, jot down the person’s name, where and when you met, and the person’s features. When you are going to be with this person again, review your notes first.

Before leaving to meet this person again, make up a sentence that includes names and places to remember and say it out loud.

Recalling Names

Try to focus on one key feature to aid in recall. For example, Mr. Bush has bushy eyebrows.

Activity

Find a partner. It needs to be someone you do not know.

Introduce yourself. Focus on one feature of your new

acquaintance and make up a sentence to remember his/her name.

Any volunteers to introduce your new acquaintance?

Items

Keep things in the same place at all times, such as keys hanging on a hook by the door, an address book and stamps in a drawer by the phone, scissors in a sewing box, etc.

Establish a spot or box near the door to place objects you need to take with you, such as memory books, keys, wallets, packages, umbrellas, etc.

Items

Make up a silly sentence that includes items to remember and say it out loud. For example, “Pour detergent on the bananas in the envelopes” to remember to buy detergent, bananas and envelopes at the store.

Items

Mnemonics may be used to help you with recalling lists. Never Eat Sour Watermelons HOMES to remember the Great Lakes

To remember where your car is parked, look for permanent visual cues and describe them out loud.

Events

Do activities on the same day each week or month. For example, pay bills on the last day of the month, go to the bank every Wednesday, to go the grocery store every Tuesday, go to therapy on the same days each week, etc.

Use direct deposit and direct bill paying services, available through your bank, to ensure that your checks are deposited and that important bills are paid on time.

Events

Use verbal rehearsal to help you remember things as you do them. For example, “I’m putting the scissors in the top drawer so the baby can’t reach them” or “I’m checking the burners on the stove and turning on the porch light before I go upstairs.”

This will improve your attention to the task and help to move this information into your memory

Telephone Use

Keep a notebook by your phone and keep a log of who called, what time, and what each person wanted. Also keep track of calls you made, who you called and what time. – You can also keep this log in your memory notebook

When you take a phone message, write down the most important information. – First: write down the caller’s name and phone number. – Second write down the date and the time. – Third, write down the content of the message.

Conversations

During conversations, comment on what the other people are saying. Restate their comments in your own words. Actively participating in the discussion will help you remember the main points of the conversation later.

Routines

Low demands on working memory Capitalizes on implicit learning Reduced demands on executive functions Procedural memory (the memory to

complete routines) is the last type of memory we lose

Remember

Reduce demands on your brain!– Write things down, use your strategies, find

ways to manage stress

Practice makes perfect Out of sight out of mind