Difficulties with thinking skills are common consequences of ABI and are implicated in poor educational outcomes and reduced achievement of everyday activities (Wright and Limond, 2004; Limond, Adlam, and Cormack 2014). Learning and recalling information is particularly important for developing independence, educational and vocational outcomes, and long term emotional functioning (Wright and Limond, 2004). There are three stages of learning and memory (see diagram). Memory can fail when we have difficulties with any one or more of these stages.
Considerations for intervention
Children with a brain injury may have a unique pattern of memory difficulties. Sometimes they may appear to have everyday memory difficulties due to underlying issues with concentration or processing speed (e.g. difficulty remembering instructions because they weren’t listening to all instructions). Some examples of memory difficulties in a therapeutic setting are listed below.
- Difficulty following instructions, and needing repetition.
- Forgetting requirements such as homework tasks.
- Taking a long time to learn new skills.
- Forgetting information that was given a few minutes ago.
- Difficulty recalling information when asked.
Ideas to help support memory in therapy
- Limit the amount of information given at any one time.
- Encourage the child to ask for information if they have trouble understanding it or have missed hearing it.
- Check how much they have learned by asking them to repeat the information before moving onto the next task.
- Link new information to things they have learnt before.
- When the child has difficulty recalling the information, give prompts before providing the answer.
Recommended Treatment Approaches
Memory rehabilitation can include either restoration techniques or compensatory techniques.
- Restoration: Refers to cognitive techniques (e.g. internal strategies such as visual imagery, rehearsal techniques) that may promote natural recovery or reduce a primary memory deficit over time (Schaffer and Geva, 2015; Sohlberg and Mateer, 2001).
- Compensation: Refers to techniques that allow the individual to circumvent memory difficulties by relying on intact cognitive functions, using external aids and modifying the environment (Schaffer and Geva, 2015; Wilson, Gracey, Evans and Bateman, 2010). Compensatory techniques have been found to be the most effective at minimizing the impact of memory problems (Cappa et al., 2005; Schaffer and Geva, 2015).
Unfortunately, there is limited evidence for “brain training”, computer-based interventions, or “cognitive training” for persons with an ABI. Most research suggests that these programs lack scientific efficacy and/or have limited transfer of skills to real world setting or effect enduring change in memory skills (Rossignoli-Palomeque, Hernandez and Gonzales-Marques, 2018)
Memory strategies can be divided into ‘internal’ or ‘external’ strategies.
- Internal: Internal strategies include cognitive compensation (e.g. using visual memory to compensate for verbal memory difficulties), and strategies to enhance encoding of new information (e.g. spaced retrieval).
- External: External strategies include aids to assist with retrieval of information (e.g. diaries, alarms) and environmental modifications (e.g. reducing distractions in the individual’s workspace).
When are they useful?
- When there are interfering activities between encoding and recall (e.g. having to remember to buy groceries after work).
- When there is a long time between encoding and recall (e.g. needing to make a doctor’s appointment two months in the future).
- When internal aids are not trusted to be sufficiently reliable (such as when precise details need to be remembered, or there is strict timing that must be adhered to – e.g. when to check cake in the oven).
- When information is difficult, and doesn’t cohere easily.
- When there is insufficient time to properly encode the information.
- When memory load is to be avoided (such as when you are attending to more than one activity).
Key things to remember for memory interventions
- Keep in mind the impact of other thinking skills on everyday memory. For instance, attention, processing speed, and executive functioning can impact a person’s ability to remember information. It might be that you need to support these skills to achieve improved memory skills.
- Anxiety and tiredness can impact memory, so encourage the young person to be positive, reduce their stress, take regular breaks and to do important tasks in the morning when they are less likely to be fatigued. If they do forget something, encourage them not to be too upset – everyone forgets things!
- Organisation is important for memory so encourage the young person to keep to a fixed schedule such as doing things at the same time of day and on set days of the week. Creating systems is also helpful (such as having places for everything and putting things back in their correct place).
- If something needs to be done, then encourage the young person to do it when they remember rather than waiting until later to do it.
- If they need to remember information such as a message or a name, then encourage them to go over it in their mind at regular intervals. Rehearsing increases the likelihood of remembering.
- Try to get the young person to find meaning in things they need to remember (e.g. making associations).
- Use memory aids to help the young person remember to do things at the right time (e.g. whiteboards, post-it notes, diaries, calendars, mobile phones and alarms).
Limond, J., Adlam, A-L.R., and Cormack, M. (2014). A model for pediatric neurocognitive interventions: Considering the role and development and maturation in rehabilitation planning. The clinical neuropsychologist, 28(2), 181-198.
Rossignoli-Palomeque, T., Perez-Hernandez, E., and Gonzales-Marques. (2018). Brain training in children and adolescents: Is it scientifically valid? Frontiers in Psychology, 9 (565) 10.3389/fpsyg.2018.00565
Schaffer, Y and Geva, R. (2015): Memory outcomes following cognitive interventions in children with neurological deficits: A review with a focus on under-studied populations. Neuropsychological Rehabilitation, 26(2), 1-32. doi: 10.180/09602011.2015.1016537.
Sohlberg, M.M., and Mateer, C.A. (2001). Cognitive rehabilitation: An intergrative neuropsychological approach. New York: Guildford Press
Wilson, B.A. (2009). Memory Rehabilitation: Integrating Theory and Practice. New York: Guildford Press.
Wilson, B.A., Gracey, F., Evans, J.J. and Bateman, A. (2010). Neuropsychological Rehabilitation: Theory, Models, Therapy & Outcomes. Cambridge University Press. doi: https://doi.org/10.1017/CBO9780511581083
Wright, I., and Limond, J. (2004). A developmental framework for memory rehabilitation in children. Pediatric Rehabilitation, 7(2), 85-96.
Queensland Paediatric Rehabilitation Service
Queensland Children’s Hospital
Level 6, 501 Stanley Street, South Brisbane 4101
t: 07 3068 2950
t: 07 3068 1111 (general enquiries)
f: 07 3068 3909