Memory Notebooks & Other Strategies

Rebuilding Your Memory: Memory Notebooks & Other Strategies Kaleena Valente, M.A., CCC/SLP MetroHealth Rehabilitation Institute of Ohio Cleveland, 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 page Monday, 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, todo 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 Wrist PDA

Casio 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