Neuropsychology and Models of Memory Flashcards
3 Components of Memory
-Encoding - how memory gets in
-Storage - capacity to hold memory
Retrieval - Pulling memory back out
Define Memory Encoding and how it can be improved
Encoding - How memory gets in!
- can be improved by providing more contextual information in the beginning
- can be improved by allowed more time for encoding
- improved when providing important information across multiple domains (verbal, visual, tactile)
Define Memory Storage and what it contains
Storage- capacity to hold memory!
- fixed phenomenon
- can hold 3-4 at a time
- decreased with injury in neurodegenerative conditions
- storage is reduced with certain conditions
- IS NOT DIRECTLY changed by OTs
Define Memory Retrieval and how it can be improved
Retrieval - How memory gets back out!
- can be improved with environmental cues (checklists, cues)
- Can be improved by allowing increased time to recall information
- improved when providing options of possible answers (AKA recognition memory)
Memory Retrieval Strategies:
3 types of recall
Free Recall - Hardest
- “What did you do today?”
- Needs to come up with the answer correctly on their own
Cued Recall - Easier
- “What did you eat for breakfast today?”
- Specific cue, or verbal
- Environmental cues may cue recall
Recognition- Easiest
- “Did you have cereal or eggs for breakfast today?”
- Have to know the correct answer
- Can include an accurate reporter (family member) but must know the answer
Retrospective Memory (THE PAST)
What is it? Memory from “THE PAST”
- Short-term - trying to remember something over a brief period of time and you forget (looking up a phone number and trying to remember it to dial it up)
- Personal - cannot remember information personal to you (forgetting names of people you know, where you left your keys, a message you were told, or events from your past)
- Fact-based - cannot remember factual information for quizzes, tests, or trivia (forgetting presidents name during covid)
Prospective Memory (THE FUTURE)
What is it? Remembering to do something in “THE FUTURE”
**most common - know where the checklist is and remember to use the checklist for the task
- Activity - When you fail to remember to do something after completing a different activity (Forgetting to attach a document when you finish writing an email)
- Time - When you fail to go to meeting or appointment at a predefined time (forgetting to cook dinner at 7 pm, forgetting to go to meeting at 2 pm)
- Event - when you fail to attend an event, or when you fail to remember to do something tied to an environmental event (forgetting to go to your friend’s birthday party, or get a card for the party)
Memory Impairment
Prospective vs Retrospective
-population
-best intervention option
- prospective memory is most frequently impaired in clients following ABI or neurological conditions
- retrospective memory problems (event and personal) for patients with dementia or severe TBI
- Compensatory interventions for retrospective
- Environmental modifications and external aids for prospective memory loss
Assessments for Memory Impairments (5)
- Neuropsychology Assessment
- Rivermead Behavioral Memory Test
- Contextual Memory Test (OT based)
- Everyday Memory Questionnaire - (self-report)
- Prospective Memory Test (self-report)
Assessments for Memory Impairments:
(1) Neuropsychology Assessment
N-Back - utilized in children in school
Wechsler Memory Scale - commonly given to school children, part of neuropsychology report.
-Rate/observation of performance in school
California Verbal Learning Test (CVLT)
-memory specific words, very language, likely to be given by SLP but needs to be understood by OT
Assessments for Memory Impairments:
(2) Rivermead Behavioral Memory Test
**Not typically given by OTs
**Gold standard memory test
Assess - Immediate memory, delayed memory, observation of simulated task performance
-Paper-pencil test
Cost: $500
Immediate Memory Tasks Components
- Story - a story is read and they have to recall it immediately
- Route - The examiner shows a route to walk around the room and then asks the person to demonstrate it
- Messages - The person is required to take a message and book with them when they demonstrate the route and put them in the same place that the examiner did
- Novel Task - the person uses different colored pieces to make a shape as demonstrated by examiner
Delayed Memory Tasks
First/Second Names - two portraits are shown and asked to remember the first and second names of both people in the photo
Belongings- two possessions belonging to the person are borrowed and hidden
Appointments - alarm is set, person is required to ask some specified questions when alarm sounds
Picture Recognition - person is shown a set of pictures and then asked to recognize them from a further set of pictures at a later time
Face Recognition - shown set of faces, then asked to recognize them at a later time
Assessments for Memory Impairments:
(3) Contextual Memory Test
**OT specific, dynamic assessment (Toglia)
Evaluation Components:
-Awareness of memory - uses self-predict and self-assessment of task performance
- Actual Memory - immediate and delayed (15 minute) recall of 20 line drawings
- -Procedures for both recall and recognition memory
- -Remember as many photos as they can
-Strategy Use - meta-cognition strategies; ask about strategies spontaneously used by client; provide client with a theme strategy to see how well it works
Assessments for Memory Impairments:
(4) Everyday Memory Questionnaire
- *Self-report
- *Requires good level of insight
Long and short forms available
Cost: Free
Time: 10 minutes
Easy to use
Sections:
- Speech (forgetting names, conversation detail)
- Reading/writing
- Faces/places (routes)
- Actions (routes)
- Learning New Things
Assessments for Memory Impairments:
(5) Prospective and Retrospective Memory Questionnaire
- *Self-report
- *Requires insight
- *can also get caregiver report to compare with client report
Examines Prospective vs Retrospective memory (future and past)
Examines Short vs Long term memory (10 minutes vs 15 years)
Examines Self vs environmental Cues (spontaneously on my own vs something in environment)
Cost: Free
Time: 10 Minutes
self-reports tend to be more useful in outpatient - require patient to go get some experience first - acute and inpatient is a bit challenging for this assessment
Alternate Presentations of Memory Impairments
Client may report:
- being tired all the time
- feeling slow
- loosen interest in favorite tasks
- seem difficult to engage in activity/conversation
- may be easily distracted
these comments may also reflect difficulties with attention, EF, and/or processing speed
Remedial Interventions for Memory
**Not typically done by OTs
-Computerized software programs - propose to increase working memory performance following ABI
**Often done by neuropsychologists and may be seen in outpatient or day programs
**NOT appropriate source of therapy and billing for OT
**Limited evidence
TAKE HOME MESSAGE: Use compensatory techniques and NOT remedial for memory impairments!
Compensatory Strategies for Memory
Internal Strategies - ways person approaches or think about problems
–includes mnemonics (memory encoding) and Chaining, spaced retrieval (memory encoding and retrieval)
External Strategies - devices or techniques that can be used to cue memory performance
–includes memory books (memory retrieval) and electronic devices (memory retrieval)
Mnemonic Strategies (VERBAL) for Memory
**Form of Internal Strategy
-Rhymes, Songs, Stories, Acronyms
Problem: If a person has memory problems these can be really hard to learn for new material
-also only useful for coding few pieces of information they will need to use a lot (home address, therapist’s name, etc.)
Mnemonic Strategies (VISUAL) for Memory
Method of Loci
- imagine a place you know well
- imagine items/objects you are trying to remember placed around the room
- Walk around placing/retrieving the items
Visual Pegboard
-Visualized lined up items on a counter
Visual Link
- try to create relationship between the to be remembered items
- *EX: banana, cat = think of a cat eating a banana
What are the 3 types of Teaching Techniques for Memory Impairment
- Errorless Learning for SEVERE memory impairments
- Chaining Techniques for IADL performance and MODERATE memory impairments
- Spaced Retrieval if a client best for verbal information to be learned when done with simple motor activities.
Teaching Techniques for Memory Impairments:
Errorless Learning
- Errorless Learning (Neurofunctional approach)
- clients with memory impairment likely to remember their mistake = STOP THIS
USE When:
- Appropriate for hands on activities (to learn)
- self-care
- ADL performance
- SEVERE memory impairment
Teaching Techniques for Memory Impairments:
Chaining
- Chaining Techniques
**Requires task to be done the same way every time!
USE When:
- tasks with multiple steps and some motor components
- IADL performance
- MODERATE memory impairment
Definition: Break task into steps to be accomplished. Previous steps are used to cue current step. (seeing the tea bag in cup cues person to pour water)
- Forward Chaining
- more successful for clients with severe memory loss
- requires less reorganization of steps
- requires less understanding of end goal of activity - Backward Chaining
- require more time to learn a task for clients with severe memory loss
- motivation to engage in task is higher because end goals is achieved during every trial
- use errorless learning techniques in conjunction
**Very typical in OT sessions –> teaching a child to tie their shoes, child becomes adept at the last step first, then slowly takes on more responsibility for other steps which are harder
Teaching Techniques for Memory Impairments:
Spaced Retrieval
- Spaced Retrieval
Done at several time points:
- immediate - identical to errorless learning
- 15 second delay
- 30 second delay
**delay period can be increased as client is successful
**If incorrect after delay, provide corrective information and test again as errorless learning
USE when:
- client already learned through errorless learning
- works best for verbal information to be learned but can be done with simple motor activities
**Record time delays and accuracy to form a record over time of how well it is working
External Aids and Task Specific Aids
- Can be more or less technologically advanced
- Broad overall external 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
Considerations for External Memory Aids
Organic vs Personal Factors
Organic Factors
- Severity of client’s cognitive or memory deficits (mild, moderate, severe)
- Any potentiation physical impairments (visual, sensory, or motor difficulties)
**consider how the client can interact with aid or device
**someone with visual impairment = no phone as an aid
Personal Factors
- Client experience with aid
- Preference for types
- What is the main goal?
- What are they trying to get out of this therapy?
2 types of External Memory Aids
Orientation Book Vs Memory Notebook
- Orientation Book
- SEVERE memory impairments
- Autobiography orientation page include PERMANENT information - important info, phone numbers, injury info
- ONLY include few pieces of information
- Memory Notebook
- Best for MILD to MODERATE memory impairment
- requires client recognition of impairment to daily life
- Components include:
–Daily Schedule (staff –> patient with cueing –> patient independently
–Memory Log (client checks off events that happened; may need cueing
–To Do List (add new things, should be checked by someone)
External Memory Aids
Orientation Book vs Memory Notebook
Orientation Book
- severe memory impairments
- includes less information
- for permanent or semi-permanent information
- information is likely to be added by others
- GOAL: client use to find needed information
Memory Notebook
- mild to moderate memory impairment
- includes more information
- information is likely updated on a daily basis
- information is likely created/added by client
- GOAL: client become independent in using the external device to manage memory impairment
Tips for using daily memory notebook system
- put book in HIGH TRAFFIC AREAS so client will use it more likely
- make a plan to check the book frequently, at least 3 times a day
- educate family members who can help with cues and reminders to enter information into the book or to check book for additional information
- Integrate an alarm - watch, cell phone, etc. to remind to check the notebook
Electronic Aids for Memory
-Cell phone - alarms, note taking features, calendars
Others:
- Voice organizers - record goals, set alarms to remind you of goals
- Timers - particularly useful in kitchen with safety concerns
- Smart pens - will record pen strokes to make an audio recording of written information
**more appropriate for clients who only need help with one or two specific tasks or clients with little to no experience with cell phones
Low-Tech Options for memory aid
- Post-it notes
- Mail sorters
- Calendars
- Large dry erase boards
- Written Lists
**BETTER when located near the task
Environmental Modifications for Memory Aid
- Labels/pictures on drawers/doors to identify contents - if client has trouble finding items = not really good
- Bright consistent locations - keys on pegboard, in a bowl by the door; shoes on rack = better option
- Back up items may be needed - extra glasses or keys
- Use checklists, written instructions
- Reduce noise and clutter environments
