AbstractAcquired memory impairment commonly occurs after acquired brain injury such as traumatic brain injury, stroke, seizure disorder and encephalitis and is one the defining features of progressive disorders, such as Alzheimer’s disease. There is a growing body of knowledge about the use of compensatory memory aids in the rehabilitation of memory disorders. This study investigated the effect of the systematic training of compensatory memory aids on everyday memory performance within a Memory Aids Clinic, a specialised outpatient clinic which supplied and trained the use of memory aids.
A comparison was made between subjects with acquired memory disorders in a
treatment group (n=63) and control group (n = 28) in a between subjects design. All subjects underwent a baseline session which was comprised of a neuropsychological assessment, clinical interview and goal setting session. Treatment subjects then underwent three training sessions, matching memory aids to goals, across a six week period. Training was based upon Sohlberg and Mateer’s (1989) application, acquisition and adaptation program. A follow-up session was conducted 12 weeks after the conclusion of training and included a review neuropsychological assessment and interview. Following the baseline session, control subjects were given written information about the management of memory problems and placed on an 18 week waiting list, prior to the three treatment sessions. The main outcome measure was everyday memory performance as assessed by a memory goal attainment diary. This
was administered at baseline, the end of training and at the follow-up session.
Outcome was also measured in terms of neuropsychological performance and
performance on measures of mood, self-esteem, subjective memory performance, participation and carer strain. Generalisation was measured in terms of performance on a Problem Solving Inventory, a list of hypothetical memory scenarios which was developed for this study.
The systematic training of memory aids in a Memory Aids Clinic was effective in
improving everyday memory performance, but only across timefrom the end of
training to follow-up. A significant difference in goal attainment was evident between the treatment and control group at follow-up but not at the end of training. Further analysis confirmed a significant treatment effect for participants with a non-progressive condition but not a progressive condition. This pattern is further illustrated by a series of case reports describing in detail the training content in the Memory Aids Clinic for both non-progressive and progressive subjects. In contrast to previous literature, there were no demographic or neuropsychological profile predictors of outcome in the current study. In addition, training in the Memory Aids Clinic did not impact upon the psychosocial measures of mood, self-esteem, participation, subjective memory function or carer strain. The treatment effect did generalise to the Problem Solving Inventory, notably for subjects with a progressive condition, suggesting adaptation of training to similar but diverse memory scenarios.
Systematic training within the setting of a Memory Aids Clinic is beneficial for individuals with acquired memory problems as a consequence of a non-progressive condition. Improvement in everyday memory performance was attained with three training sessions and maintained across time. Training requires matching the memory aid to the client’s goals and scope remains for extension of training to encompass awareness of when to use the memory aid and acceptance of memory problems. Whilst the current results indicated that individuals with progressive memory disorders did not benefit from training in the Memory Aids Clinic, it is premature to suggest that this group cannot benefit from the use of memory aids. Additional training sessions may be required to facilitate generalisation into the home environment, to enhance the use of a significant other as co-therapist and to consolidate initial gains. A different and more general approach to using memory strategies including compensatory aids may be more beneficial in this group given more widespread and severe cognitive impairments. Finally, the results of the current study highlight the need for ecologically valid measures of outcome, including appropriate tools to determine self-efficacy and participation.
|Date of Award||2014|
|Supervisor||Michael Kopelman (Supervisor)|