Treating Memory and Learning in the Individual with Traumatic Brain Injury

This text-based course is a written transcript of the course, "Treating Memory and Learning in the Individual with Traumatic Brain Injury", presented by Victoria Harding on January 10 2011.

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This text is being provided in a rough draft format. Communication Access Real time Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.

>> Amy Natho: I would like to welcome everyone to the SpeechPathology.com e learning seminar entitled, "Treating Memory and Learning in the Individual with Traumatic Brain Injury." I am Amy Natho and I'll be your moderator. At this time, it is very much a pleasure and honor to introduce Victoria Harding. Tori Harding provides specialized program and location development for Neurorestorative and acts as the Clinical Projects Coordinator for Virginia NeuroCare, a Defense and Veterans Brain Injury Center program in Charlottesville, Virginia. Tori's primary research and clinical interests include outcome measurement in post-acute settings, the self efficacy mechanism in post-acute brain injury, neurogenic communication disorders, and family training for long-term success and family advocacy. As a speech language pathologist she works as a clinician and educator and a Certified Brain Injury Trainer, teaching through the Academy of Brain Injury Specialists. Currently a Ph.D. candidate at James Madison University, Tori received her Master's Degree of Business Administration at Plymouth State University and completed her Master's of Science in speech language pathology at Dalhousie University, Nova Scotia, Canada. Tori, welcome and thank you so much for being here with us today.

>> Tori Harding: Thank you so much, Amy, and thank you to the participants who are tuning in today. I sure appreciate your time in participating. Today we're going to be looking at some of the challenges experienced by individuals with brain injury that they indicate in terms of using memory and learning. We're going to look at some models of memory, including cortical and subcortical structures that are thought to be responsible for different types of memory. We'll be looking at some types of amnesia seen in individuals with brain injury and then finally look at the rehab approaches that are found to be effective in treating memory impairments in individuals with brain injury. I'll be sure to leave some time at the end for any questions.

Individuals with traumatic brain injury have identified problems such as forgetting to write things down, remembering to use those compensatory strategies that they are typically taught, and writing things down but not in enough detail, so that the information gets thrown away or not catalogued correctly. Oftentimes as clinicians we'll hear challenges in individuals with brain injury who miss appointments. This becomes a problem in outpatient environments because the very things that they're looking to improve on are prohibiting them from making the appointment to be involved in the therapy environment. They report challenges in misplacing things over and over; not being able to locate where they have put things; and forgetting conversations, including agreed upon strategies and agreements that they have made with individuals about times to meet and places to meet and things that they have agreed to do. They report repeating statements and questions over and over and find that their listeners become aggravated by this. They don't enjoy conversations because of this tendency. They forget what they did last week, have difficulty accessing their personal history and some everyday things. This translates into forgetting things such as items that are cooking on the stove - so this certainly becomes a safety challenge. They can't remember to let the dog back in - so difficulty caring for things that are important to them. They can't remember if they have already put on deodorant - so some of the activities of daily living are challenging to remember in sequence. They might not remember where their kids are going after school - so again, difficulty with some safety and "caring for their family" types of issues.

Typically, short-term and sensory memory are functional in the individual that has traumatic brain injury, but not always. Short-term memory and sensory memory do not always respond well to formalized testing. In terms with difficulty with short-term memory and sensory memory, often it is due to the reduced ability to attend. They may report that they become distracted very easily and that their attention drifts to other conversations, so they're not able to maintain their focus or to attend to items that are occurring in the environment at the time. Therefore there is not an opportunity for that information to get into long-term memory.

We're going to review a couple of different models of memory. We tend to like to conceive of information in terms of a model so we can separate out what is responsible for some of the challenges that individuals see in their memory. This one is from Maureen Dennis and it talks about the sensory register, the working or short-term memory, and the long-term memory.