Electronic memory aids for outpatient brain injury: follow-up findings

Utility of a novel tablet computer software for memory impairment in participants with brain injuries: A randomized control trial

This study examined the effectiveness of a novel information and communication technology (ICT) tool developed for external memory compensation to improve memory function in participants with brain injuries. In this 3-month randomized control study, participants with memory impairment secondary to brain injury were randomly assigned on a 1:1 basis to either intervention (the ICT tool [ARATA]) or 3-month waitlist control groups. This study's primary outcome measure was memory-related difficulties in everyday life, assessed using the Everyday Memory Checklist (EMC). Secondary outcomes included tests for memory function and psychosocial status, all of which were administered by blinded assessors. Seventy-eight participants (53 males, 25 females; mean age, 43.5 ± 12.7 [SD] years) were enrolled and 39 participants were allocated to each group (intervention and control). There was no significant difference in EMC scores between the two groups throughout the study (mean 0.26; 95% CI: -2.55-3.07; p=0.853); however, the intervention group scored significantly higher on the Rivermead Behavioural Memory and General Self-Efficacy tests compared to the control group. While the ICT tool did not improve the primary study outcome, evidence suggests that the ICT tool can improve memory functions related to activities of daily living.

The impact of using implementation intentions as task instructions on prospective memory performance after stroke

Prospective Memory (PM), the ability to remember to carry out intentions in the future, is often impaired after stroke. Little is known about rehabilitation of PM post-stroke with literature limited by small sample sizes and reliance on self-reported memory performance. Implementation intentions may make prospective remembering more automatic and follow a simple if-then structure (if X occurs, then I will do Y), focusing on the cue rather than the task. We aimed to investigate the effect of implementation intentions on PM post-stroke. Twenty-eight individuals with stroke and 27 controls were randomly allocated to a standard instruction or implementation intention condition and completed an assessment battery over two sessions. Implementation intention instructions were provided for PM tasks on the Delayed Message Task, Lexical Decision Prospective Memory Task (LDPMT), and the Virtual Reality Prospective Memory Shopping Task. The implementation intention groups performed better on all PM tasks compared to the standard instruction group, but no results reached statistical significance, likely due to the small sample size. In addition, the implementation intentions group monitored the time significantly more on the LDPMT than those in the standard instruction group.

Combined Memory Training: An Approach for Episodic Memory Deficits in Traumatic Brain Injury

Purpose The study aimed to test a combination of semantic memory and traditional episodic memory therapies on episodic memory deficits in adults with traumatic brain injury. Method Twenty-five participants who had been diagnosed with traumatic brain injury and had episodic memory deficits were randomly assigned either to a combined memory treatment group (n = 16) or to a wait-list control group (n = 9). Before and after treatment, they completed standardized neuropsychological testing for episodic memory and related cognitive domains, including the California Verbal Learning Test-Second Edition, the Controlled Oral Word Association Test, the University of Southern California Repeatable Episodic Memory Test, the Wechsler Abbreviated Scale of Intelligence-Second Edition Matrices, the Test of Everyday Attention, the Memory Assessment Clinics Self-Rating Scale, the Expressive Vocabulary Test-Second Edition, and the Story Recall subtest from the Rivermead Behavioural Memory Test. In addition to a traditional episodic memory therapy, the treatment group received a novel semantic memory-focused therapy, which involved participants finding meaningful connections between diverse concepts represented by sets of two or three words. Results The treatment group demonstrated statistically significant improvement in memory for list learning tasks, and there was a significant difference from pretest to posttest between the treatment group and the wait-list control group. Clinical significance was demonstrated for the treatment group using minimally important difference calculations. Conclusion Combined memory therapy resulted in significant improvements in episodic memory, semantic memory, and attention, in comparison to no treatment. Supplemental Material https://doi.org/10.23641/asha.14049968.

A review of prospective memory in individuals with acquired brain injury

OBJECTIVE

Prospective memory (PM) deficits have emerged as an important predictor of difficulty in daily life for individuals with acquired brain injury (BI). This review examines the variables that have been found to influence PM performance in this population. In addition, current methods of assessment are reviewed with a focus on clinical measures. Finally, cognitive rehabilitation therapies are reviewed, including compensatory, restorative and metacognitive approaches.

METHOD

Preferred reporting items for systematic reviews and meta-analyses guidelines were used to identify studies. Studies were added that were identified from the reference lists of these.

RESULTS

Research has begun to elucidate the contributing variables to PM deficits after BI, such as attention, executive function and retrospective memory components. Imaging studies have identified prefrontal deficits, especially in the region of BA10 as contributing to these deficits. There are now several clinical measures available with good psychometric properties. Rehabilitation techniques have mostly focused on compensatory strategies, but, in addition, some restorative and metacognitive approaches have shown preliminary promise.

CONCLUSIONS

PM deficits are a common and important deficit after BI. Clinical evaluation is recommended and further understanding of rehabilitation techniques is needed.

Prospective memory rehabilitation using smartphones in patients with TBI

PURPOSE

The aim of the present study was to investigate the effectiveness of a prospective memory aid that combines smartphones with Internet-based calendars among community-dwelling patients with traumatic brain injury.

METHOD

An uncontrolled pre- and post-assessment design was employed to study the use of unmodified, low-cost, off-the-shelf smartphones combined with Internet-calendars as a compensatory memory strategy in community-dwelling patients with traumatic brain injury. Thirteen participants received a 6-week group-based intervention with pre-, post- and 2-month follow-up-assessments by questionnaires and by daily assessment of target behaviors for 2-week periods.

RESULTS

Participants reported significantly fewer retro- and prospective memory problems on questionnaires after the intervention and at follow-up with large effect sizes. The performance of target behaviors, however, improved insignificantly with moderate effect sizes. There were no changes in quality of life or symptoms of emotional distress.

CONCLUSIONS

This study adds to a growing body of evidence that smartphones are a useful compensatory aid in rehabilitation of prospective memory that should routinely be considered in rehabilitation of traumatic brain injury patients. Implication for rehabilitation Smartphones are easy-to-use and accessible assistive technology for compensatory memory rehabilitation to most traumatic brain injury patients. By using low-cost, off-the-shelf devices, the technology becomes available to a broader range of patients. By combining smartphones with Internet-based and cross-platform services (e.g., calendars, contacts) the participants are less device-dependent and less vulnerable to data loss. Smartphones should routinely be considered as compensatory aid in rehabilitation of prospective memory of traumatic brain injured patients.

The efficacy of prospective memory rehabilitation plus metacognitive skills training for adults with traumatic brain injury: study protocol for a randomized controlled trial

BACKGROUND

Impairment of prospective memory (PM) is common following traumatic brain injury (TBI) and negatively impacts on independent living. Compensatory approaches to PM rehabilitation have been found to minimize the impact of PM impairment in adults with TBI; however, poor self-awareness after TBI poses a major barrier to the generalization of compensatory strategies in daily life. Metacognitive skills training (MST) is a cognitive rehabilitation approach that aims to facilitate the development of self-awareness in adults with TBI. This paper describes the protocol of a study that aims to evaluate the efficacy of a MST approach to compensatory PM rehabilitation for improving everyday PM performance and psychosocial outcomes after TBI.

METHODS/DESIGN

This randomized controlled trial has three treatment groups: compensatory training plus metacognitive skills training (COMP-MST), compensatory training only (COMP), and waitlist control. Participants in the COMP-MST and COMP groups will complete a 6-week intervention consisting of six 2-h weekly training sessions. Each 1.5-h session will involve compensatory strategy training and 0.5 h will incorporate either MST (COMP-MST group) or filler activity as an active control (COMP group). Participants in the waitlist group receive care as usual for 6 weeks, followed by the COMP-MST intervention. Based on the sample size estimate, 90 participants with moderate to severe TBI will be randomized into the three groups using a stratified sampling approach. The primary outcomes include measures of PM performance in everyday life and level of psychosocial reintegration. Secondary outcomes include measures of PM function on psychometric testing, strategy use, self-awareness, and level of support needs following TBI. Blinded assessments will be conducted pre and post intervention, and at 3-month and 6-month follow-ups.

DISCUSSION

This study seeks to determine the efficacy of COMP-MST for improving and maintaining everyday PM performance and level of psychosocial integration in adults with moderate to severe TBI. The findings will advance theoretical understanding of the role of self-awareness in compensatory PM rehabilitation and skills generalization. COMP-MST has the potential to reduce the cost of rehabilitation and lifestyle support following TBI because the intervention could enhance generalization success and lifelong application of PM compensatory strategies.

TRIAL REGISTRATION

New Zealand Clinical Trials Registry, ACTRN12615000996561 . Registered on 23 September 2015; retrospectively registered 2 months after commencement.

Do memory aids help everyday memory? A controlled trial of a Memory Aids Service

There is a growing body of knowledge about the use of compensatory memory aids in memory rehabilitation, but relatively few controlled trials on how to train the use of such aids. This study investigated the effects of systematic training in the use of compensatory memory aids on everyday memory functioning within a Memory Aids Service. In a controlled clinical trial, a comparison was made between treatment participants and waiting list controls. Participants had everyday memory problems secondary to progressive or non-progressive neurological conditions. Following baseline assessment and goal setting, treatment participants underwent three training sessions, in which memory aids were matched to goals, across a six week period, with a follow-up assessment 12 weeks later. Outcome was measured by a goal attainment diary, neuropsychological test performance, psychosocial questionnaires and a problem solving inventory. There was a significant treatment effect of training on the goal attainment diary but only at 12 weeks follow-up. A post-hoc analysis indicated that treatment was effective for participants with a non-progressive condition but not for participants with a progressive condition. We conclude that a Memory Aids Service can be beneficial for patients with a non-progressive neurological condition, and make suggestions that might inform future applications of memory aids with those who have a progressive neurological disorder.

Prospective Memory After Stroke: A Scoping Review

The aim of this paper was to review the limited, but growing, literature on prospective memory (PM) following stroke using a scoping study methodology. Multiple databases were systematically searched and yielded 11 studies that were classified as observational (n = 7) or intervention studies (n = 4) and reviewed for quality. PM impairment after stroke was more commonly identified using behavioural measures compared to self-report measures. There were mixed findings regarding the extent and nature of PM impairment poststroke; however, more studies reported impairment for time-based PM, compared to both event- and activity-based PM. Studies examining rehabilitative techniques for PM resulted in mixed findings and were limited as most were case studies of poor methodological quality. Overall previous research in this area was limited as most studies were often underpowered due to small sample sizes, or used single-item measures which may not be robust enough to reliably measure PM impairment. Additionally, the methods used to measure PM were varied and many studies did not control for retrospective memory impairment, which could impact the results, as PM has both a retrospective (remembering both the action and when it needs to be completed) and prospective component (remembering to perform the action when appropriate). In conclusion, PM impairment is apparent poststroke, specifically for time-based PM. However, more research is needed to determine why PM impairment occurs, and how it can be improved.

Google Calendar: A single case experimental design study of a man with severe memory problems

A single case experimental design across behaviours was utilised to explore the effectiveness of Google Calendar text alerts delivered to a mobile phone as a memory aid. The participant was a 43-year-old man (JA) with severe memory problems and executive difficulties caused by a traumatic brain injury (TBI). JA was initially very unwilling to use any memory aid and so a detailed assessment of his beliefs about memory aids, his cognitive difficulties and his social context was performed and a set of specifications for an aid was produced collaboratively. Six weeks of baseline data and six weeks of intervention data were collected for three target memory behaviours and three control memory behaviours. Results were analysed using nonoverlap of all pairs (NAP) analysis which showed a reduction in forgetting in the three target behaviours and no change in two of the three control behaviours. A subjective measure (the revised Everyday Memory Questionnaire) also suggested improvement. This study illustrates that Google Calendar is a highly effective memory aid and emphasises the importance of choosing a memory aid to suit the person's lifestyle and beliefs.

Errorless learning of prospective memory tasks: An experimental investigation in people with memory disorders

The term prospective memory (PM) refers to memory for future intentions. PM problems are frequent in people with cognitive impairment and, because they are central to the realisation of many everyday goals, are important in rehabilitation. Event-based PM tasks (EBPM) are environmentally-cued and have primarily mnemonic demands, whereas time-based PM tasks (TBPM) require self-initiated retrieval, and have greater executive demands. Errorless learning (EL) is an encoding method that results in superior retrospective memory compared with “errorful” learning (EF). As this EL advantage (ELA) likely stems from its reduced explicit memory demands, and there is no such advantage for executive tasks, a greater ELA for EBPM than TBPM was predicted. Fourteen adults with neurological memory impairment completed PM tasks under four counterbalanced conditions: EL of EBPM, EL of TBPM, EF of EBPM, and EF of TBPM. A significant ELA was observed for EBPM (d = .63), but not TBPM (d = –.01). These results extend the evidence for EL within cognitive rehabilitation, by showing for the first time that the method can benefit future action in addition to retrospective memory. The clinical implications are also clear: errorless learning techniques may be usefully employed to support completion of day-to-day EBPM tasks.

Comparison of remedial and compensatory approaches in memory dysfunction: a comprehensive literature review

ABSTRACT Memory is a cognitive process of information storage and retrieval that is essential to performing daily functional activities efficiently. Occupational therapists regularly help individuals with memory impairment to manage their memory deficits. The purpose of this paper was to review the main memory strategies and instructional methods used to improve or manage memory. Studies were identified by searching for the relevant literature published between 1980 and 2007 through the use of several databases with the inclusion criteria that the study must identify at least one specific memory rehabilitation method with an outcome measure representative of the specific method. The reviewed studies included three reviews, 10 randomized control trials, 17 quasi-experimental studies, and five single subjects' designs. The results suggest that there is empirical evidence to support the effectiveness of certain remedial and compensatory memory rehabilitation methods with healthy populations, but weaker evidence can be identified for the memory-impaired populations. In general, remedial methods are effective in lab settings with primarily healthy populations, yet effectiveness in daily activities is less clear. Compensatory methods are generally more efficient than remedial ones and more easily generalized to daily activities, even with memory-impaired populations.

Electronic reminding technology for cognitive impairment

Demographic changes highlight the need to address disabilities associated with the costly morbidities of old age, such as dementia. Memory impairment associated with dementia represents a significant challenge for many older people. Difficulties occur in carrying out activities in their entirety or in commencing them at all. Technology has the potential to help individuals overcome the barriers created by cognitive disability in terms of performing activities of daily living and therefore help to maintain independence and enhance quality of life (Czaja, 2005). This literature review examines the current reported research, which employs electronic reminding technology to support individuals with cognitive impairment. These devices range from everyday technologies, such as phones, to sophisticated interactive devices with specifically designed software. A summary of the current evidence base is presented and recommendations for future practice are made.

Long-term benefits of the Memory-Link programme in a case of amnesia

Objective:

To systematically evaluate the maintenance of clinical gains from a structured memory intervention programme. Efficacy of the programme was initially demonstrated in RR, a woman with moderate-to-severe memory impairment following colloid cyst removal. In the current study (Svoboda and Richards, 2009), we examined RR’s day-to-day memory functioning 18 months after completion of the intervention programme.

Design:

Within-subject A1B1A2B2B3 single-case experimental design.

Setting:

Outpatient memory rehabilitation clinic.

Intervention:

A theory-driven training programme in the use of commercially available smartphones for individuals with moderate-to-severe memory impairment.

Main measures:

A phone call task was used as an objective measure of prospective memory function. Self-report, ecologically valid questionnaires were also completed to further assess generalization of smartphone use to day-to-day memory function.

Results:

Eighteen months after intervention, RR completed 80% of scheduled calls using the smartphone, a rate significantly higher than at baseline (40%) and comparable to her success rate immediately following intervention (90%) and at the four-month follow-up (90%). Responses to questionnaires indicated that RR felt more confident in her ability to handle memory-demanding situations and was making fewer memory mistakes. This favourable outcome was not found with the use of another smartphone brand for which training was not received.

Conclusions:

Results from ecologically valid measures of memory functioning demonstrated robust maintenance of independent commercial smartphone use over an 18-month period, with increases observed in independence, confidence and real-life memory functioning. The findings further suggest poor cross-device generalizability.

Innovative technology for the assisted delivery of intensive voice treatment (LSVT®LOUD) for Parkinson disease

PURPOSE

To assess the feasibility and effectiveness of a newly developed assistive technology system, Lee Silverman Voice Treatment Companion (LSVT(®) Companion™, hereafter referred to as "Companion"), to support the delivery of LSVT(®)LOUD, an efficacious speech intervention for individuals with Parkinson disease (PD).

METHOD

Sixteen individuals with PD were randomized to an immediate (n = 8) or a delayed (n = 8) treatment group. They participated in 9 LSVT LOUD sessions and 7 Companion sessions, independently administered at home. Acoustic, listener perception, and voice and speech rating data were obtained immediately before (pre), immediately after (post), and at 6 months post treatment (follow-up). System usability ratings were collected immediately post treatment. Changes in vocal sound pressure level were compared to data from a historical treatment group of individuals with PD treated with standard, in-person LSVT LOUD.

RESULTS

All 16 participants were able to independently use the Companion. These individuals had therapeutic gains in sound pressure level, pre to post and pre to follow-up, similar to those of the historical treatment group.

CONCLUSIONS

This study supports the use of the Companion as an aid in treatment of hypokinetic dysarthria in individuals with PD. Advantages and disadvantages of the Companion, as well as limitations of the present study and directions for future studies, are discussed.

Prospective Memory and Traumatic Brain Injury: A Review

This article aimed to review the assessment and treatment of prospective memory impairment in individuals with traumatic brain injury. The three assessment techniques reviewed included questionnaires, psychological tests, and experimental procedures. Because interest in this area is relatively new, not many assessment techniques have been specifically developed to assess the various constructs of prospective memory. Of these, most lack a firm theoretical basis, adequate norms, and strong psychometric properties. Rehabilitative techniques, based on remedial and compensatory approaches, were then evaluated. Intervention methods that show promise include a prospective memory training approach, diary or memory notebook use, and electronic aids. Nevertheless, there is a need for further controlled trials with larger sample sizes to more thoroughly evaluate these methods. Self-awareness of memory impairment and generalisation of gains from treatment are another two issues identified as important for assessing and treating prospective memory impairment.

Cognitive function and assistive technology for cognition: a systematic review

The relationship between assistive technology for cognition (ATC) and cognitive function was examined using a systematic review. A literature search identified 89 publications reporting 91 studies of an ATC intervention in a clinical population. The WHO International Classification of Functioning, Disability and Health (ICF) was used to categorize the cognitive domains being assisted and the tasks being performed. Results show that ATC have been used to effectively support cognitive functions relating to attention, calculation, emotion, experience of self, higher level cognitive functions (planning and time management) and memory. The review makes three contributions: (1) It reviews existing ATC in terms of cognitive function, thus providing a framework for ATC prescription on the basis of a profile of cognitive deficits, (2) it introduces a new classification of ATC based on cognitive function, and (3) it identifies areas for future ATC research and development.

Prospective memory in patients with closed head injury: a review

This paper aimed to review the limited, but growing literature on prospective memory (PM) following closed head injury (CHI). Search of two commonly used databases yielded studies that could be classified as: self- or other-report of PM deficits; behavioral PM measures in adults with CHI, behavioral PM measures in children and adolescents with CHI, and treatment of PM in adults with CHI. The methodology and findings of these studies were critically reviewed and discussed. Because of the small number of studies, meta-analysis was only conducted for studies that used behavioral PM measures in adults to integrate findings. PM deficits were found to be commonly reported by patients with CHI and their significant others and they could be identified using behavioral measures in adults, children and adolescents with CHI. However, more work is needed to clarify the nature and mechanisms of these deficits. Although some promising results have been reported by studies that evaluated PM treatment, most studies lack tight experimental control and used only a small number of participants. The paper concluded with some suggestions for future research.

Efficacy and usability of assistive technology for patients with cognitive deficits: a systematic review

Objective: To determine the efficacy of portable electronic aids such as personal digital assistants (PDAs), pagers or mobile phones for patients with cognitive deficits by means of a systematic review. The usability of these aids is also briefly discussed.

Data sources: PubMed, CINAHL, PsychINFO, EMBASE and MEDLINE were searched up to February 2009. The references of identified and relevant articles were scanned to find additional relevant titles.

Review methods: Papers referring to ‘electronic aids’, ‘cognition’ and ‘brain injury’ were included. The population had to be adult and have cognitive impairments as a result of acquired brain injury. Outcome measures were change in cognitive or occupational performance or the level of participation in daily life. The criteria of Cicerone et al. were used to evaluate the quality of the retrieved studies.

Results: Twenty-eight papers presenting 25 studies were reviewed. The total number of participants was 423. Most identified papers described case reports or non-randomized clinical trials. Only one randomized controlled trial was identified, in which the NeuroPage proved effective in supporting prospective memory. Other kinds of assistive technology such as PDAs and voice recorders showed positive results in supporting retrospective and prospective memory.

Conclusion: The efficacy of assistive technology in general is not yet sufficiently studied in randomized controlled trials, although promising results has been reported. Furthermore, several survey studies established that both potential users and clinicians have optimistic expectations about the usability of assistive technology.

The NeuroPage system for children and adolescents with neurological deficits

OBJECTIVE

Several studies have demonstrated the effectiveness of a paging system, NeuroPage, in helping survivors of brain injury compensate for everyday memory and planning problems. This study examines the effectiveness of the paging system in the sub-group of 12 children and adolescents with neurological deficits who took part in a larger study.

METHODS

Twelve participants aged 8-17 years took part in a randomized controlled crossover trial in which their completion of everyday goals was monitored prior to and during use of the NeuroPage system, where participants were sent reminder messages regarding tasks they should complete.

RESULTS

All 12 young people showed significant improvements in carrying out everyday tasks between the baseline and treatment phases.

CONCLUSIONS

The NeuroPage system can be successfully used by children and adolescents with neurological deficits and can alleviate some of the everyday difficulties caused by their memory and planning difficulties.

The assessment and rehabilitation of prospective memory problems in people with neurological disorders: a review

People with neurological disorders often report difficulty with prospective memory (PM), that is, remembering to do things they had intended to do. This paper briefly reviews the literature regarding the neuropsychology of PM function, concluding that from the clinical perspective, PM is best considered in terms of its separable but interacting mnemonic and executive components. Next, the strengths and limitations in the current clinical assessment of PM, including the assessment of component processes, desktop analogues of PM tasks, and naturalistic PM tasks, are outlined. The evidence base for the rehabilitation of PM is then considered, focusing on retraining PM, using retrospective memory strategies, problem-solving training, and finally, electronic memory aids. It is proposed that further research should focus on establishing the predictive validity of PM assessment, and refining promising rehabilitation techniques.

Prospective memory rehabilitation for adults with traumatic brain injury: A compensatory training programme

PRIMARY OBJECTIVE

To describe a prospective memory rehabilitation programme based on a compensatory training approach and report the results of three case studies.

RESEARCH DESIGN

Programme evaluation using pre- and post-intervention assessments and telephone follow-up.

METHODS AND PROCEDURES

Three participants with traumatic brain injury completed 8 weeks of training with 1-2 hour individual sessions. Assessments were formal prospective memory assessment, self-report and measures of diary use.

EXPERIMENTAL INTERVENTIONS

Intervention aimed to identify potential barriers, establish self-awareness of memory deficits, introduce a customized compensatory tool, a cueing system and organizational strategies. A significant other was involved in training to assist generalization.

MAIN OUTCOMES AND RESULTS

All three participants improved on formal prospective memory assessment and demonstrated successful diary use after the programme. Self-report of prospective memory failure fluctuated and may reflect increased self-awareness.

CONCLUSION

A compensatory approach may be useful in improving prospective memory performance following TBI.

Improvement patterns among survivors of brain injury:Three case examples documenting the effectiveness of memory compensation strategies

Three case examples illustrate possible patterns of improved functioning that may emerge as survivors of traumatic brain injury (TBI) attempt compensation for persistent memory deficits impeding independent living. The task selected for report was independence in remembering to take regularly-prescribed medications. Strategies applied to promote learning included use of written reminders and use of two assistive technology (AT) devices-a wristwatch alarm (WatchMinder) and a digital voice recorder and alarm system (Voice Craft ). With participation in the intervention programme, two of the three individuals demonstrated increased independence in remembering to take medications; the third did not. The case examples illustrate varying responses of people with TBI to intervention using compensatory strategies and AT devices. Professionals and caretakers working with survivors must recognize the uniqueness of each survivor, must adjust intervention programmes accordingly and must be willing to persist in trying to increase functional independence repeatedly for many years post-injury.

Clinician influences on use of portable electronic memory devices in traumatic brain injury rehabilitation

PRIMARY OBJECTIVE

To explore the relationship between a group of clinicians' own experience, training and confidence with portable electronic memory devices and their use of the same in traumatic brain injury (TBI) rehabilitation.

RESEARCH DESIGN

Survey study.

METHODS AND PROCEDURES

Eighty-one TBI clinicians from various disciplines and work settings completed a survey distributed in person or by mail.

MAIN OUTCOMES AND RESULTS

Twenty-nine respondents (36%) reported using portable electronic memory devices with patients with TBI. Using regression analysis, respondent device training and confidence teaching patients device use were statistically associated with respondents' use of such devices in TBI rehabilitation.

CONCLUSIONS

Portable electronic memory device use with persons following TBI may be under-utilized. The importance of ongoing clinician training and of maximizing clinician confidence utilizing these devices in TBI rehabilitation is emphasized. The representativeness of the respondent sample is discussed. Specific training strategies and continued research needs are presented.

A generic, ‘in-house’, alphanumeric paging system for prospective activity impairments after traumatic brain injury

OBJECTIVE

For settings having suitable infrastructure, generic, 'in-house' alphanumeric paging systems can be constructed that are fully under clinician control. Development of such a system for therapeutic application is described and a single-case study presented that assessed whether the system could improve repetitive, prospective use of a daily planner.

DESIGN

ABA' single case.

METHODS

The participant was male, in his mid-30s, having cognitive impairments subsequent to recent TBI superimposed on remote neurological changes. The pager reminded him to record therapeutic information in a daily planner, for discussion with a family member each evening.

RESULTS

During intervention (B) trials, reliable memory log usage was noted. By trial five of return-to-baseline (A') trials, there was decreased memory log use.

CONCLUSIONS

Alphanumeric paging facilitated reliable use of a memory log compensation technique. The 'in-house' paging system proved particularly suitable for intervention development. Limits of the study are discussed and other therapeutically useful wireless technologies are noted.

Compensating for anterograde amnesia: a new training method that capitalizes on emerging smartphone technologies

Following a neuropathological event, individuals left with moderate-to-severe memory impairment are unable to reliably form new memories. The most common challenges involve the capacity to perform a task in the future and to consciously recall a recent event. Disruption of these memory processes leaves the individual trapped in the present, unable to stay on track, and alienated from ongoing events. Memory research has demonstrated that implicit memory is often preserved despite severe explicit memory impairment and that preserved memory systems can provide avenues for acquiring new skills and knowledge. A within-subject single-case A1-B1-A2-B2 experimental design was used to introduce an established theory-driven training program of technology use for individuals with moderate-to-severe memory impairment. We describe its application to enabling RR, an individual with memory impairment postcolloid cyst removal, to independently support her memory using a commercial smartphone. RR showed successful outcome on both objective and qualitative measures of memory functioning. Moreover, she demonstrated consistent and creative generalization of acquired smartphone skills across a broad range of real-life memory-demanding circumstances. Our findings suggest that individuals with moderate-to-severe memory impairment are able to capitalize on emerging commercial technology to support their memory.

Incentive effects on event-based prospective memory performance in children and adolescents with traumatic brain injury

Prospective memory (PM) is the formation of an intention and remembering to perform this intention at a future time or in response to specific cues. PM tasks are a ubiquitous part of daily life. Currently, there is a paucity of information regarding PM impairments in children with traumatic brain injury (TBI) and less empirical evidence regarding effective remediation strategies to mitigate these impairments. The present study employed two levels of a motivational enhancement (i.e., a monetary incentive) to determine whether event-based PM could be improved in children with severe TBI. In a crossover design, children with orthopedic injuries and mild or severe TBI were compared on two levels of incentive (dollars vs. pennies) given in response to accurate performance. All three groups performed significantly better under the high- versus low-motivation conditions. However, the severe TBI group's high-motivation condition performance remained significantly below the low-motivation condition performance of the orthopedic injury group. PM scores were positively and significantly related to age-at-test, but there were no age-at-injury or time-postinjury effects. Overall, these results suggest that event-based PM can be significantly improved in children with severe TBI.

Using electronic aids to daily living after acquired brain injury: a study of the learning process and the usability

PURPOSE

The purpose was to study the ability of persons with memory impairments after acquired brain injury to learn how to and use electronic aids to daily living (EADL) and to describe changes in function and quality of life.

METHOD

Eight participants stayed in two apartments equipped with a set of basic and advanced EADL for either 4 or 6 months during an intervention time of 2 years. The teaching and learning method was influenced by certain principles of errorless learning. Ability to learn to use EADL was measured by structured observations. Function and quality of life were assessed with self-rating questionnaires.

RESULTS

Results indicate that the participants learned to use EADL in their everyday activities. They perceived that EADL were very useful and easy to learn. Occupational performance and satisfaction with occupational performance and quality of life was improved.

CONCLUSION

The results indicate that EADL may play an important role in facilitating everyday activities and improve satisfaction with occupational performance and quality of life for people with memory impairments. The study indicates the importance of adjusting technology to the user's needs and calls for more consideration for human-technology interaction factors.

Traumatic brain injury: future assessment tools and treatment prospects

Traumatic brain injury (TBI) is widespread and leads to death and disability in millions of individuals around the world each year. Overall incidence and prevalence of TBI are likely to increase in absolute terms in the future. Tackling the problem of treating TBI successfully will require improvements in the understanding of normal cerebral anatomy, physiology, and function throughout the lifespan, as well as the pathological and recuperative responses that result from trauma. New treatment approaches and combinations will need to be targeted to the heterogeneous needs of TBI populations. This article explores and evaluates the research evidence in areas that will likely lead to a reduction in TBI-related morbidity and improved outcomes. These include emerging assessment instruments and techniques in areas of structural/chemical and functional neuroimaging and neuropsychology, advances in the realms of cell-based therapies and genetics, promising cognitive rehabilitation techniques including cognitive remediation and the use of electronic technologies including assistive devices and virtual reality, and the emerging field of complementary and alternative medicine.

Review of ICT-based services for identified unmet needs in people with dementia

Some of the needs that people with dementia and their informal carers currently perceive as insufficiently met by regular care and support services might be alleviated, or even be met, using modern Information and Communication Technology (ICT). The study described in this paper was designed to provide an insight into the state of the art in ICT solutions that could contribute to meet the most frequently mentioned unmet needs by people with dementia and their informal carers. These needs can be summarized as (1) the need for general and personalized information; (2) the need for support with regard to symptoms of dementia; (3) the need for social contact and company; and (4) the need for health monitoring and perceived safety. Databases that were searched include: PubMed, Cinahl, Psychinfo, Google (Scholar), INSPEC and IEEE. In total 22 websites and 46 publications were included that satisfied the following criteria: the article reports on people with dementia and/or their informal carers and discusses an ICT-device that has been tested within the target group and has proven to be helpful. Within the first need area 18 relevant websites and three studies were included; within the second need area 4 websites and 20 publications were included. Within the third and fourth need area 11 and 12 publications were included respectively. Most articles reported on uncontrolled studies. It is concluded that the informational websites offer helpful information for carers but seem less attuned to the person with dementia and do not offer personalized information. ICT solutions aimed at compensating for disabilities, such as memory problems and daily activities demonstrate that people with mild to moderate dementia are capable of handling simple electronic equipment and can benefit from it in terms of more confidence and enhanced positive effect. Instrumental ICT-support for coping with behavioral and psychological changes in dementia is relatively disregarded as yet, while support for social contact can be effectively realized through, for example, simplified (mobile) phones or videophones or (entertainment) robots. GPS technology and monitoring systems are proven to result in enhanced feelings of safety and less fear and anxiety. Though these results are promising, more controlled studies in which the developed ICT solutions are tested in real life situations are needed before implementing them in the care for people with dementia. It is recommended that future studies also focus on the integration of the current techniques and solutions.

Cognitive rehabilitation for memory deficits following stroke

BACKGROUND

Memory problems are a common cognitive complaint following stroke. Memory rehabilitation programmes either attempt to retrain lost or poor memory functions, or teach patients strategies to cope with them.

OBJECTIVES

To determine the effectiveness of cognitive rehabilitation for memory problems following stroke.

SEARCH STRATEGY

We searched the Cochrane Stroke Group Trials Register (last searched September 2006). In addition, we searched the following electronic databases; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005), CINAHL (1982 to June 2005), PsycINFO (1980 to July 2006), AMED (1985 to June 2005), British Nursing Index (1985 to June 2005), CAB Abstracts (1973 to May 2005) and the National Research Register (June 2006). We handsearched relevant journals and searched reference lists.

SELECTION CRITERIA

We selected controlled trials of memory retraining in stroke. We excluded studies with mixed aetiology groups unless 75% or more of the participants had a stroke or separate data were available for the stroke patients.

DATA COLLECTION AND ANALYSIS

Two review authors selected trials for inclusion, assessed quality, and extracted data.

MAIN RESULTS

Two trials, involving 18 participants, were included. One study compared the effectiveness of a mnemonic strategy treatment group with a 'drill and practice' control, while the other compared the effectiveness of an imagery mnemonics programme with a 'pragmatic' memory rehabilitation control programme. Formal meta-analyses could not be performed due to a paucity of studies and lack of commonly-employed outcome measures. The results do not show any significant effect of memory rehabilitation on performance of objective memory tests, and no significant effects of treatment on subjective and observer-rated measures of memory.

AUTHORS' CONCLUSIONS

There was no evidence to support or refute the effectiveness of memory rehabilitation on functional outcomes, and objective, subjective, and observer-rated memory measures. There is a need for more robust, well-designed and better-reported trials of memory rehabilitation using common standardised outcome measures.

Technology in the Lives of Women Who Live With Memory Impairment as a Result of a Traumatic Brain Injury

A large number of individuals who have experienced a traumatic brain injury are women; unfortunately, there is a lack of literature focusing on their treatment preferences. Electronic memory aids have the potential to offer tremendous assistance to increase the independence of individuals with memory impairment; however, the use of electronic memory aids with this female population has not been explored. The objective of this study was to investigate the perceptions and use of electronic memory aids in women with memory impairment as a result of a traumatic brain injury to further their use of this technology to enable their independence. Two focus groups were conducted, each with five women who self-reported a moderate to severe head injury. The primary theme that emerged was the willingness and interest of this sample to use this technology when provided with an appropriate introduction and learning environment. The results reaffirm current literature supporting the use of electronic memory aids with a population with a head injury. Individuals not currently using this technology were motivated to employ electronic memory aids in their daily lives. Further research must be conducted to develop strategies to enable this population's use of electronic memory aids.

Successful guidance by automatic output of music and verbal messages for daily behavioural disturbances of three individuals with dementia

There have been no previous reports of daily home activities of individuals with dementia being guided by the combination of music and verbal messages. This study evaluated the effectiveness for three individuals of music and messages which were automatically output by an IC recorder. After music was presented, messages instructed the participants to go to a day care centre, behave more peacefully and eat more at meals, respectively. These stimuli were highly effective for guiding the above activities. This study suggests that automatic output of music and messages has potential as a strategy for guiding individuals with dementia at their home. For the third individual, the music and messages were output through a doll. The implications of using a doll are also discussed.

Planning and realization of complex intentions in traumatic brain injury and normal aging

The realization of delayed intentions (i.e., prospective memory) is a highly complex process composed of four phases: intention formation, retention, re-instantiation, and execution. The aim of this study was to investigate if executive functioning impairments are related to problems in the formation, re-instantiation, and execution of a delayed complex intention. In this context, it was another aim of the study to investigate the executive functioning hypothesis of cognitive aging in prospective memory performance. It was, therefore, explored if age-related prospective memory decline leads to similar decrements in the process of prospective remembering as executive functioning-related decline in young patients with traumatic brain injury. A group of patients with traumatic brain injury with retrospective memory within normal limits but impaired executive functions, a group of healthy older and a group of healthy younger adults completed a complex prospective memory task that allows for the separate assessment of the four phases of the prospective memory process. All groups showed a similarly high performance in the intention retention phase, whereas the patients with deficits in executive functioning and the older participants performed worse than the healthy young participants in the intention formation, re-instantiation and execution phases. The importance of executive functioning for prospective remembering in traumatic brain injury and normal aging is discussed.