Perceived importance of prospective memory failures in adults with traumatic brain injury

Demographic Characteristics, Motivation and Perception of Change as Determinants of Memory Compensation Self-Reports After Acquired Brain Injury

INTRODUCTION

Individuals with brain injuries experience cognitive and emotional changes that have long-lasting impacts on everyday life. In the context of rehabilitation, surveys have stressed the importance of compensating for memory disturbances to ease the impact of disorders on day-to-day autonomy. Despite extensive research on the nature of neurocognitive impairments following brain injury, few studies have looked at patients' perceptions of these day-to-day compensations. This study examines these perceptions; in particular, what brain-injured people believe they do to compensate for memory deficiencies in everyday life. It also investigates the determinants of reported compensation strategies (age, gender, perceived stress, change awareness and motivation to succeed).

METHODS

Eighty patients and 80 controls completed the French Memory Compensation Questionnaire, a self-report measure of everyday memory compensation. Five forms of compensation were investigated: External and Internal strategies, Reliance on social help, and investments in Time and Effort, along with two general factors: the degree of importance attached to Success (motivation) and perceptions of Change. Participants also completed measures of demographic and emotional aspects that may affect everyday compensation perceptions.

RESULTS

The brain-injured group reported significantly more frequent use of memory compensation strategies than controls, with the exception of External aids. Large effects were observed for Reliance and Effort. Demographic, motivation and perception of change determinants were found to have different effects depending on the compensation strategy, and mediated the direct effect of brain injury on reported compensation.

CONCLUSION

Clinical and rehabilitation neuropsychologists often seek to have a better sense of how their patients perceive their compensatory behaviors. In practice, such an understanding is needed to help select appropriate methods and improve the long-term impact of rehabilitation programs: memory rehabilitation will fail if neuropsychologists do not deal, first and foremost, with the emotional and metacognitive issues surrounding traumatic brain injury (TBI), rather than focusing on cognitive efficiency.

Predicting Remembering: Judgments of Prospective Memory After Traumatic Brain Injury

PURPOSE

Adults with traumatic brain injuries (TBIs) often struggle with prospective memory (PM), the ability to remember to complete tasks in the future, such as taking medicines on a schedule. Metamemory judgments (or how well we think we will do at remembering) are linked to strategy use and are critical for managing demands of daily living. The current project used an Internet-based virtual reality tool to assess metamemory judgments of PM following TBI.

METHOD

Eighteen adults with moderate to severe TBI and 20 healthy controls (HCs) played Tying the String, a virtual reality game with PM items embedded across the course of a virtual work week. Participants studied PM items and made two judgments of learning about the likelihood of recognizing the CUE, that is, when the task should be done, and of recalling the TASK, that is, what needed to be done.

RESULTS

Participants with TBI adjusted their metamemory expectations downward, but not enough to account for poorer recall performance. Absolute difference scores of metamemory accuracy showed that healthy adults were underconfident across PM components, whereas adults with TBI were markedly overconfident about their ability to recall TASKs.

CONCLUSIONS

Adults with TBI appear to have a general knowledge that PM tasks will be difficult but are poor monitors of actual levels of success. Because metamemory monitoring is linked to strategy use, future work should examine using this link to direct PM intervention approaches.

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.

A comparison of laboratory, clinical, and self-report measures of prospective memory in healthy adults and individuals with brain injury

Individuals with traumatic brain injury (TBI) have demonstrated deficits in prospective memory (PM) functioning when compared to healthy adults. These deficits have been measured using laboratory measures, clinical measures, and self-report questionnaires. However, PM has been shown to involve multiple cognitive processes and have a variety of stages. Thus, it is not known whether these measures all assess the same aspects of PM. Thus, this study was designed to measure the convergent validity of the three types of PM measures in both healthy adults and individuals with TBI. We aimed to investigate the convergent validity of the three types of tasks in two ways. First, we sought to investigate whether the PM deficits experienced by people with TBI are consistent across tasks. Second, we sought to examine the relationship between the three types of tasks. Results demonstrated that while all three types of measures were sensitive to PM deficits in TBI, there were differences in the aspects/processes of PM being measured. Data from the laboratory measure suggested a specific difficulty with detecting the correct cue. Data from the clinical measure suggested that TBI has a greater effect on time-based cues than event-based cues and that the primary deficit is a prospective intention retrieval deficit rather than the retrospective memory component. In addition, those with TBI did not differ from healthy adults when the time delay was short enough, suggesting that PM is not universally impaired. Data from the self-report questionnaire suggested that those with TBI are more sensitive to difficulties with basic activities of daily living rather than instrumental activities on daily living. These results are discussed in terms of rehabilitation techniques that could focus first on cue detection and use basic activities of daily living as outcome measures.

Prospective memory intervention using visual imagery in individuals with brain injury

Prospective memory deficits are common after brain injury and can create impediments to independent living. Most approaches to management of such deficits are compensatory, such as the use of notebooks or electronic devices. While these can be effective, a restorative approach, in theory, could lead to greater generalisation of treatment. In the current study a metacognitive technique, using visual imagery, was employed under conditions of rote repetition and spaced retrieval. Treatment was provided in an AB-BA crossover design with A as the active treatment and B as a no-treatment attention control to 20 individuals with brain injury. A group of 20 healthy participants served to control for effects of re-testing. Individuals with brain injury demonstrated improvement on the main outcome measure of prospective memory, the Memory for Intentions Screening Test, only after the active treatment condition. In addition, some generalisation of treatment was measured in daily life. Moreover, treatment gains were maintained for one year after treatment was completed.

Development of Neuropsychological Measures: Personal Experience and Lessons Learnt

This paper briefly reviews the history and purposes of neuropsychological assessment, as well as advancements in this area, and discusses the development of neuropsychological tests, using examples developed by the author and his colleagues to measure different aspects of human memory. These include the Shum Visual Learning Test, the Australian Retrograde Memory Test, the Comprehensive Assessment of Prospective Memory and the Virtual Reality Prospective Memory Task. The intended uses and psychometric properties of these tests, as well as examples of their use in research and clinical settings, will also be discussed. The paper will conclude with recommendations and advice on the development of neuropsychological tests based on the author's own experience.