Memory Strategy Training

What can memory strategy training help with?

Accommodating problems with memory due to brain injury or cognitive decline

What makes for effective memory strategy training?

Memory strategy training is usually carried out by a licensed psychologist, an occupational therapist, a speech language pathologist, or other clinical professional with specialized training in conducting cognitive rehabilitation with people with brain injury. The key is that providers need to have specialized knowledge and training in both brain injury and cognitive rehabilitation.

Effective treatment could be one on one or in a group. And your sessions could be very structured (for example, a group that meets three days a week, 30 minutes per session, for 6 weeks), or they could be more flexible depending on your provider and your progress.

What is memory strategy training like?

Memory issues affect daily life in all kinds of ways: losing your wallet, forgetting a loved one’s name, or leaving the stove on by mistake. Depending on the nature and severity of the problems you are having, you will work closely with a health care provider to discover which tools, techniques, aids, and strategies can best help meet your daily needs.

For someone with a mild TBI who might be having trouble remembering details, steps in a task, or items in a list, your healthcare provider may teach you an internal strategy — a different way of thinking about something you need to remember. For example, they might teach you how to develop your own mnemonic devices. Imagine you want to go to the supermarket for spinach, apples, lemons, bacon, and ice cream. You can play with the first letter of each word until you come up with BASIL, which captures all five items, leaving you with only one word to remember instead of five.

With mild TBI, your health care provider might also help you learn how to use external aids, like timers or labelling. These can help keep you organized and help you compensate for a less-than-perfect memory. External aids can also be effective for people with moderate to severe TBI, who typically cannot benefit from internal strategies.

Some of the best tools are simple and low tech: memory notebooks, checklists, calendars, daily planners, and pill boxes with individual compartments that say “Sunday a.m.,” “Sunday p.m.,” “Monday a.m.,” etc. There are also some great digital tools that can help with memory, such as user-friendly memory apps; smart phone reminders; digital calendars and timers; and digital voice recorders that convert voice recordings to text so that you can review a conversation later on.

Memory strategy training involves learning and then practicing some of these tools and strategies until you can comfortably and independently use them in your daily life. Depending on your injury, you might focus on one thing, like learning to respond to an alarm that reminds you to take your medication, which is in a clearly marked pillbox in a highly visible place. Or you might be able to tackle more complex strategies, like learning how to set the alarm for your medications yourself on your own smartphone or developing the best system for recording your upcoming work meetings, so you don’t miss any and are prepared.

It can take a lot of time to learn these strategies, and you might need to try several different ones to find which is right for you. Your health care provider will provide you with support as you learn these and then gradually decrease the support. It may at times be pretty frustrating as you learn, make mistakes, and try a different approach. But please remember that many people with TBI have gained independence at home and at work with the help of these strategies.

Why does memory strategy training work?

Memory strategy training works by either improving your memory with internal strategies or by compensating for your memory loss with external aids.

For internal memory strategies, memory strategy training can help you better encode memories in your injured brain through exercises like creating mnemonic devices. All the time and effort you spend trying to create the mnemonic device helps you better remember it, or encode it in your brain for storage and easy retrieval. One part of your initial assessment should involve identifying relative strengths so that you can use these strengths to compensate for weaknesses. For example, if you’re having trouble remembering new people’s names but do better remembering meaningful associations, you can be taught to create associations that will help you remember. So if you meet Claire who is very pleasant and cheerful, you might remember her name by thinking of her as “Cheerful Claire.”

External memory strategies teach you to supplement your memory with other cues and behaviors so you don’t have to rely on your memory. For example, a key hook gives you a regular, reliable place to hold your keys so you don’t have to remember each time where they are. By setting and sticking to a routine, you gradually learn to change your behaviors, to use such new tools, and to develop your muscle memory, so you don’t need to rely so heavily on remembering everything every time.

Finally, memory strategy training works because it tries to capitalize on what is already natural to you. We all use both internal and external strategies in daily life, so results are better if you work with what is already in your repertoire. For example, training to use a smartphone will likely work well for a tech savvy person. They probably have automatic skills using it. However, that might not work as well for a person in their 80s who only uses a flip phone. That person, however, may already be in the habit of using a daily planner or other written aid. This is why it is important to conduct a thorough assessment to guide selection of treatment strategies.

Memory and Brain Injury, The University of Washington TBI Model System and the University of Washington Medical Center

Where can I go to get this treatment?

You’ll need to find a health care provider with specialized knowledge, training, and experience in cognitive rehabilitation for brain injury. Here are some places to try:

• Ask your primary care physician or neurologist for a referral to a cognitive rehabilitation specialist.
• Contact your local hospital to speak with someone from the rehabilitation department.
• Contact your local brain injury association [link] or brain injury alliance [link] for information on brain injury services providers in your area.
• Contact the vocational rehabilitation services office for your state.

Note: Everyone’s brain is different and in most cases professional treatment for memory issues should begin with a careful assessment and evaluation.

What do patients say?

I just learned over the years various coping mechanisms. … I keep Post-its in business. I buy thousands and thousands of Post-its. If I have something coming up I’ll write a note and put it on my mirror. I know in the morning I go to brush my teeth there is it, ‘Don’t forget your 11 o’clock appointment.

— Retired NFL player George Visger

Jason Cowper and Tonya Howell share their stories of coming to terms with changes in their memory, and strategies they use to compensate for these changes.

Videos

• Is It a Memory Problem or Something Else?
• When Memory Issues After Brain Injury Impact Other Health Problems
• Memory Problems: When Am I Going to Get Better?
• The #1 Way Caregivers Can Help with Memory Problems After Brain Injury

Research, Articles, and Books

• Memory Compensations - Find memory compensation strategies that work for you
  From BrainLine
• Why Is It So Difficult to Commit Information to Memory Following a Brain Injury?
  From BrainLine
• Electronic Versus Paper Reminders for Remembering After Brain Injury
  From BrainLine
• Where Are My Keys? - Helpful strategies to keep track of your belongings.
  From BrainLine
• Using External Aids to Compensate for Memory and Organizational Problems Post-TBI
  From BrainLine
• Now What Did I Come In Here For? Strategies for Remembering What You’re Looking For
  From BrainLine
• Book: Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence (2011), Chapter: 10 Memory
• 9 Types of Mnemonics to Improve Your Memory
  From Verywell Health