Rebuilding Your Memory: Memory
Notebooks & Other Strategies
Kaleena Valente, M.A., CCC/SLP
MetroHealth Rehabilitation Institute of Ohio
Cleveland, Ohio
November 1, 2010
Common memory problems after TBI
 Short term and recent memory
– Names and faces
– Details and sequences during the day
– Information that someone told you
 Declarative memory
– Knowledge base (storage of events, facts, words)
 Prospective memory
– Remembering to complete a task in the near future
– Future appointments
The memory process
 Attention
 Encoding
– It can be described as “understanding” the
information
 Storage
– Transferring of information to a specific area
of the brain
 Retrieval
– Searching for existing memory traces
The memory process
 Memory failure
– Can be attributed to one of these processes
• Encoding
• Storage
• Retrieval
 Types of memory
– Procedural—implicit, nondeclarative, automatic
(routines)
– Semantic—explicit, declarative, encyclopedic
knowledge (facts)
– Episodic—explicit, declarative, you remember the
event
Brain Injury and memory
 One or more of these areas of memory
and attention are often affected following
a brain injury
 Using compensatory strategies such as a
memory book, planner, self-talk,
mnemonics, etc can be very effective in
targeting these different stages of the
memory process.
Common Memory Problems After a Brain
Injury
 Difficulty recalling:
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Names
Items
Events
Personal information
Phone calls
Conversations
Evidence based practice of external memory
aids (Sohlberg et al, 2007)
 19 studies with 270 subjects (Mostly
young adults)
 Every study showed a positive treatment
effect
 Evidence did not show:
– Which strategies worked for which patients
– How to best assess and train people in use of
strategies
Evidence-based practice for memory aids
 Clinical recommendation from researchers noted
that external memory aids may be considered a
practice guideline for individuals with TBI.
Kennedy, 2007
 Technical reports from ASHA for several
treatment modules are near completion that
include the reports on training external memory
aids.
ASHA, 2008
External memory strategies
 Compensatory (versus restorative)
strategy.
 Can be used for one domain (one specific
use) or can be used for a set of tasks.
 Goal: Rely on preserved memory
processes (non declarative memory) to
learn a new procedure such as using
memory aids.
Considerations when selecting an external
memory aid
 Needs assessment
– Organic factors
• Severity of cognitive or memory deficits
• Physical profile (are there physical
limitations…such as visual or motor difficulties?)
– Personal factors
• Have they used a planner before? What kind?
• What is their preference?
• What is their goal? (manage daily activities, return
to school or work)
Examples of external memory aids
 Written planning systems (planners, notebooks,
calendars)
 Electronic planners (PDA, Blackberry, cell
phone)
 Computer based planning systems (Outlook)
 Task specific aids:
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Memo pads
Post-it notes
Pill box
Key finder
Bulletin boards/Dry erase boards
Grocery lists
Memory Notebook System
 Improves orientation
 Helps with recall of past, present and
future information
 Improves planning of tasks
 Can be tailored to the individual
Sample page
Monday, November 1, 2010
Appointments/Scheduled Activities:
 9:15am—Brain Injury Conference
 5:00pm—Hair cut
 6:00pm—Dinner at Applebee's with Barb
To Do:
 Call about water bill
 Schedule cable TV installation
Log:
Saw a very old friend of mine at the Conference today (Barb
Smith). She lives in Dayton (phone #: 937-555-1234).
On my way home from dinner I was pulled over by a state
trooper because one of my headlights is burned out. I’ll have
to schedule an appointment to get it fixed tomorrow!
Tips for using a daily memory notebook system
 Put the book in a high traffic area so you’ll
be more likely to use it or look at it.
 Check the book frequently—plan on
looking at the book at least 3 times per
day.
 Family members can help with cues and
reminders.
 Set an alarm (watch, cell phone, kitchen
timer) as a reminder to check notebook.
More tips for using a daily memory notebook
system
 Clinicians: start with orientation goals and
progress towards higher level tasks (think
errorless learning!)
 Clinicians: a questionnaire can be used to
check understanding of planner usage.
Electronic aids
 BlackBerry’s, PDAs, even iPods.
 These devices often have calendars, todo lists and note features.
Blackberry
iPod touch
PDA
Electronic aids
 Even cell phones can have alarm and
calendar features.
 Many of these electronic devices can be
hooked up with your computer, making it
even easier to manage your calendar,
appointments, to-dos, etc.
 Through gmail, you can set up a calendar
and have reminders text messaged to
your phone.
Other Electronic Resources
 Voice Organizers
– Record goals, set alarms to
remind you of goals
 Timers
 Smart Pens
– Will record pen strokes and audio
More Electronic Resources
 Reminder Watches
Timex USB Data Link
Watchminder 2
Fossil Palm
Wrist PDA
Casio
Databank
Specialized Devices
 The Jogger
– www.thejogger.com
 Pocket Endeavor
 PEAT
– www.brainaid.com
Other memory aids
 Pill reminder boxes (can also be purchased with
alarms)
 Appliances and lights with automatic shut-off
features
 Beeping key chains
 Key hooks by the door
 Post-it notes
 Mail Sorters
 Calendars
 Large dry erase boards
Beyond memory notebooks
 Utilizing other strategies to assist with our
memories.
 Strategies for recalling:
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Names
Items
Events
Phone calls
Recalling Names
 When meeting someone new, repeat the
person’s name as soon as it’s said.
 Ask the person to spell his or her first or
last name, even if it’s easy to spell.
 When you leave a situation when you’ve
just met someone, end the conversation
by saying the person’s name
Recalling Names
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As soon as you leave, jot down the
person’s name, where and when you
met, and the person’s features. When
you are going to be with this person
again, review your notes first.
Before leaving to meet this person
again, make up a sentence that includes
names and places to remember and say
it out loud.
Recalling Names
 Try to focus on one key feature to aid in
recall. For example, Mr. Bush has bushy
eyebrows.
Activity
 Find a partner. It needs to be someone
you do not know.
 Introduce yourself.
 Focus on one feature of your new
acquaintance and make up a sentence to
remember his/her name.
 Any volunteers to introduce your new
acquaintance?
Items
 Keep things in the same place at all
times, such as keys hanging on a hook by
the door, an address book and stamps in
a drawer by the phone, scissors in a
sewing box, etc.
 Establish a spot or box near the door to
place objects you need to take with you,
such as memory books, keys, wallets,
packages, umbrellas, etc.
Items
 Make up a silly sentence that includes
items to remember and say it out loud.
For example, “Pour detergent on the
bananas in the envelopes” to remember
to buy detergent, bananas and envelopes
at the store.
Items
 Mnemonics may be used to help you with
recalling lists.
 Never Eat Sour Watermelons
 HOMES to remember the Great Lakes
 To remember where your car is parked,
look for permanent visual cues and
describe them out loud.
Events
 Do activities on the same day each week or
month. For example, pay bills on the last day of
the month, go to the bank every Wednesday, to
go the grocery store every Tuesday, go to
therapy on the same days each week, etc.
 Use direct deposit and direct bill paying services,
available through your bank, to ensure that your
checks are deposited and that important bills are
paid on time.
Events
 Use verbal rehearsal to help you remember
things as you do them. For example, “I’m putting
the scissors in the top drawer so the baby can’t
reach them” or “I’m checking the burners on the
stove and turning on the porch light before I go
upstairs.”
 This will improve your attention to the task and
help to move this information into your memory
Telephone Use
 Keep a notebook by your phone and keep a log
of who called, what time, and what each person
wanted. Also keep track of calls you made, who
you called and what time.
– You can also keep this log in your memory notebook
 When you take a phone message, write down
the most important information.
– First: write down the caller’s name and phone number.
– Second write down the date and the time.
– Third, write down the content of the message.
Conversations
 During conversations, comment on what
the other people are saying. Restate their
comments in your own words. Actively
participating in the discussion will help
you remember the main points of the
conversation later.
Routines
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Low demands on working memory
Capitalizes on implicit learning
Reduced demands on executive functions
Procedural memory (the memory to
complete routines) is the last type of
memory we lose
Remember
 Reduce demands on your brain!
– Write things down, use your strategies, find
ways to manage stress
 Practice makes perfect
 Out of sight out of mind