Memory Training as a Prerequisite of Identity Rebuilding following brain injury mia foxhall and birgit gurr. Jr's memory improved: he could locate places on the map, and remember routes around the hospital ward. Despite accuracy in route finding and recall, he could not consistently construct a mental map of the ward and link it to reality. Seven sessions of errorless, face-name learning trials were administered, spread across 14 days.
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Original Title
Memory Training as a Prerequisit of Identity Building Following Brain Injury
Memory Training as a Prerequisite of Identity Rebuilding following brain injury mia foxhall and birgit gurr. Jr's memory improved: he could locate places on the map, and remember routes around the hospital ward. Despite accuracy in route finding and recall, he could not consistently construct a mental map of the ward and link it to reality. Seven sessions of errorless, face-name learning trials were administered, spread across 14 days.
Memory Training as a Prerequisite of Identity Rebuilding following brain injury mia foxhall and birgit gurr. Jr's memory improved: he could locate places on the map, and remember routes around the hospital ward. Despite accuracy in route finding and recall, he could not consistently construct a mental map of the ward and link it to reality. Seven sessions of errorless, face-name learning trials were administered, spread across 14 days.
Memory Training as a Prerequisite of Identity Rebuilding
following Brain Injury
Mia Foxhall and Birgit Gurr
Procedure Background Intervention 1: Errorless Face - Name Learning Intervention 2: Orientation and Map - Learning Intervention 3: Cognitive Music Therapy to aid Identity Rebuilding JRs memory improved: he could independently locate places on the map, and remember routes around the hospital ward. Despite accuracy in route finding and recall, JR could not consistently construct a mental map of the ward and link it to reality. Procedure 2b Outcome Patient Information To optimise orientation and improve learning ability, seven sessions of errorless, face-name learning trials were administered, spread across 14 days. JR was presented with four staff photos and trained to match photos to staff name and occupation. Trials were repeated three times within each session. Delayed recall was tested after 15 minutes. The interval period was spent completing basic sustained attention tasks. JR scored one point for each correct name and occupation. Outcome
JRs score improved from 22.5 to 30 with training, suggesting an improvement in memory. This success transferred to independently recognising staff in day-to-day interactions on the ward. JR experienced a sense of achievement and felt more confident working with ward staff. 20 22 24 26 28 30 32 T1 T2 T3 T4 T5 T6 T7 M e m o r y
R e c a l l
S c o r e
Sessions Patient JR continued to present with confusion regarding the ward environment e.g. he believed that he had several other rooms on different wards. JR participated in six sessions of errorless, map-learning trials across 12 days. He was shown photos of important rooms on the ward and taught their locations on a corresponding map. He was trained to match the photographs to their position on the map across three trials per session, followed by basic sustained attention trials, before attempting delayed recall.
Occupational Therapists created an electronic reminder system on JRs phone, sending him reminders before each therapy session began, to support punctuality.
Outcome JR was independently able to use the memory reminder system.
JR could use the system to orientate himself around the ward.
JRs punctuality improved for therapy sessions.
Procedure 2a Despite JRs memory improvements he was unable to link his life events or places he had lived in with his biographical memory. His memory training optimised his recall, but more on a mechanical level. He expressed that the events he had participated in had no meaning on a personal or emotional level. As a result he was unable to apply his learning to reality. As he began to gain insight into his memory deficits and inability to emotionally connect to day-to- day experiences, JR began to experience a loss of identity, which manifested as low mood and reduced participation. An intervention was designed to develop a timeline of JRs life, in collaboration with JR. As JR expressed that music was a large part of his life, and given research that suggests music therapy can support autobiographical memory (Janata, Tomic & Rakowski, 2007; El Haj, Postal & Allain, 2012), JR was asked to listen to popular music from the late 1970s to the early 2000s and recall periods of his life and any specific autobiographical memories. During the first session of the intervention, focussing on music from the late 1970s to the early 1990s, JR was able to recall the period of his life each song reminded him of and could recall a specific autobiographical memory 85% of the time. However, on the second and third session, JR could only recall autobiographical memories 61.5% and 58.3% of the time, respectively. Despite this, the autobiographical memories JR could recall were carried over to subsequent sessions and other occasions. JR began to show insight into the type of person he was through listening to the songs and was able to reflect on his past emotional associations as the intervention developed. This effect transferred to memories cued through discussion, rather than music. JR was able to build a collection of life events that helped define who he was and was able to reflect on his emotions during past events, even when music had not prompted recollection. Finally, JRs mood and motivation with rehabilitation improved, which supported his progress in other areas of rehabilitation more generally. References: El Haj, M., Postal, V. & Allain, P. (2012). Music enhances autobiographical memory in mild Alzheimers Disease. Educational Gerontonolgy. 38: 30-41. Janata, P., Tomic, S.T. & Rakowski, S.K. (2007). Characterisation of music-evoked autobiographical memories. Memory. 15: 845-860. Sohlberg, M.M., & Mateer, C.A. (1987). Effectiveness of an attention-training program. Journal of Clinical and Experimental Neuropsychology. 9: 117-130. Wilson, B. A., Baddeley, A., Evans, J., & Shiel, A. (1994). Errorless learning in the rehabilitation of memory impaired people. Neuropsychological Rehabilitation. 4: 307-326. Wilson, B. A., & Gracey, F. (2009). Towards a comprehensive model of neuropsychological rehabilitation. Cited in B. Wilson, F., Gracey & J.J. Evans [Eds.] Neuropsychological rehabilitation: Theory, models, therapy and outcome. Cambridge, UK: Cambridge University Press
Contact: Dr Birgit Gurr , Neuropsychology Service, Dorset HealthCare, University NHS Foundation Trust, Poole Community Clinic ,Shaftesbury Road, Poole BH15 2NT, birgit.gurr@dhuft.nhs.uk Cognitive rehabilitation is a comprehensive approach for improving cognitive function via compensation or remediation (Wilson, 2002). Interventions are based upon empirical models, such as attention-process training (i.e. employing attention drills to support other cognitive functions, Sohlberg & Mateer, 1987) or errorless learning (repeated errorless teaching of information until perfect performance is achieved (Wilson et al., 1987). Successful cognitive rehabilitation draws from more than one theoretical basis in order to focus on a variety of elements of cognitive function (Wilson, 2002). Cognitive rehabilitation should evolve throughout treatment according to the patients emerging needs. This poster presents a case study of a patient recovering from an acquired brain injury and illustrates the importance of comprehensive and responsive rehabilitation. Patient Details: JR, 47 year old, single man; previously worked as a laminator and DJ; periods of social isolation. Brain Injury Details: Subarachnoid haemorrhage, intraventricular and intraparenchysmal haemorrhage; found collapsed on floor. Neuropsychological presentation: Severe anterograde amnesia and retrograde amnesia; confabulations; disorientation to time and place; anhedonia. Initial rehabilitation aims: Enhance orientation and confidence and improve learning potential.