May 2010  << Back  

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Memory Rehabilitation. Integrating Theory and Practice

Richard Balon, MD

Wayne State University, Detroit, MI, USA

By Barbara A. Wilson. New York, NY: The Guilford Press; 2009; ISBN 978-1-60623-287-3; pp 284; $48 (hardcover).

Rehabilitation of memory impairment is a timely and important area, especially with our aging population and increasing numbers of patients surviving serious brain injuries or illnesses. Like many, I was attracted by the title of this book, erroneously thinking that it would address rehabilitation of all causes of memory impairment, including dementia. However, as Barbara Wilson, the author of this book, points out, “Memory Rehabilitation is about the condition and treatment of people with nonprogressive brain damage and does not, for the most part, consider work that is being conducted with patients suffering from dementia” (pp xi-xii). This volume addresses memory rehabilitation in patients with conditions such as multiple sclerosis (34% of whom have moderate to severe memory problems), survivors of nonprogressive brain injury (36% have significant memory impairment for the rest of their lives), survivors of encephalitis (70% have some memory impairment), patients with temporal lobe epilepsy (10% experience significant memory impairment), and survivors of stroke, myocardial infarction, cerebral tumors, carbon monoxide poisoning, meningitis, and other conditions, all of whom may also experience memory problems (p xii). According to its author, this book tries to offer help not only to these patients, but also their families. The author also emphasizes that another reason for writing this book is because “the prevailing view of many neurologists and neurosurgeons, some psychiatrists, and a few neuropsychologists is that little can be done to alleviate problems faced by memory-impaired people” yet, “they can be helped to cope with, bypass, or compensate for their memory problems; they can learn how to come to terms with their condition.”

The book consists of 11 chapters, an Appendix, and References. Chapter 1, “Understanding memory and memory impairment,” is a solid introduction to the topic of memory. It explains and discusses various categories of memory such as time-dependent memory, semantic memory, procedural memory, modality-specific memory, explicit memory, implicit memory, retrospective memory, prospective memory, retrograde, and anterograde memory. The following chapter, “Recovery of memory functions after brain injuries,” focuses on what is meant by memory recovery and mechanism of recovery. There seem to be 3 types of brain injury patients—those who will recover without help, those who show no significant change even with help, and those who do reasonably well provided they receive assistance (p 22). Numerous factors, such as age at insult, diagnosis, number of insults sustained, and premorbid status of the brain, influence recovery. Some people may show less impairment after the injury as they may have some cognitive reserve (mostly people with more education and higher intelligence). The author proposes that we can help natural recovery through rehabilitation.

Chapter 3, “Assessment for rehabilitation,” explains that, “assessment is concerned with judgment, estimation, appraisal, analysis, and evaluation.” Good assessment is quite important before starting rehabilitation. The assessor needs to know about cognitive functioning in general, the level of premorbid functioning, emotional and psychosocial problems, and the patient’s main concerns. The chapter also reviews which aspects of memory should be evaluated in memory assessment for rehabilitation and which tests of memory should be used. Chapter 4, “Compensating for memory deficits with memory aids,” written with Narinder Kapur, is probably the most practical and important of the entire book. The authors emphasize that “The ultimate goal of rehabilitation is to enable people to function as independently as possible in their most appropriate environment” (p 52). External memory aids are the most efficient strategies for memory-impaired people. They include, among others, wall calendars, notebooks, appointment diaries, asking others to remind, alarm clocks, notes in special places, writing on hand, repetitive practice, electronic organizers, pill boxes, “First-Letter” mnemonics, pagers, mobile phones, and many others. Many of us use these devices in routine life anyway, yet some memory-impaired people need to be taught and reminded how and when to use them alone or in a combination. It is not always easy for memory-impaired people to use these devices. “Efficient use of many external memory aids involves a degree of motivation, patience, planning, problem solving, concentration, learning, and, indeed, memory, so the people who need them most often have the greatest difficulty in learning how to use them” (p 53). The most widely used aids are not necessarily the most effective ones. Interestingly, following a weekly or daily routine, making lists, and asking others for reminders usually receives high ratings for effectiveness. This chapter also describes setting up a memory aids clinic (only a few are available in the United Kingdom, though). The final part of this chapter discusses how advances in technology will impact memory aids in the future (smart homes, mobile phones, cameras, location detection devices, virtual reality, and advanced brain imaging). The following chapter, “Mnemonics and rehearsal strategies in rehabilitation,” reviews in detail mnemonics—systems that enable us to remember things easily. The author discusses verbal mnemonics, visual mnemonics, and motor movements as memory aids. The second part of this chapter deals with rehearsal, which simply means to practice or repeat something until it is remembered (p 82).

Chapter 6, “New learning in rehabilitation. Errorless learning, spaced retrieval (expanded rehearsal), and vanishing cues,” continues presenting readers with various techniques of memory rehabilitation. Errorless learning “is a teaching technique whereby people are prevented, as far as possible, from making mistakes, while they are learning a new skill or acquiring new information” (p 89). Chapter 7, “Memory groups,” advocates establishing groups for persons with memory impairment and discusses how to run them. Chapter 8, “Treating the emotional and mood disorders associated with memory problems,” brings to our attention the fact that people with memory impairment could suffer from associated anxiety, depression, and other problems that should be properly treated (although the proposed treatment is not comprehensive). The following 2 chapters discuss “Goal setting to plan and evaluate memory rehabilitation” (chapter 9) and a framework for memory rehabilitation (chapter 10, called “Putting it all together”). The very last chapter, “Final thoughts and a general summary,” summarizes the previous chapters. The Appendix is a comprehensive list of resources, such as Web sites, societies, etc, in countries around the world.

This book is an interesting introduction to a less known area of memory impairment and memory rehabilitation in various brain non-dementia injuries and disorders. Its attractiveness is in the relative novelty of this area and the author’s scholarship and intimate knowledge of and familiarity with the topic. The book could help clinicians taking care of patients with similar memory impairments. However, busy clinicians probably would appreciate even more concrete and specific advice and guidance. This book’s greatest weakness is that it is a classic example of the schism of the present era care for our patients. It is written from a psychology or neuropsychology point of view. The book does not mention psychiatric or neurology care or medications (many memory-impaired patients are on medications and these can impact memory; the book discusses managing emotional problems associated with memory impairment, not medication). This fragmented care certainly is not anything we wish for our patients.