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The Memory Process (Part 3)
Improving one's memory after a brain injury seems to be a life-long struggle. Books and audiotapes available on improving memory skills most readily apply to the non-injured population, and the additional steps involved only seem to make the memory process even more difficult. There is a critical dichotomy in memory impairments that is too rarely addressed. Can the skill be improved or should energy be put instead into learning to compensate? This is rarely addressed because there are many issues involved and we still know too little about the brain. The potential for a skill to be improved after an injury depends upon at least three issues: the extent of the damage to the axons in that area of the brain, the general health of the undamaged brain tissue, and the potential of the brain to form new neural pathways to redevelop the lost skill. The extent of axonal damage can only be guessed at by the severity and range of impairments localized to that area of the brain. The general health of the undamaged brain tissue can be surmised to be good if the edema (increased fluid, commonly called "swelling") around the damaged tissue has had time to decrease (generally three to six months after the injury), and if issues with arteriosclerosis, hypertension, major seizures, medications and stress are minimized, while issues with general health, psychological state and attitude, nutrition and rest for the individual are at their best. The potential for formation of new neural pathways is a relatively new area of study and there is currently no way of evaluating it in regards to the human brain. When my students raise this question of improvement versus compensation, I generally use a 25%/75% formula to discuss my opinion. If they are less than six months since their injury, their general health is good, and the severity and range of impairments in that region of the brain is mild, then we put 75% of our efforts into improving the skill and 25% into developing compensatory strategies. That 75% gradually decreases while the 25% increases when the impairments are more severe and/or wide ranging, when health issues are a concern, or as duration since injury increases, until we are putting 75% of our efforts into compensatory strategies and 25% into improving the skill. I don't totally discontinue efforts to improve a skill, but I do put more of my time with the students on teaching compensatory techniques while encouraging them to independently continue practicing the improvement techniques we've covered if they feel the techniques are beneficial.
In order to create some structure for the following discussion, I will first address the issue of auditory memory for information that is only heard or for those whose preferred processing style is auditory. Within this area I will discuss ways of improving and types of compensatory strategies as each relates to the steps of processing, short-term storage, and long-term storage and retrieval. Later, I will do the same with visual memory, and then with kinesthetic memory. Logically, it seems this structure will help clarify the information, but keep in mind that the most effective memory uses multiple modalities and strategies, most often auditory and visual, for long-term storage and retrieval.
With brain injuries that occur when traveling quickly and then suddenly stopping (the acceleration-deceleration types of injuries from most car accidents and some falls), attention deficits and processing speed are the most common reasons for memory problems. The damage to the frontal lobes and anterior temporal lobes also places at a distinct disadvantage the individual whose preferred processing style was auditory. In a rather automatic way, this individual's brain continues to attempt to remember information by hearing it. Later, when trying to retrieve the information, he or she may remember how the person speaking looked, what they did, and even how the rememberer felt about what was said, but not be able to remember what was said. Information processed every other way during the event may be remembered, but not the auditory - or at least not the auditory-verbal information.
The attention deficits following an acceleration-deceleration injury are pervasive. Although the individual may feel he or she is paying attention, the distractions of the environment, the distractions of other people around, even the distractions of his or her own thoughts will interfere with selectively attending to information. In a way, it is all divided attention, the highest form of attention, because selectively attending usually has to take place within an interactive environment. This individual often ends up actually "skimming" information rather than truly giving it the same degree of attention given before the injury. With processing speed slightly slowed, energy spent on tuning out distractions, and even possible stress about whether or not the information will be remembered, the chances of the brain being able to accurately process, store and retrieve the information later are much reduced. I cannot overstress the importance of improving attention skills for a resultant improvement in memory. Attention is a skill that often improves with training (see TPN Fall 1995), and, particularly at the divided attention level, is very important for improving both the formation of the memory trace and the effectiveness of the retrieval process.
To improve auditory processing, the individual needs to find ways to linger with the information, to really process and absorb it, and to let his or her brain make its links. One problem with auditory processing is the information that we hear is transient. Unlike words on a page, we can't look at them until they sink in, we have to repeat them. Compensatory strategies to help process auditory information can include audio or video-taping, and identifying relevant information heard by taking notes, or episodic summarizing. I have seen little to improve auditory short-term storage other than to challenge it by repeating lengthier and more complex information. Otherwise, information for long-term storage may need to be reduced into smaller chunks (smaller than the 5-9 pieces of information our short-term memory usually handles). Then, unless word-finding is a problem, the issue with auditory memory tends to be in retrieval.
When trying to improve auditory memory retrieval, I usually discuss a process of repeated retrieval. This is not rehearsal, which is repeatedly putting the information into short-term memory, but is rather repeatedly pulling the information out of long-term memory. The goal is to gradually increase both the time delay between remembering and the complexity of the distraction that occurs during each time delay. For example, a friend of mine was having difficulty after his injury remembering the beginnings of songs. Once the song was begun, he was could handle the rest of the melody and lyrics, but unfortunately, these were songs he was responsible for beginning. Once he had the beginning of the song clearly in mind, I'd have him wait quietly for several seconds and then start the song again for me. This was usually successful, so then I'd have him recite the pledge of allegiance or something fairly automatic and then start the song again. Once this was successful we'd move on to simple, social conversation for a few minutes. followed by remembering the song. The time delay and the difficulty of the task would increase, until ultimately nearly an hour of distractions (and usually a different song) would elapse before I'd have him start the song. On his own, I'd have him try even longer periods of delays. He observed that the beginning notes of the song took on an almost visual nature, and linked themselves with the beginning lyrics. He also noticed that after doing this with several songs, he was able to move through the delay/distraction process more quickly.
Compensatory strategies for auditory memory storage and retrieval usually involve organizing the information and/or associating the information with prior knowledge. Well-documented in books and tapes, these processes can be especially cumbersome after a brain injury, but they are less so if students begin thinking them up within a group, and they do get easier and faster with practice. Alone and without practice, their success rate is very low. When I teach our class on memory strategies. I employ small group assignments on using each strategy within tasks in our computer lab to encourage this practice.
Mentally organizing information helps both in understanding and in memorizing because it usually arranges the information in a relevant, efficient way. A friend of mine commonly bets people that they cannot name all 50 states in the United States. Most people take on his bet, confident that they know all the states. I have yet to see anyone win the bet, because we don't usually organize this information. One way of organizing the states could be in alphabetical groups; for example, there are eight states beginning with the letter N: four are New, two are North, and two simply begin with N. Knowing this could assure that you would retrieve all of the states beginning with the letter N. Translating information about a process into steps is another way organizing information can help in remembering it. A chapter about the Civil War could be translated into a series of battles, or the process of solving quadratic equations by factoring can be broken down into a six step procedure.
The most common group of strategies for auditory memory storage and retrieval involve verbal associations. These are links based on familiar words or phrases to connect them with the new information you want to memorize. For example, to remember that Baton Rouge is the state capital of Louisiana, two of my students made up the phrase "Louise and Anna were playing with batons and rouge." Remembering the difference in meaning and spelling between desert and dessert can be done with the phrase "strawberry shortcake for dessert" or the concept that the fatter word - dessert(with 2 s's) - stands for something that will make you fatter if you eat it. These are other forms of verbal associations. They are more effective when your association also has some connection with why you are remembering the information. My two students' verbal association for Baton Rouge might have been a little more effective if it contained some concept of "state" and/or "capital." But again, thinking up associations is most successful when begun in small groups, and gets better when practiced repeatedly.
More entertaining strategies for remembering auditory-verbal information use rhymes, songs, acronyms or acrostics. Advertisers rely heavily on these techniques so that we will remember their products or businesses. "In fourteen hundred and ninety-two Columbus sailed the ocean blue" is a rhyme commonly used to remember the year Columbus arrived in America. Information can be even more cryptic in a rhyme, just enough to jog your memory, such as "Divorced, beheaded, died. Divorced, beheaded, survived" which describes, in order, the outcome of each of the six wives of King Henry VIII of England. Songs are more difficult to create but very effective. Many people can hardly keep from adding the melody when they recite the alphabet. I can't spell Massachusetts without using their song. More songs are being marketed now to teach a variety of academic information such as phonics, grammar, punctuation and multiplication. An acronym is a single word made from the first letter of each word from a list or phrase. Rearrange the first letters of each of the five Great Lakes surrounding Michigan (Superior, Michigan, Heron, Erie and Ontario) and you can get the word "HOMES." NASA, OPEC, MADD, and NAFTA are all acronyms designed to make it easier to remember their names and yet (hopefully) still be able to generate the words for which each letter stands. An acrostic is similar, but instead of a single word, each letter begins a word in a phrase. "My Very Educated Mother Just Showed Us Nine Planets" not only provides us with the first letter of each planet in order, but the phrase relates itself to the nine planets very nicely. "Please Excuse My Dear Aunt Sally" (or the acronym PEMDAS) is commonly taught for memorizing the order of operations in math (parentheses, exponents, multiplication, division, addition and subtraction) but I recommend relating the phrase to math, creating something like "Place Each Math Digit As Sequenced."
One other auditory-verbal type of strategy that can be helpful relates specifically to memorizing numbers. When a series of numbers (like a date, phone number, or the combination to a lock) needs to be memorized, it can be very effective to create a phrase where each word has the needed number of letters. For example, counting the number of letters in each word of "How I wish I could remember pi" yields 3, 1, 4, 1.5, 8, and 2. Pi (a mathematical constant used to measure the area or circumference of circles) to 6 places is 3.141582. "I wrote Hamlet well" yields 1564, the year Shakespeare was born. Using "is" for the equal sign helps "Biggest elephant is large legend" mean 7 x 8 = 56. While strategies can assist auditory memory, one of their best assets is that they keep us focused on and playing with the information we want to retain.
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