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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.
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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.