[WEB SITE] 5 top tips for managing memory problems after brain injury

5 top tips: memory

Managing memory problems after brain injury

 

 

 

Impairment of memory is one of the most common effects of a brain injury and can cause serious problems with day-to-day living.

While there is unfortunately no cure available, there are a number of strategies that for many people make it easier to live with memory problems and can increase independence.

Adapt the environment

One of the simplest ways to help with memory problems is to adapt your environment so you rely on memory less.

Some ideas for doing so which have helped others are:

• Keeping a notepad by the phone to make a note of phone calls and messages
• Putting essential information on a noticeboard
• Deciding on a special place to keep important objects like keys, wallets or spectacles and always putting them back in the same place
• Attaching important items to your person so they can’t be mislaid, for example using a neck cord for reading glasses
• Labelling cupboards and storage vessels as a reminder of where things are kept
• Labelling perishable food with the date it was opened
• Painting the toilet door a distinctive colour so it is easier to find
• Labelling doors as a reminder of which room is which

Use external memory aids

Many people use external memory aids, regardless of whether they have a brain injury or not. External memory aids are particularly important for people with memory problems as they limit the work the memory has to do.

Some examples of external memory aids you could try include:

• Smartphones with diary or calendar applications
• Diaries, filofaxes or datebooks
• Notebooks
• Lists
• Alarm clocks
• Watches
• Calendars
• Wall charts
• Tape recorders and dictaphones
• Electronic organisers
• Pagers
• Pill reminder boxes for medication
• Sticky-backed notes
• Photo albums
• Cameras

Follow a set routine

Having a daily and weekly routine means that people with memory problems can get used to what to expect, which helps to reduce the demands on memory. Changes in routine are, however, often necessary, but can be confusing.

Relatives and carers can help by explaining any changes in routine carefully to help you prepare for the change, giving plenty of spoken and written reminders.

You could also try the following reminder strategies in order to establish routines:

• Make a note of regular activities in a diary or on a calendar
• Make a chart of regular events, perhaps using pictures or photographs, on a noticeboard

Combine several strategies to make a substitute memory system

Most people with memory problems find it useful to combine several aids and strategies. A combination of two or three strategies can cover the areas where there would otherwise be problems and provide a safety net for things that must be remembered.

Here are examples of the components of two such ‘combination systems’ you can try:

System one:

• Three lists – one showing routine tasks, one showing where to find files in the filing cabinet and one showing key ‘rules’, such as when to do the filing each day
• A ring binder with sections on ‘immediate/urgent tasks’ and ‘long-term projects’

• A notebook
• A telephone message pad to make notes of conversations
• A computer calendar and alarm
• Practising assertiveness techniques to ‘buy time’ instead of having to respond to requests immediately. For instance, encouraging the person with the memory problems to say, “hang on, let me just find my notepad” and then taking their time with finding the relevant information in the notepad
• Simple relaxation and breathing techniques to reduce anxiety

System two:

• Filofax
• Journal
• Watch
• Dictaphone
• Various lists
• Sticky-backed notes
• Menu chart
• Keeping things in the same place
• Following routines

Improve general well-being

Memory is very important in giving us a sense of our own identity. Memory problems often have major emotional effects, including feelings of loss and anger and increased levels of depression and anxiety. Some approaches to dealing with this are as follows:

• Share your feelings with others. People with memory problems often find that talking to people who understand their problems can provide relief and reassurance. Headway Groups and Branches can be an excellent source of support and details of how to find your local service are provided at the end of this factsheet.
• Identify activities you find enjoyable and relaxing, such as listening to music or exercising, and take the time to indulge in them.

Find out more

Finding a strategy that suits you can be a case of trial and error, and it is important to take things slowly. You should always speak to your doctor before changing your routine, and you might like to seek a referral to a specialist such as a neuropsychologist or occupational therapist for personalised professional support.

This information is adapted from Headway’s factsheet Coping with memory problems – practical strategies, which you can download below or from our information library. Much of the information contained here is included in the book Coping with memory problems, and is used with kind permission from Pearson Assessment. You can purchase this book in the Headway shop.

You can contact our helpline on 0808 800 2244 or helpline@headway.org.uk to discuss any of the issues covered here, or get in touch with your local Headway group or branch.

 

via 5 top tips for managing memory problems after brain injury | Headway

[Abstract] Cognitive rehabilitation for memory deficits after stroke – The Cochrane Library

Abstract

Background

Memory problems are a common cognitive complaint following stroke and can potentially affect ability to complete functional activities. Cognitive rehabilitation programmes either attempt to retrain lost or poor memory functions, or teach patients strategies to cope with them.

Some studies have reported positive results of cognitive rehabilitation for memory problems, but the results obtained from previous systematic reviews have been less positive and they have reported inconclusive evidence. This is an update of a Cochrane review first published in 2000 and most recently updated in 2007.

Objectives

To determine whether participants who have received cognitive rehabilitation for memory problems following a stroke have better outcomes than those given no treatment or a placebo control.

The outcomes of interest were subjective and objective assessments of memory function, functional ability, mood, and quality of life. We considered the immediate and long-term outcomes of memory rehabilitation.

Search methods

We used a comprehensive electronic search strategy to identify controlled studies indexed in the Cochrane Stroke Group Trials Register (last searched 19 May 2016) and in the Cochrane Central Register of Controlled Trials (CENTRAL2016, Issue 5), MEDLINE (2005 to 7 March 2016), EMBASE 2005 to 7 March 2016), CINAHL (2005 to 5 February 2016), AMED (2005 to 7 March 2016), PsycINFO (2005 to 7 March 2016), and nine other databases and registries. Start dates for the electronic databases coincided with the last search for the previous review. We handsearched reference lists of primary studies meeting the inclusion criteria and review articles to identify further eligible studies.

Selection criteria

We selected randomised controlled trials in which cognitive rehabilitation for memory problems was compared to a control condition. We included studies where more than 75% of the participants had experienced a stroke, or if separate data were available from those with stroke in mixed aetiology studies. Two review authors independently selected trials for inclusion, which was then confirmed through group discussion.

Data collection and analysis

We assessed study risk of bias and extracted data. We contacted the investigators of primary studies for further information where required. We conducted data analysis and synthesis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. We performed a ‘best evidence’ synthesis based on the risk of bias of the primary studies included. Where there were sufficient numbers of similar outcomes, we calculated and reported standardised mean differences (SMD) using meta-analysis.

Main results

We included 13 trials involving 514 participants. There was a significant effect of treatment on subjective reports of memory in the short term (standard mean difference (SMD) 0.36, 95% confidence interval (CI) 0.08 to 0.64, P = 0.01, moderate quality of evidence), but not the long term (SMD 0.31, 95% CI -0.02 to 0.64, P = 0.06, low quality of evidence). The SMD for the subjective reports of memory had small to moderate effect sizes.

The results do not show any significant effect of memory rehabilitation on performance in objective memory tests, mood, functional abilities, or quality of life.

No information was available on adverse events.

Authors’ conclusions

Participants who received cognitive rehabilitation for memory problems following a stroke reported benefits from the intervention on subjective measures of memory in the short term (i.e. the first assessment point after the intervention, which was a minimum of four weeks). This effect was not, however, observed in the longer term (i.e. the second assessment point after the intervention, which was a minimum of three months). There was, therefore, limited evidence to support or refute the effectiveness of memory rehabilitation. The evidence was limited due to the poor quality of reporting in many studies, lack of consistency in the choice of outcome measures, and small sample sizes. There is a need for more robust, well-designed, adequately powered, and better-reported trials of memory rehabilitation using common standardised outcome measures.

Plain language summary

Cognitive rehabilitation for memory deficits after stroke

Review question

We reviewed the evidence for the effectiveness of cognitive rehabilitation for memory problems in people with stroke.

Background

People often struggle with memory problems following stroke and this can lead to difficulties in everyday life. The degree and kind of memory problems, mood changes, and performance of everyday activities can vary widely depending on many factors, including the location of the stroke in the brain, severity, age, and the previous health of the person experiencing a stroke.

Memory rehabilitation, a part of cognitive rehabilitation, is a therapeutic activity that may play a role in the recovery of memory functions, or in enabling the individual to adapt to the problems. Memory rehabilitation is a standard part of rehabilitation in many settings. However, it is uncertain whether memory rehabilitation can improve people’s memory problems, or whether it has an effect on mood, performance in everyday activities, or quality of life.

Study characteristics

The evidence is current to May 2016. In this review, we included 13 studies with 514 participants. Seven trials were conducted with community participants, four with in-patients, and two with mixed community and in-patient samples. Participants received various types of memory retraining techniques, including training using computer programs and training in the use of memory aids, such as diaries or calendars. In three studies treatment was provided in groups and in 10 studies treatment was provided individually. Treatment lasted between two weeks and 10 weeks. In these studies, those who received the treatment were compared with a control group. The control group included those who did not receive cognitive rehabilitation or received another form of treatment. The control groups varied. Some studies had a control group wherein people received their usual care, whereas in others individuals in the control groups were placed on a waiting list to receive cognitive rehabilitation.

Key results

We found that people who received cognitive rehabilitation reported fewer memory problems in daily life immediately after treatment compared with the control groups. This represents a small to moderate effect of the intervention in comparison to the control group. However, there was no evidence that the benefits persisted in the long term. We found no evidence that cognitive rehabilitation improved people’s independence in activities of daily living, mood, or quality of life. There was no information about any harm caused to participants from taking part in cognitive rehabilitation.

Quality of the evidence

The quality of the evidence ranged from very low (effect on outcomes that relate to everyday activities) to moderate (effect on self-reported memory problems, memory tests, and mood measures). There were a number of flaws in these studies, such as having very few people in them, and these could have affected our findings.

Source: Cognitive rehabilitation for memory deficits after stroke – das Nair – 2016 – The Cochrane Library – Wiley Online Library