Table Appendices: (Table 7.2)

Verbal Memory and New Learning

Individual Studies

Table 7.2 Treatments to Improve Verbal Memory and New Learning

External Aids:

Trial and Error Learning

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Powell et al.,

(2012)

USA

RCT

D&B=23

PEDro=7

N=29Participants were randomly assigned to one of two groups, the conventional instruction group (trial and error learning, errorful learning) or the systematic instruction. The systematic instruction condition emphasized mastery, while the conventional instruction emphasized exploratory learning, not mastery. Training sessions were implemented using a specific format that paralleled each key element for each instructional condition. PDAs were not allowed to be taken home during the 4-6 weeks. All participants (n=29) received 12 individualized, 45 minute training session, 2-3 times weekly for 4 to 6 weeks.

Pre-tests indicated the groups were equal prior to the introduction of the intervention. Those exposed to the intervention (systematic instruction) performed significantly more (p<0.01) correct tasks at the 30 day assessment.  Fluency scores (their ability to follow through with a task) were also found to increase in those in systematic instruction group compared to those in the conventional instruction group. Overall systematic instruction resulted in better skill maintenance and generalization compared to trial and error learning.

Cognitive Teletherapy

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Bourgeois et al.,

(2007)

USA

Quasi-RCT

D&B=20

PEDro=2

 

N=38 Individuals were quasi-randomized into either the spaced retrieval (SR) group or the didactic strategy instruction (SI) group. Daily memory logs noted areas where the participant was having difficulties and specific goals to work on were selected.  30 minute training sessions were scheduled 4 or 5 per week.  Those in the SR treatment group began with a prompt question and a treatment goal.  Participants were encouraged to answer the question(s) the same way each time it/they was asked. Those in the SI group common memory strategies were discussed. Participants were encouraged to identify problems and then apply a specific strategy to help deal with this problem. Contact with all participants was done over the phone.

The frequency of memory problems decreased in both groups over time.  Those in the SR group showed significant improvement in goal mastery (p<0.05) compared to the SI group. This was maintained at the one month post intervention time period. Results on the Cognitive Difficulties Questionnaire (CDS) showed both groups reported having fewer difficulties following treatment.  There were no significant differences between the two groups on the CIQ post treatment.  Changes in community integration were not noted over time.

Computer Calendars vs Standard Diary

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

McDonald et al.,

(2011)

UK

RCT

D&B=19

PEDro=5

N=12Participants were randomly assigned to one of two groups (Group A or Group B). All were asked to complete weekly monitoring forms indicating what activities they would like to complete within the next 15 weeks. Those assigned to Group A (the Google calendar group) were shown how to use the calendar to remind them of upcoming activities.  They were discouraged from using other reminder strategies during the next 5 weeks. Group B was the standard diary group. At the end of the 5 weeks, group B began using the Google calendar while Group A began using the standard diary.

Overall the use of memory aids assisted individuals in completing tasks as opposed to no memory aids. During the Google Calendar intervention phase, there was 40.6% increase in completing their prospective intention compared to the standard diary phase. Overall 82% of targets were reached using Google calendar but only 55% using the standard diary.

Bergquist et al., (2009)

USA

RCT

PEDro=5

D&B=18

 

N=14Participants were placed in one of two intervention groups: an active calendar acquisition intervention group or the control diary intervention group. Throughout each intervention participants had 30 sessions with a therapist and sessions were completed via the internet using instant messaging. Participants were placed in one of the 2 groups and at the end of the 30 sessions they began “other” condition. During the calendar condition, participants were encouraged to use the on-line calendar to plan events and to remind them of these events. During the diary condition, participants were asked to use their diary to keep track of their day to day events and occurrences. The IM sessions were used to review what (work, appointments) was completed during both types of sessions.

There were no significant difference between the two sessions on memory functioning as noted on the neurobehavioral functioning inventory (NFI) (p>0.05). From time 1 to time 2, improvement was found on the compensation techniques questionnaire (CTQ): specifically the notes on calendar (p<0.02) and the use of cue cards (p<0.01). Family members also noted improvement in levels of depression (p<0.02) from time 1 to time 2. Family also felt the patient’s memories had improved.

Television Assisted Prompting vs Assistive Technology for Cognition

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Lemoncello et al.,

(2011)

USA

RCT

D&B=19

PEDro=5

N=23Participants were randomly assigned to either the Television Assisted Prompting (TAP) group or the Assistive Technology for Cognition (ATC) group. The TAP system was a set-top box to allow the participant to interact with the system through the television. This system delivers reminders (either text or audio-video) at pre-specified times to participants. The ATC system was individualized to meet the needs of each person.

No significant differences were found between groups A or B; therefore data from the two groups was collapsed. Following this, the TAP group (n=23) had a higher task completion rate compared to their typical practice strategies. The TAP system improved task completion from 43% pre intervention to 72% post intervention.

Compensatory Prospective Memory Training vs Self-Awareness Training

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Shum et al.,

(2011)

Australia

RCT

D&B=22

PEDro=7

 

N=45 Individuals were assigned to 1 of 4 treatment groups using a restricted randomization with blocking procedure. All interventions involved 8 weekly attendances (1.5hrs each) at an individual therapy session. In total there were 4 programs, with each one compromising 2 weeks’ self awareness training or active control plus 6 weeks compensatory prospective memory (PM) training or active control. Programs included: self-awareness compensatory prospective memory training; self-awareness training plus active control; active control plus compensatory prospective memory training; and active control only.

All 4 groups showed no significant differences on the Cambridge Prospective Memory Test (CAMPROMPT) during the pre-intervention phase. Following intervention, those with a self-awareness training component were not significantly different from those without on the change scores. Groups with a compensatory training component were found to have a significantly larger change score than those with out. Overall, the group that received self-awareness and compensatory PM training did not have the largest change score on the CAMPROMPT. An assessment of the number of valid diary entries per week did not differ between the four groups pre interventions. Post intervention the groups with a compensatory training component were found to have larger change scores than those without (p<0.017).

Personal Digital Devices (PDAs)

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Dowds et al.,

2011

USA

RCT

PEDro=5

D&B=20

 

N=36Participants were trained how to use 2 memory aids (a PDA or a paper organizer) to assist them in organizing activities that needed to be completed throughout the week.

When using the PDAs the individuals had a higher task completion rate then when they used paper memory aids. Results also indicated that those using the Palm OS PDA had a higher completion rate than those using the Microsoft pocket PDA.

Diary to Improve Memory

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Ownsworth & McFarland (1999)

Australia

RCT

D&B = 18

PEDro = 3 

N=20Volunteer subjects with ABI were randomized into a diary only (DS) and a diary & self-instructional training (DSIT) group intervention. The DS group participated in a 6 week “Bottom-Up” approach program that emphasized the development of functional skills using compensation based, on task,-specific learning.  The DSIT group participated in a 10 week “Top-Down” approach program that emphasized the capacity for self-regulation and self-awareness using “Self Instructional Training.” 

All subjects reported significantly fewer problems with memory (p<0.001) and lower levels of distress (p<0.01) during treatment phase when compared to baseline. There was a significant increase in the degree of strategy use during treatment (p<0.05) regardless of type of diary training. There were no significant differences between the DS and DSIT groups (p>0.05).

NeuroPaging System

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Wilson et al., (2001)

UK

RCT

D&B = 18

PEDro = 4

N=143A randomized controlled cross-over study of subjects with memory impairments were divided into one of two treatment groups: group A (pager first) and group B (waiting list first). Patients chose their own tasks in which they wanted to be reminded. Outcomes measured included patients’ ability to successfully carry out everyday tasks.

During the last 2 weeks of the 7-week treatment period, the participants using the pager were significantly more successful in achieving target behaviours than the waiting list group (p< 0.001).

 

External Aids: Virtual Reality

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Grealy et al., (1999)

Scotland

Non-RCT

D&B = 15

N=13Ambulatory TBI subjects with no perceptual disabilities participated in a random allocation crossover study that used non-immersive virtual reality (VR) exercises to test attention, information processing, learning, memory, reaction and movement times. Information for 320 patients was collected and acted as the control for this study.

Intervention group (n=13) performed significantly better than control group (n=320) on digit symbol (p<0.01), verbal (p>0.01) and visual (p<0.05) learning tasks. Reaction (p<0.01) and movement (p<0.05) times improved significantly after a single VR session.

Computer Assisted Memory Retraining

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Tam and Man (2004)

China

Non-RCT

D&B = 15

 

N=34A study of adults with post-head injury amnesia due to closed-head injury was conducted to assess the effectiveness of computer-assisted memory retraining programs.

 

Participants were randomly assigned to one of four treatment groups (matched diagnostically and demographically): (1) self-paced group; (2) feedback group; (3) personalized group; and (4) the visual presentation group.  Each group went through one of the four computer-assisted memory re-training strategies. Each participant was involved in 10 sessions, approximately 20-30 minutes in length. The Rivermead Behavioural Memory Test (RBMT) was used to evaluate self-efficacy

After intervention, in any one of the four computer-assisted memory programs, patients performed significantly better in memorizing and remembering ‘drilled content’ (p< 0.05).

 

All four memory-training conditions showed a positive trend in the treatment group as compared to the control group although there were no statistical differences between measures.

Memory Retraining Programs

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Thickpenny-Davis & Barker-Collo

2007

RCT

New Zealand

PEDro = 5

D&B = 15

N=14Individuals were randomly assigned to either the treatment group (memory rehab group) or the waitlist control group. Those assigned to the treatment group participated in a memory rehabilitation program. The memory group consisted of 8 learning modules, each 1 hr in length and held 2x a week for 4 weeks. Didactic teaching about memory and memory strategies, small group activities, discussions, problem solving, practice implementing memory strategies was used. Errorless learning was also used when reviewing materials.

Overall improvement was seen for the treatment group across the various time periods. When comparing pre-group results on the various memory scales, improvement was seen at time of post group testing and again at follow-up.

O’Neil-Pirozzi et al.,

(2010)

USA

Non-RCT

D&B = 21

N=98Individuals were assigned to either the experimental group (n=57) or the control (wait-list group n=41).12-90 minute sessions, held 2 x weekly for 6 weeks intervention sessions were held. The intervention included memory education and emphasized internal strategy acquisition to improve memory function from encoding, storage and retrieval perspectives. Primary emphasis was placed on semantic association (categorization and clustering), followed by semantic elaboration/chaining and imagery.

Pretesting revealed a significant difference between both groups on the Hopkins verbal learning test-revised (HVLT-R) only. Individuals who had had a severe TBI performed more poorly on the HVLT-R than those with moderate injuries. Although those with a severe injury did not improve as much as those with a mild or moderate injury, they did improve more than those in the control group from week 1 to week 7. Results of the Rivermead Behavioural Memory test II revealed similar results. Overall memory performance was improved for all those in the experimental group compared to the control group.

Cranial Electrotherapy Simulation

Author/Year/ Country/Study design/PEDro and D&B Score

Methods

 

Michals et al., (1993)

USA

RCT

PEDro = 7

D&B = 22

 

N=24A double blind, sham controlled trial was performed on a group of individuals who had sustained a BI. The purpose of the treatment was to evaluate the effectiveness of cranial electrotherapy stimulation (CES) on post-traumatic memory impairment. After a four-week study period, memory performance was measured using subtests from the Wechsler Memory Scale-Revised, California Verbal Learning Test, and Recurring Figures Test.

Results revealed that CES stimulation in brain-injured patients did not improve memory or immediate and delayed recall compared with controls.

Repeated trial effects showed no significant differences between groups.

Computer Assisted Training

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Dou et al.,

(2006)

Hong Kong, (China)

RCT

PEDro = 5

D&B=18

N=37 Participants were randomized to 2 memory training programs:the computer assisted memory training group (CAMG) and the therapist administered memory training group (TAMG). Each group received 1 month memory training programs that were similar in content but delivered differently. The control group received no training. Those in the treatment groups received 20 training sessions. Sessions ran for 6 days each week and last approx 45 mins. Post treatment follow up last for one month.  Sessions consisted of training a basic component memory skills, in the management of typical daily tasks utilizing/integrating the component memory skills, in customized programs and skill consolidation as well as in the generalization of those skills in practice.

Scores from the NCSE indicate that was a significant increase in the TAMG (p<0.015) and the CAMG (p<0.02) on the memory sub-test of each scale compared to the control group. When looking at the results of the scores on the RBMT test, there was only a significant difference between the CAMG and the control group (p=0.0001).

Internal Aids:

Aids to Improve Verbal Memory and New Learning

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Twum and Parente (1994)

USA

RCT

D&B = 15

PEDro = 3

N=60Consecutively referred TBI subjects from Maryland State Dept. of Vocational Rehabilitation (mean age: 21 years) were randomized into four groups: no imagery / verbal labeling; imagery / no verbal labeling; imagery / verbal labeling and a no imagery / no verbal labeling (control). Delayed recall and trials to criterion were measured on the VerPA and VisPA tasks.

MANOVA analysis revealed an overall significant main effect of mental imagery instructions (p < 0.0001) and a main effect of verbal labeling instructions on the VisPA (p < 0.0001).

Potvin et al.,

(2011)

Canada

Non-RCT

D&B=21

N=30Individuals were assigned to either the experimental group (n=10) or the control group (n=20). Those assigned to the experimental group participating in a 10 prospective memory rehabilitation groups lasting 90 minutes. The Test Ecologique de Memoire Prospective (TEMP) was used to evaluate change in the experimental group.

The experimental group performed significantly better on the TEMP post PM training (p<0.05) than the control group. During the learning phase cued recall improved for those in the experimental group, although this improvement was not found to be significant. Participants who took part in the rehabilitation program improved their performance on the PM experimental task. These changes were seen when performing everyday tasks.

Errorless Learning and Impact on Memory

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Tailby & Haslam (2003)

Australia

Non-RCT

D&B = 10

N=24TBI subjects with acquired deficits in explicit memory were divided into groups of 8 based on Verbal Memory Index (VMI) score, and matched across groups in terms of age, gender, premorbid and current intellectual functioning. Ninety-six 5-6 letter concrete nouns were used over two sessions to practice 3 learning conditions: errorful, errorless (examiner generated), and errorless (self-generated). Following the learning tasks, memory was tested explicitly and implicitly 5 and 30 minutes after study phase generating 6 scores for each learning condition at both testing times.

Cued recall performance following self-generated errorless learning was significantly better than standard errorless learning conditions (p<0.0001).  Level of priming did not differ significantly between groups (p>0.05).  Memory performance was significantly better following errorless learning (examiner generated) activity (p<0.0001). Mild and moderate groups performed significantly better than severe group (defined by VMI – p<0.0001)

Using Visual Imagery to Enhance Recall of Names and Faces:

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Milders et al.,

(1998)

Netherlands

Prospective Control

D&B = 17

 

N=2613 closed-head injury subjects (mean PTA 36 days) and 13 healthy controls matched on age and level of education participated in 8 individual 60-90 minute sessions over four months using exercises with standardized instructions that help make the new name more significant to the learner.

ANOVA (cases vs controls, baseline vs post-training were significant for group (p<0.01), evaluation moment (p<0.001), and interaction (p<0.001).  At follow up, only verbal learning scores reached significance (p<0.01).

Glisky & Delaney (1996)

USA

Prospective Control

D&B = 12

N=16TBI patients (mean LOC 10 days) who experienced PTA (mean of 53 days) participated in 3 separate sessions practicing stem completion of 4-7 letter words using cued recall, free recall and recognition.

Priming effect in PTA patients was not significant from the controls (p>0.05), but was significant within the PTA group (p<0.05) – compared to those without prior exposure to word lists).  Controls substantially improved their results when given explicit instructions while PTA patients performed equivalently.  Control group recalled significantly more words than the PTA group (p<0.01).  None of the PTA patients were able to recall any of the list items, made significantly more false alarms (p<0.01). 

Modeling vs Hand over Hand for Learning and Recall

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Zlotowitz et al., 2010

UK

RCT

PEDro=6

D&B=22

N=16Participants were randomly assigned to either the modeling or moulding group. All learned a hand movement sequence (A). During their first learning trial and hand movement (B) during their second. The moulding technique involved a hand over hand technique and the modeling technique had the participant copy the experimenter.

Test on recall occurred twice. The first time was after a short delay and the second time was after a longer delay. No significant differences were seen after the short delay; however, after the longer delay, recall was significantly better after using the modeling technique.

Memory Training

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Berg et al.,

(1991)

Netherlands

RCT

PEDro=5

D&B=17

N=39 Individuals were randomly assigned to either the treatment or control conditions. The strategy rehabilitation group participated in daily homework exercises, 3 times a week for 6 weeks, with each session lasting 1 hour. Training which was individualized was based on the memory problems individuals identified. Group 2, The drill and practice (pseudo-rehab) group participated in sessions consisted of memory tasks and games that were practiced in the lab and at home. The no treatment group were tested on the same time schedule as the trained groups but received no training. Individuals were assessed 4 different times pre and post intervention.

Following training, both groups 1 and 2 reported being happy with training. At the final follow-up (4 months post interventions), the strategy training group performance significantly better on the 3 memory tests (memory sum score, acquisition score, delayed recall score) than those in the other groups.

Milders et al.,

(1995)

Netherlands

Follow-up to Berg et al. (1991)

 

N=31 of the original 39subjects participated in a four year follow up of the Berg et al. (1991) RCT that compared Memory Strategy training vs. Drill and Practice vs. no treatment. Follow-up consisted of control tasks, and subjective reports.

Standardized memory sum scores at long-term are significantly lower in the three patient groups than in the normal control group (p<0.05). Drop out effect on follow-up results was significant (p<0.05). The strategy groups 1995 results were significantly lower than in 1991 (p<0.05).  Drill & Practice improved significantly (p<0.05), and no training improved but not significantly. The difference between groups at the 4 yr follow-up is no longer significant (p> 0.1). 

PEDro = Physiotherapy Evidence Database rating scale score (Moseley et al., 2002).

D&B = Downs and Black (1998) quality assessment scale score.