Rehabilitation of memory impairment after brain injury

  Memory impairment is one of the most frequent, persistent and disabling aspects of cognition that occurs after traumatic brain injury. All patients with moderate to severe injury and most patients with mild brain injury experience permanent amnesia for events before and after the injury. This amnesia for the time before and after the injury is referred to as retrograde and posttraumatic amnesia, respectively. The duration of retrograde amnesia is one of the most commonly used measures of injury severity.  Many other methods have been attempted to address memory problems in patients with traumatic brain injury. Because there is little convincing evidence that memory can be enhanced by medication, the most promising approaches include teaching the use of compensatory methods. For example, in a group of patients with independent living traumatic brain injury, training in real-world applications of memory enhancement methods improved results on objective tests of memory and supervisor tests, while such improvements lasted for 4 months.  For patients with severe memory impairment, a more common approach is to train patients to use reminder systems such as notebooks, planners, electronic notepads, and handheld computers. The success of using any reminder system depends in part on the patient’s awareness of the memory deficit and acceptance of the need to use exogenous methods, but both of these methods can be problematic. If the patient has been using these methods prior to the injury, it will likely be more likely to be successful.  Also, patients with traumatic brain injury may have difficulty performing these methods, that is, knowing when something needs to be recorded, remembering to do it all the time, and applying this recorded information prospectively. However, it is also worthwhile to work on how to employ a structured training program for the compensatory memory system. For example, a comprehensive training program that taught traumatic brain injury patients how to use a memory notebook showed that training was beneficial in improving daily memory function.  Similarly, improvement in prospective memory function can be demonstrated through a program centered on memory difficulty self-awareness, use of a customized compensatory tool, a cueing system, and note-taking, which can be demonstrated through journaling.