Clinical Decision-Making for Memory Impairments Due to Traumatic Brain
Injury
Kristin Hatfield, M.A. & Joyce L. Harris Ph.D., CCC-SLP
Department of Communication Sciences and Disorders
The University of Texas at Austin
ABSTRACT
This report consists of a critical review of the literature
on treatments for memory impairments due to traumatic
brain injury (TBI). The information from and questions
raised by the current literature is presented in an
annotated decisiondecision-tree, which illustrates critical decisiondecisionpoints, followed by treatment alternatives for memory
impairments following TBI. Answers to the following
questions were sought: 1) Which treatments provide the
most effective and functionallyfunctionally-relevant outcomes for
survivors exhibiting a range of cognitive abilities and
concomitant conditions? and 2) How should research
studies be focused and structured in order to maximize the
clinical usefulness of findings?
This figure is intended for the use of clinicians choosing treatments for clients with
memory impairments due to TBI. The following are general guidelines: treatment
should be always individualized to best meet a client’s needs. A stop sign indicates
that another condition needs to be managed before proceeding with memory
intervention.
Does the patient have emotional
difficulties or decreased motivation?
STOP
BACKGROUND
•Memory impairment is a common and often debilitating
consequence of TBI.
•Any degree of memory impairment can significantly
exacerbate other cognitive problems or injuries and
hinder learning/use of strategies to compensate for other
deficits as a result of the injury.
•Clinicians use techniques such as errorless learning,
spaced-retrieval training, and external memory aides to
improve functional memory abilities.
Articles were chosen for review in this study based on
the following criteria:
1.Published in a peer-reviewed journal between 2001
and 2007
Yes
No
Does the patient have concomitant
conditions that should be considered
when choosing treatment?
STOP
METHOD
GUIDELINES FOR FUTURE RESEARCH
DECISION TREE
Yes
No
Is there a support system?
Yes
No
STOP
Is the patient literate?
No
Yes
STOP
What is the target skill?
Factual
Compensatory
What is the severity
of the memory impairment?
Mild
Severe
Moderate
What is the severity
of the memory impairment?
Mild
Severe
Moderate
2.Evaluated treatment techniques for clients with
memory impairments following TBI
3. Described treatment techniques in detail (as
opposed to general terms such as “rehabilitation
program”)
Articles were collected from the University of Texas
at Austin Libraries and through electronic searches.
Problems with the reviewed studies on memory interventions for clients with
TBI include: inadequate description of participants, inadequate description of
treatment techniques, small sample size, results insufficiently described,
lack of data on generalization and implementation of learned information.
Addressing these problems will increase the clinical utility of research
findings.
Specifically, articles should include answers to the following questions
about intervention strategies:
• What behavior does this intervention target? (i.e. remembering factual
information or remembering a compensatory strategy)
• What theory/research underlies the treatment?
• Where is the best place to provide intervention? (i.e. via the phone, in the
client’s home, etc.)
• How long do treatment sessions last?
• How frequent are the treatment sessions?
• What type of cueing hierarchy is used?
• How much is the family involved in the intervention?
• Is the treatment adaptable to an individual’s changing cognitive skills? How?
• What materials are required? (include thorough description of external aids)
Spaced Retrieval Training or
External Aide
Spaced Retrieval Training or
External Aide
External
Aide
CONCLUSION
While many studies demonstrated positive outcomes for memory
interventions such as external memory aides and errorless learning, few
reported how the treatment affects the person’s daily life. Moreover,
participant characteristics varied widely across studies, making it difficult to
determine which treatments are appropriate for individual survivors. The
literature review revealed that the development of a clear-cut, evidence-based
decision model would of necessity be fraught with ambiguities, due to many
unanswered questions about participant variables and generalizability of the
results. To make research more useful to clinicians, researchers should
thoroughly describe participants and treatment techniques, use an adequate
sample size to generalize findings and include data about generalization and
maintenance of learned information.
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