PCBIC 2010 Roberta DePompei: Strategies to Enhance Memory

8/7/2019 PCBIC 2010 Roberta DePompei: Strategies to Enhance Memory

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Strategies to Enhance Memory andOrganization for Persons with Cognitive-

Communicative Challenges

Roberta DePompei, PhDDistinguished Professor

School of Speech-Language Pathology

The University of Akron, Akron, Ohio 44325-3001

[email protected]

330-972-6114


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Lives and Dreams

are Shattered in aSplit Second


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PET Scans: New Learning

Initial Learning: Widespread activation Practice results in newer, more efficient

pathways

Pathways rewire to accommodate newlearning


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New Learning: New Connections

Research Study: Normal & MentallyRetarded (MR) adults played Tetris

Initial Learning: Global areas Practice for Normals: Fewer pathways Practice for MR: Global areas


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New Learning: New connections

Intelligent Brains:Use fewer, moreefficient neuralcircuits

The greater thedecline in neuralactivity withpractice:

The higher the IQ


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Strategic Learning

! One of most important brainfunctions that underlies learning

! Extracting important informationwhile inhibiting unimportantinformation

! The brain is most effective atabstracting meaning and not

storing detail(Brainert & Reyna, 1998; Gabrieli, 2004)


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Strategic Learning

! NOT about how much you learn! But rather,

how efficiently you extract the mainpoint of the central meaning(Gabrieli, 2004)

how efficiently you exclude irrelevantinformation so not to use up vital

storage capacity(Vogel et al 2005)


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Strategic Learning Abilities

! Individuals show a bias toward seeing theforest instead of the trees Verbatim details fade rapidly Abstracted learning persists over long intervals

! The is a severe impairment in strategiclearning after TBI Tasks like summarization, finding main idea,

interpretive statements are impaired


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Strategic Learning Concepts

! High capacity individuals are moreefficient at learning only relevant items

! Low capacity individuals (TBI)inefficiently encode and learn

irrelevant information

! People with TBI may actually store asmuch or more information in memorythan high capacity people-just the

wrong stuff.


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Strategic Learning Starts Early

! Little children should be provided with the tools tobegin strategic learning throughout thedevelopmental preschool years

! If there is an acquired brain injury (ABI), morespecific interventions may be needed.


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Cognitive Impairments WhichMay Affect Language-Learning

Impaired attention, perception, and/ormemory

Inflexibility, impulsivity, and/ordisorganized thinking, or acting

Inefficient processing of information:Rate, amount, & complexity


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Cognitive Impairments Which MayAffect Language-Learning

Difficulty processing abstractinformation

Difficulty learning new information,rules and procedures

Inefficient retrieval of old or storedinformation


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Cognitive Impairments Which MayAffect Language-Learning

Ineffective problem solving and judgment Inappropriate or unconventional social

behavior

Impaired Executive Functions:Self-awareness of strengths and

weaknesses, goal-setting, planning, self-

initiating, inhibiting, monitoring & evaluating


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INTERVENTION

STRATEGIES


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Growing Up

Perfo

rmance

Benefit of Interventions toImprove Brain Functioning


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ContextWork with people

in daily environments

and situations of

competence thatare personally relevant.


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Intervention

! Attention Task analysis Task completion


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Attention and ConcentrationStrategies

! Reduce distractions in work area! Divide work into smaller sections! Have person summarize new information! Use cue words to alert person to pay

attention

! Develop a nonverbal cueing system


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Intervention

! Memory Internal aides External aides


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Memory Strategies: Internal

! Repeat information often and summarize it! Rehearsal! Categorize or chunk information! Link new information to prior knowledge! Give examples with instructions


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Memory Strategies: external

! Carry an assignment sheet for each class! Pre-teach vocabulary! Use devices as self-reminders: watches,

computers, PDAs, smartphones, day

planners


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Intervention

! Organization and Planning


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Organizational Strategies

! Extra time for review! Written checklist of steps for complex tasks! Instruction for checking each step when done! Written schedule of daily routine! Person to meet with at start and end of school/ work

day


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Organizational Strategies

! Practice sequencing material! Outline to match lectures with notetaking

sections

! Color coded materials for each class! Practice organizing activities


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Intervention

! Strategic Learning


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Provide Strategic Learning Skills

! Identify main idea Find 2-3 supporting pieces of

information

State main ideas and supportingfacts/ideas

Highlight main ideas and supportsif reading information

Discuss main ideas if verbal Demonstrate main directions/

ideas


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Interventions with Young Children

! Play, Play, Play!! Introduce social interactions

with other children and family

! Stimulate receptive andexpressive vocabulary

! Start vocational transitions Teach turn taking Teach responsibility

! cleaning up, organizing toys


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Why Care about Research on ThursdayAfternoon?

! Evidence based research is asked for inorder to fund generic devices

! This research can be used to justify bestclinical practices

! This information can be used to advocate forpolicy change and for third party payers toprovide devices.


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What are ElectronicOrganizers?

Personal data assistants(Palm, Pocket PCs)

Wearable/handheldcomputers

Pagers Smartphones Portable voice organizers


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Why study electronicorganizers?

At school: Improved independence, follow schedule, stay ontask, and move between tasks (Epstein et al 2001)

At work: Increased accuracy and performance in complex tasks,improved scheduling and time management, decreased use ofexternal prompts, and easily integrated into work place (Davies etal 2002; Furniss et al 1999)

Independent living skills including medication and oral hygiene(OHara & Davies, 2002)


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Why Focus on Memory and

Organization?

! Problems with memory and attention are clearly linked to difficultylearning in school, performing activities of daily living, andparticipating in community activities for these iindividuals.

! Organization does not develop as a part of executive functioning.! Support personnel in functional environments report considerable

amounts of time are spent in providing reminders for functional tasksrequired during the daily activities of these individuals.

! The desire to foster independence for functional activities isincreasing.

! If memory and organization can be enhanced with electronic devicessuch as PDAs or smart phones at a young age, independence might

be fostered.


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Purpose of the Collaborative

! Explore electronic organizers re: cognitive disabilitiesin memory and organization

! Conduct surveys with potential users! Determine potential adaptations of devices Present

findings to developers of personal data assistants(PDAs)

! Conduct user trials to identify best practices inimplementation! Inform consumers and other stakeholders as they

make technology decisions


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Why Generic AssistiveTechnology?

! It is in the public domain-we all use it! The prices are more reasonable for purchase

and replacement

! The adaptations needed and that should berecommended to manufacturers will aid all of

us! These devices are more socially acceptable


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Collaborative Partners

University of Akron, School of Speech-LanguagePathology and Audiology

Temple University, Institute on Disabilities

Spaulding Rehabilitation Hospital

Brain Injury Association of America, Inc.


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What Have We learned?

! Electronic aids are useful for some personswith memory/organization problems as aresult of cognitive challenges.

! Evidence based studies are emerging tosupport use.

! Generic devices may be most accessible anduseful

Handhelds (Mobile Devices): PDAs, smartphones


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!Generic devices have appealbecause

Socially more acceptable

Prices are lower than dedicateddevices

General public understands usemore easily


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! PDAs and smartphones provide the most support formemory and organization

! Success is related to the beep and vibration of thedevice

! Day planners were the least effective-even less thansimple lists

! Persons do not have to learn to program the devicesresponding consistently to the alarm is more

important

! Social benefits are an added bonus!


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Clinical Applications fromthis Research

! Brochure for Manufacturers

! Brochure for Consumers

! Brochure for Clinicians


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Our future is bright because of the

professionals who share their researchand clinical work

! We stand on the shoulders of giants!! Our gratitude goes especially to our colleague

Mark Ylvisaker, philosopher, thinker, planner,

innovator, writer, organizer, executive functioning

champion, situational context champion, father,

and friend. His efforts will live on in all who weretaught by him and our future is bright because ofhim and others who are so willing to share their

work.


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Web sites that are useful to you

! http://www.projectlearnet.org

! http://www.free.braininjurypartners.com


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A New International Group is Forming

! International Pediatric Brain Injury Society(IPBIS)

! www.ipbis.org! Dr. Jane Gillett


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Web Sites with Information About TBI

! www.biausa.org! www.nashia.org! TBISERV.NIH.gov! www. lapublishing.com! www.cdc.gov


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Community Based Web Sites

! http://www.cdc.gov/ncipc/tbi/physicians_tool_kit.htm!

http://www.cdc.gov/ncipc/tbi/Coaches_Tool_Kit.htm! http://www.helpingkidsbrains.com/! http://www.mitbitraining.org/! http://www.cdc.gov/ncipc/tbi/FactSheets/

VictimizationTBI_FactSheet4FriendFam.htm


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References

! Bilbao, Alvaro, et al, 2003. The ICF: Applications ofthe WHO model of functioning, disability and health

to brain injury rehabilitation, NeuroRehabilitation, 18,239-250

! Singer, B., & Bashir, A. (1999). What are executivefunctions and self-regulation and what do they have

to do with language-learning disorders? Language,Speech and Hearing in the Schools, 30(3), 265-273.


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References

! Blosser, J.,& DePompei, R. (2003) PediatricTraumatic Brain Injury: Proactive Interventions. New

York: Delmar.

! Gabrieli, J.D. (2004). Memory: Pandorashippocampus? Cerebrum, 6 (4) 39-48.

! Vogel, E.K., McCollough, A.W., Machizawa, M.G.(2005). Neural measures reveal individualdifferences in controlling access to working memory.

Nature, 438/24, 500-501.


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References

! Gillette, Y. & DePompei, R. (2004). The potential of electronicorganizers as a tool in the cognitive rehabilitation of young

people. Neurorehabilitation, 19(3), 233-243.

! Hart, T., Buchhofer, R., & Vaccaro, M. (2004). Portableelectronic organizers vs. memory and organizational aids after

TBI: A consumer survey study. Journal of Head Trauma

Rehabilitation, 19(5), 351-365.


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References

! Gillette, Y. & DePompei, R. (2008) Do PDAsEnhance the Organization and Memory Skills

of Students with Cognitive Disabilities? Psychology inthe Schools: 45(7) 665-677.

! DePompei, R., Gillette, G., Goetz, E, et al (2008)Practical applications for use of PDAs and

Smartphones with children and adolescents whohave TBI. Neurorehabilitation, 23(6) 487-500.


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References

! Carey, A.C., Friedman, M.G., & Bryen, D. (2005).Use of electronic technologies by people with

intellectual disabilities. Mental Retardation, 43(5),322-333.

! Friedman, M., & Bryen, D, (2007). Web accessibilitydesign recommendations for people with cognitivedisabilities. Technology and Disability, 19 (4).

PCBIC 2010 Roberta DePompei: Strategies to Enhance Memory

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