The

study of the structure and function of

the brain
Purpose:
Assessment of specific cognitive and

psychological processes, and overt

behaviors
Management and rehabilitation of people
who have suffered illness or injury
Delineate how illness and injury may affect
and be affected by psychological factors
Difficulties due to brain pathology or as a
consequence of emotional or other (potentially)
reversible cause

1. Encode (take in)

2. Consolidate (store)
3. Retrieve information

Memory is a complex process requiring many

cognitive functions, including:
A)
Perception
B)
Attention and focus
C)
Speed of thinking
D)
Comprehension
E)
Intention to remember/effort
F)
Flexible thinking
G)
Organization
A breakdown or problem in any of these areas
can result in difficulty in recall

Process by which large amounts of

information are held in sensory store for less
than one second after the stimulus has ceased

Visual,
Auditory or
Tactile
information

Happens
automatically

 Large

capacity for unprocessed

information, but only able to hold
accurate images of sensory information
momentarily

Information
Guided

is either transferred or lost

by attention and selection

Short-term: time-limited

storage of
limited amount of information
Time:15-30 seconds
Capacity: 7 plus or minus 2
Increase capacity with chunking

 Involves

neurochemical or
electrical changes
within the brain
Temporary storage:
memory lasting from
one hour to up to two
days, most likely to
occur as a result of
training

Hippocampal Formation

 Immediate

memory: information selected

from registration is held in storage up to 30
seconds for immediate use [easily disrupted
by distraction]

Working

memory: mental scratchpad,

information is available from 30 seconds to one
hour
Think of it as a "conveyor belt," "assembly line," or

"workbench"
http://library.med.utah.edu/neurologicexam/html/
mentalstatus_abnormal.html#buffet

 Storing

and consolidating information

on a more permanent basis, requiring
structural changes in the neurons
Recent: information stored within hours, days,

or weeks
Remote: information stored months to years
ago

Declarative (FACTS)
Episodic: remembering information

about events, facts, or shared

knowledge in relation to an
experience

E.g., your last birthday party

Semantic: information about a fact

or an item of academic
knowledge

Presidents name, meaning of words

Procedural (SKILLS):
remembering how to do
something (e.g., riding a bicycle;
driving a car)

Incidental: remembering without trying

Retrospective: recalling past actions, events, or
knowledge
Prospective: remembering to do something in
the future

Self-initiated; does not operate directly on external

stimuli
Exs: remembering to make phone call; or to take
meds
Event-based prospective memory can be exploited
using deliberate acts that will produce a notable
event at the time that the memory needs to be
recalled e.g., setting an alarm
Prospective memory can be enhanced by ordinary
acts such as making a grocery list or a to-do list

 Difficulty

learning new information

Difficulty learning a new skill
Repeating a question or story to the same
person
Forgetting to do things (e.g., appointments,
tasks)
Forgetting a change in routine
Forgetting where you placed something
Getting lost
Forgetting to use datebooks and notebooks

 Forgetting

someones name after just meeting

them
Forgetting where you learned new information
Forgetting something you recently saw or did
Confabulation: filling in the gaps with
logical guesses or information which you
believe to be correct (but is incorrect) when
memory fails

 Fatigue

and sleep the more tired you are, the

worse your learning and recall will be
Stress being very anxious or stressed can
make it harder to learn or recall information
Substances/medication alcohol, drugs, and
certain medications (e.g., narcotic pain killers)
can make memory performance worse

 Most

of the methods used to help

memory focus on the first step - getting
the information in
The more severe the memory problem, the more

the patient will need to concentrate on this step

The

focus is on the depth of encoding

 Simplify/streamline

the information by
eliminating irrelevant information
e.g. getting directions

Reduce

the amount of information

e.g. chunking
Make

sure you understand

e.g. repeat information

 Link

new information to what you already know

Organize the information (e.g., categorize,
sequence)
Intend to remember (phone pad)
Decrease distractions

 Practice

or rehearse, following the "little and

often" rule
Test yourself periodically
Write the information down (Take notes!)
Multi-modal methods (verbal and visual)

 First

letter prompts (alphabetical

searching, acronyms, tip of the tongue)
Associative information
Develop routines - anchor your memory
with habits and consistency

 State

dependent learning: Recall is dependent

upon the state you were in when the
information was learned.
External state (environmental context)
try to be in the same environment as where

information was learned

picture the information, where you saw it
come up with as many details as you can

Internal

states

anxiety (e.g., draw a blank)

substances (e.g., caffeine, nicotine)

 Pts

should be encouraged to be honest

about their injury and their functional
difficulties
This will put others at ease and set the
tone for the interaction

Repeating questions, stories,

or jokes to the same people
Not recognizing people or
recalling their names
Appearing to be untruthful
(confabulation)
Appearing to be unreliable,
appearing not to pay
attention, or avoiding or
withdrawing from social
interaction
Not getting all the information
because someone is speaking
too fast

Ask, "Did I tell you this

already?"
Use mnemonic strategies to
learn new names; don't
avoid asking for name again
Say: "I don't remember" or
"I'm not sure."

Acknowledge your memory

problem ahead of time and
show that you have ways of
compensating
Say, Could you [repeat that
/ slow down], I want to be
sure and get this right.

 Usually

semantic info or episodic

material (except for maybe accident or a
few weeks, months ago, or a new skill
acquired just before accident) is not
forgotten

Most

pts have problem with STM which

leads to problem with long term memory
These memories are needed to guide our
daily lives at home (groceries) and work
(deadlines, content of meetings)

 It

is critical to establish habitual routines

Plan how you will be reminded
Decide when would be the best time to get the
reminder
Make sure your written note is detailed enough
Check datebook routinely

 Use

a back-up cue (e.g., set a needed object in

a conspicuous place)
Complete task ahead of time, when possible
Schedule a specific time to do the task, if
necessary
Use change in routine to remind you of a
special situation

 Independence:
Definition: freedom from the control, influence,

support, aid, or the like, of others

Compensations:
Facilitate independence
Can make it possible not to have to rely on

others for day to day functions

Reduce feelings of being overwhelmed, which
leads to difficulty processing and problemsolving

 Datebook

(the complimentary brain)

Advantages:
Verbal and visual
Helps with encoding and retention
Reduces strain on executive functions
Assists with planning and problem-solving
Eg planning entries
Located in one place
Assists with organization

 Datebook can hold:

Food records, work notes, medical

information, questions to ask professionals,
meetings, etc
What about a PDA?
Research indicates power and value in
writing information down
More complicated devices can be confusing
Recommend at CTN: try to use Datebook
first and supplement with PDA, or transition
to PDA with further recovery

 Checklists

Purpose: find out where the breakdown is and

develop a strategy or procedure list for

successful task completion

Comprehensive (eg work)

Specific (eg laundry)

Functionally:
Executive Function: assists with initiation, planning,
organizing
Memory: log to indicate what activities need to be
and have been completed

 Datalink

watch

Watch that is updated via computer

Compatible with Microsoft Outlook
Easy to program
Can tailor to daily, weekly, week day, weekend,
etc.

Potential problems: hearing, attention

Around $70

Posting

signs

Visual cues

 Medication

devices

Weekly
Daily
Programmable

Medication

card
Other tools:

Lists
Maps (eg grocery store)
Expense tracking
Budgeting

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States: emergency department visits, hospitalizations, and deaths. Atlanta (GA):
Centers for Disease Control and Prevention, National Center for Injury
Prevention and Control; 2004.

2)

Defense and Veterans Brain Injury Center (DVBIC). Washington (DC): U.S.
Department of Defense; 2005.

3)

Ivins BJ, Schwab K, Warden D, Harvey S, Hoilien M, Powell J, et al. Traumatic brain
injury in U.S. army paratroopers: prevalence and character. Journal of Trauma
Injury, Infection and Critical Care 2003;55(4): 617-21.

4)

Thurman D. The epidemiology and economics of head trauma. In: Miller L,

Hayes R, editors. Head trauma: basic, preclinical, and clinical directions. New
York (NY): Wiley and Sons; 2001.

5)

Thurman D, Alverson C, Dunn K, Guerrero J, Sniezek J. Traumatic brain injury in

the United States: a public health perspective. Journal of Head Trauma
Rehabilitation 1999;14(6):602-15.