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Managing Memory and Metamemory Impairments in Individuals with Traumatic Brain Injury Mary Kennedy, The ASHA Leader (page 3 of 3) Page 3 of 3

• Integrate metacognitive strategies into training individuals to use memory aids. Make explicit the link between self-monitoring (e.g., predictions) and strategy decisions. Modifying instructional sequences to individuals' needs will help to upgrade beliefs about memory and will improve memory. One example of such a sequence is as follows: Skim the material, make memory predictions and create a study plan, carry out the study plan, take a self-quiz, compare results with predictions, update predictions and plan. See Kennedy, Carney, & Peters (2003) for an example of the memory benefits to adults with brain injury when study strategies are linked to accurate self-predictions.
• Provide distributed practice at high levels of accuracy. Practice with strategy supports in a sequence of steps is critical for individuals with memory impairment. Building in breaks in between practice sessions (i.e., distributed practice) increases the likelihood that the person will use the memory strategy or recall the information. Shaping correct use of supports through cues or prompts will foster high levels of accuracy. Fading the cues while maintaining accuracy is demonstrated in a technique called "spaced retrieval." See Sohlberg, Ehlhardt, & Kennedy (2005) for a discussion of instructional techniques that are built on errorless learning and spaced retrieval.

As with other cognitive-communication disorders, individualizing treatment approaches is critical to clients' success. Actively involving our TBI clients in treatment strategy decisions will provide them with the metacognitive tools to tackle situations that will arise in the future when the SLP is not present to assist the client.

Mary Kennedy is an associate professor in the Speech-Language-Hearing Sciences Department at the University of Minnesota. Her research focuses on memory, metamemory, discourse, and executive function deficits. She is chair of the Academy of Neurological Communication Disorders and Sciences Committee on Practice Guidelines for Cognitive-Communication Disorders after Traumatic Brain Injury. Contact her at kenne047@umn.edu.

From Kennedy, M. Managing Memory and Metamemory Impairment in Individuals with Traumatic Brain Injury. The ASHA Leader, 11(14), 8-9, 34-36. Reprinted with permission. www.asha.org.

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