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Mary Kennedy, The ASHA Leader (page 3 of 3) Page 3 of 3
- Individualize educational information about the client's specific memory and cognitive disabilities. There is little evidence that self-awareness improves when an individual is presented with general educational information. Individuals with TBI need individualized, specific information about their abilities and disabilities, so that they do not have to figure out what applies to them and what does not.
- Involve the client in setting memory goals and in selecting memory aids. See Webb and Gluecauf (1994) for an example of high-goal involvement and low-goal involvement. Those who were highly involved were better at setting goals two months after treatment ended, compared with those who were less involved.
- Create opportunities for accurate self-monitoring. Regardless of brain injury or frontal lobe injury, adults are very accurate at predicting their memory when the predictions are slightly delayed (Kennedy & Yorkston, 2004). When predictions are made immediately after or during studying (within about 30 seconds), our predictions are barely above chance. Clinicians can create an opportunity for accurate self-monitoring by forcing a delay between, for example, studying a grocery list and asking clients to predict how many items they will remember. If they predict that they will remember very few items, they can be directed by the clinician to use a memory aid. Thus, the link between self-monitoring and self-control is made explicit. Additionally, by showing the client how accurate they can be when making delayed predictions compared with immediate predictions, we give the client positive, direct feedback that they can be "good" at judging their learning. See Dunlosky, Hertzog, Kennedy & Thiede (2005) [posted online] for a description of a self-monitoring approach to effective learning across adult populations.
- 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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