Finding New Ways To Treat Memory Problems

Kessler Foundation
Chiaravalloti Study

A major focus of our research at Kessler Foundation seeks to improve difficulties with thinking and memory in persons who are living with Traumatic Brain Injury (TBI).

In an attempt to improve a person’s ability to learn and remember new information, we have been conducting studies testing the efficacy of the modified Story Memory Technique (mSMT). This low cost, low-risk treatment for memory difficulties entails 10 sessions of treatment in which the patient works with a therapist to learn additional skills to help them learn and remember information. The skills taught are remarkably similar to the techniques used by memory champions. The mSMT incorporates information to be memorized (such as a grocery list) into meaningful context like a story, and teaches persons to apply mental imagery to help them remember the keywords they need to remember. During training, the person is shown how to use the new techniques with shopping lists, to-do items, important words or names and directions.

Our research is demonstrating that the mSMT is effective in treating the memory problems people with TBI are experiencing. A recent study of 69 persons with TBI demonstrated that participants showed a significant improvement on memory tasks from before to after treatment. Similar results were noted on objective measures of everyday memory, specifically prospective memory, i.e., remembering to perform a planned action or intention at some future point. Finally, participants’ families reported improvements in their daily life activities at home.

Perhaps most intriguing is the finding that the mSMT results in changes in the way the brain is learning and remembering new information. Before and after treatment, participants underwent functional magnetic resonance imaging (fMRI) during the learning task. We found that after treatment, their brain activity was increased during learning task. This increased activity was specific to regions of the brain involved in imagery and context.

There are many advantages to mSMT treatment that make it quite practical for clinical use. First, the mSMT is low risk to the patient; there are no drugs and no invasive procedures, and thus, no unwanted side effects. This also means that the mSMT can be safely combined with other interventions, such as medications for memory deficits, depression or other conditions. The mSMT is also low-cost and can be administered on a laptop or a desktop computer. It is also possible to use the program without a computer at all.

The mSMT protocol has been translated into Spanish and is being used in the U.S., Mexico, and Argentina. A Chinese translation has also been completed for use in upcoming studies.

In addition to our work in persons with TBI, our original research on the mSMT was performed with persons with MS. Similar effects were noted in persons with MS − improved memory on objective testing, improvements in everyday life and additional brain regions involved in learning information. Thus, although TBI and MS are very different, the mSMT can be effective in helping people with both conditions. This research is also being used to support reimbursement for cognitive rehabilitation. 

While much of the cognitive rehabilitation work at Kessler Foundation has focused on the mSMT over the last 10 years, additional treatments have been developed and tested by our scientists. Stylistic Memory Enhancement is an 8-session treatment that provides patients with a “toolbox” of 3 techniques to improve learning and memory − self-generation, self-testing and spaced learning. These techniques are helpful for ANYONE who wants to improve his/her memory and have the potential to transform the lives of persons with memory impairment. Speed of processing training, developed at the University of Alabama, is currently being tested in persons with TBI and MS at Kessler Foundation, in an effort to simultaneously improve processing speed and memory in these populations.

Our newest work incorporates Virtual Reality into the design of cognitive rehabilitation protocols, to make treatment more engaging and applicable to the memory demands of daily life.

As our understanding of the cognitive consequences of TBI and MS continue to expand, so does the potential for effective treatment. Developing, testing and distributing new and effective treatments will result in overall improvement in the quality of life of persons with TBI and MS.

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Posted on BrainLine March 16, 2016.

Nancy Chiaravalloti, PhD., an expert in cognitive rehabilitation research, is director of Neuropsychology, Neuroscience & Traumatic Brain Injury (TBI) Research at Kessler Foundation, and project director of the Northern New Jersey TBI System, one of 16 federally funded model systems that form a national comprehensive system of care, research, education and dissemination aimed at improving quality of life for people with TBI.