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Symposium on disorders of memory
009 Rehabilitation of memory disorders
  1. B Wilson

    Author information: Barbara Wilson CPsychol, ScD., FBPsS, FMedSci, AcSS, is a clinical neuropsychologist who has worked in brain injury rehabilitation for over 30 years. She has won many awards for her work including an OBE for services to medical rehabilitation n 1998 and two lifetime achievement awards, one from the British Psychological Society and one from the International Neuropsychological Society. She has published 18 books, over 260 journal articles and chapters and 8 neuropsychological tests. She is editor of the journal “Neuropsychological Rehabilitation” which she founded in 1991 and in 1996 she founded the Oliver Zangwill Centre for Neuropsychological Rehabilitation. A rehabilitation centre in Ecuador is named after her. She is currently president of the Encephalitis Society, Vice president of the Academy for Multidisciplinary Neurotrauma and on the management committee of The World Federation of Neuro Rehabilitation. The Division of Neuropsychology is to name a prize after her, the Barbara A Wilson prize for distinguished contributions to neuropsychology. She is a Fellow of The British Psychological Society, The Academy of Medical Sciences and The Academy of Social Sciences.

Abstract

Abstract: In the past memory rehabilitation focused on teaching lists of words, giving people memory exercises or teaching mnemonics that brain injured people were expected to take on board and use spontaneously. The assumption was that by giving these tasks we were somehow improving the underlying deficit or else we were enabling memory impaired people to find their own strategies to overcome their difficulties. There is no evidence that this worked over and above the fact that people improved on the tasks they practiced. Current rehabilitation for people with memory deficits is concerned with reducing problems in everyday life, bypassing memory problems, helping people to compensate for their difficulties and helping them to learn more efficiently. It also addresses the emotional consequences of memory impairment. Although restoration of memory functioning to pre-injury levels is unlikely to occur, there is a considerable amount that can be done to enable memory-impaired people and their relatives to come to terms with their difficulties and surmount a number of them by using various strategies and aids. External memory aids such as diaries, notebooks and mobile phones, widely used by the general population, are often problematic for memory-impaired people because their successful use involves memory. However, use of these aids is possible through carefully structured teaching. Internal strategies such as mnemonics and rehearsal techniques can be employed to teach new information. Errorless learning is more effective than trial-and-error learning for memory-impaired people. This is because, in order to benefit from our mistakes, we need to be able to remember them which is difficult or impossible for memory-impaired people. In the absence of episodic memory, making an error may strengthen or reinforce the erroneous response. In addition to poor memory, many brain-injured people will have other cognitive problems which need to be addressed. The emotional consequences of memory impairment such as anxiety, depression and loneliness should also be addressed in rehabilitation through counselling, anxiety-management techniques and treatment in memory or psychotherapy groups. In conclusion, it is possible to reduce the everyday memory problems faced by survivors of brain injury and help them return to their own most appropriate environments. The future of memory rehabilitation is likely to see a) more sophisticated technology b) collaboration with pharmaceutical companies c) a closer liaison with those doing brain imaging d) better evaluation of memory rehabilitation programmes and e) greater willingness of purchasers of health care to fund rehabilitation programmes.

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