Evidence-Based Practice for the Use of External Aids as a Memory Compensation Technique

Article excerpt

This article is one of a series of publications by the Academy of Neurologic Communication Disorders and Sciences (ANCDS) on evidence-based practice (EBP) in the clinical management of neurogenic communication disorders. The EBP project was initiated in 1997 with the creation of expert committees charged with reviewing the literature in order to develop evidence-based clinical practice guidelines for a range of neurogenic communication disorders. The scope and mission of the EBP project are described in detail in previous publications (Golper et al., 2001; Yorkston et al., 2001). This article was generated by the subcommittee on cognitive-communication disorders associated with traumatic brain injury (TBI). Previous publications from this subcommittee include a clinical practice guidelines document on direct attention training (Sohlberg et al., 2003), a technical report (Turkstra et al., 2003) and an accompanying practice guidelines document on standardized cognitive-communicative assessment (Turkstra et al., 2005), an overview of clinical principles and assumptions about cognitive-communication disorders in a committee report (Kennedy et al., 2002), and a practical perspective on the application of evidence for clinical decision making (Ylvisaker et al., 2002). The EBP writing group also published a series of articles in an issue of Seminars in Speech and Language dedicated to evidence-based practice for cognitive-communication disorders after TBI (Turkstra, 2005).

The purpose of this article is to examine the literature on the efficacy of using external aids for the management of memory disorders in order to generate clinical recommendations for treatment providers. The degree and nature of persistent memory deficits vary among people with brain injury, although there are common patterns of impairment. For example, many individuals experience more difficulty storing and retrieving personal experiences than they do storing procedural information. Alternatively, memory deficits are often related to impairments in attention or working memory (Sohlberg & Mateer, 2001). External aids can compensate for a variety of memory impairments.

It is important to acknowledge the somewhat artificial nature of isolating cognitive impairments. The interdependence of attention, memory, and executive functions makes it difficult to independently evaluate the different cognitive operations and associated treatments, as activities that engage the neural circuitry for one process will by necessity activate circuits for other related processes (Flavell, Miller, & Miller, 2002). Memory impairments often co-occur with impairments in other cognitive domains (Sohlberg & Mateer, 2001). We further recognize the influence of emotional functioning on cognitive processes. The primacy of emotion and personality variables in recovery from cognitive impairments is only beginning to be acknowledged (Adams, 2003). Effective cognitive intervention requires that we remain mindful of the interactions among the different cognitive functions and the influence of emotional and contextual variables. These caveats notwithstanding, there are individuals for whom a significant impairment in memory is the predominant obstacle to performing everyday tasks. While we limit our report to the use of external aids to address memory impairments, we recognize that this intervention is also an approach used in the treatment of attention and executive function disorders.

REVIEW OF THE LITERATURE

Search Process

To develop evidence-based recommendations, the committee identified, classified, and analyzed the relevant literature. In order to identify relevant studies, the following databases were searched: PsychInfo, Medline, CINAHL, and ERIC. We combined terms that described brain injury including TBI, closed head injury, brain injury, and acquired brain injury with the term memory. We searched from the beginning date of each database through 2003. …