Academic journal article The Journal of Rehabilitation

Assessment of Memory in Rehabilitation Counseling

Academic journal article The Journal of Rehabilitation

Assessment of Memory in Rehabilitation Counseling

Article excerpt

The development of neuropsychology and the study of human memory have demonstrated that individuals with a number of different disabilities are at risk for memory deficits. Substance abuse, HIV infection/AIDS, mental retardation, schizophrenia, and diabetes mellitus are examples of clinical diagnoses that carry a risk for concomitant memory disturbances (Lezak, 1995).

Ruff and Schraa (2001) suggested that detecting the specific cognitive difficulties of clients not only assists in planning rehabilitation but also facilitates client awareness of such problems and engagement in participating more fully in the rehabilitation program. Stringer and Naldone (2000) described the role of neuropsychological assessment in rehabilitation settings and in planning of vocational/educational goals. They pointed out the importance of identifying cognitive and behavioral deficits to better understand their possible effects on the individual's ability to carry out activities of daily living. Also, by identifying such deficits, cognitive rehabilitation efforts can be designed to integrate with other rehabilitation programming. Memory deficits, for example, may compromise the learning of a work routine and adaptation to new contexts. The identification of memory difficulties allows the rehabilitation counselor to include mnemonic strategies and compensation procedures in the rehabilitation plan that may facilitate successful outcomes.

Traditionally, rehabilitation counselors have tended to refer clients for neuropsychological assessment only when their primary diagnoses have a clear and direct relation to neurological deficits. According to data from the Longitudinal Study of Vocational Rehabilitation Search Program (n.d.), counselors referred only 338 clients for neuropsychological assessment from a sample of 8,500 DVR clients, even though the sample included 170 clients with traumatic brain injury as the primary disability. It appears that potential memory deficits may often not be assessed, even when the risk of occurrence is substantial, which may lead to unrealistic goals and failure to achieve successful rehabilitation outcomes.

The present paper will focus on memory assessment in vocational rehabilitation for clients who may not have diagnosed neurological disorders but may be at risk for significant memory deficits. First, a summary of the major theoretical aspects of memory as a construct will be presented, along with studies of memory disorders in individuals with diagnoses of schizophrenia, substance abuse, and mental retardation, providing examples of groups of clients that may benefit from memory assessment. Later, a model of assessment will be suggested and major memory assessment tools will be presented as instruments to be used in the assessment of memory in rehabilitation settings.

Theoretical Models of Memory Function

Lezak (1995) defined memory as "the complex systems by means of which an organism registers, stores, retains, and retrieves some previous exposure to an event or experience" (p. 429). Memory is intertwined with learning and, consequently, is important to the successful implementation of many rehabilitation services and interventions.

There is agreement in the literature that memory cannot be regarded as a unitary faculty (Baddeley, 2002). Several classification systems have been proposed, for example, according to duration (short-term and long-term memory) and content (declarative and non-declarative memory). A thorough review of theories of memory is beyond the scope of the present paper, and only a few of the most relevant aspects of the psychology of memory to vocational rehabilitation will be considered here.

Memory is frequently viewed in terms of three stages: encoding (the processes by which information is registered), storage (the maintenance of information over time), and retrieval (the accessing of information). These processes are engaged by a variety of brain structures which are governed and regulated by mechanisms of facilitation and inhibition. …

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