Abstract
Objectives: To evaluate the effectiveness of a memory rehabilitation program. To compare different outcome measures.
Participants: Twelve patients with severe traumatic brain injury.
Setting: Outpatient rehabilitation service.
Main outcome measures: Rey-Osterrieth Complex Figure Test (REY), California Verbal Learning Test (CVLT), Rivermead Behavioural Memory Test (RBMT), and the Memory Failures in Everyday Memory Questionnaire (MFE).
Statistical analysis: Exact nonparametric procedures.
Results: All patients achieved meaningful functional gains. Modest improvements were found in some of the scales of the CVLT but not in the REY, RBMT, or MFE.
Conclusion: Functional gains did not correlate with improvement in memory processes. Measurement of changes in independence in activities of daily living mediated by compensatory aids and educational intervention plans with relatives are proposed.
MEMORY rehabilitation is an essential element in treatment programs for patients with traumatic brain injury (TBI). The high prevalence of memory impairments in these patients and the devastating impact on their functional status require increasing research efforts in this area. 1-4 Memory difficulties interfere with the completion of tasks in everyday life, such as remembering instructions and appointments, conveying messages, or completing daily shopping. This type of learning impairment produces a high level of dependency and a heavy long-term burden on the carers. 5
Different rehabilitation strategies have been tried for head-injured people with memory impairments (eg, practice and repetition exercises, complex mnemonic techniques, or compensatory aids) but few studies have analyzed the effectiveness of these strategies. 6-10 Recent reviews support some effectiveness for several forms of cognitive rehabilitation, including the remediation of memory, 11 and strongly recommend the use of compensatory strategies. 12 Nevertheless, the problem of selecting the appropriate instruments to assess the outcome of memory rehabilitation programs is a key issue for this research.
A variety of instruments, which give customary data for diagnostic or cognitive evaluations, have been used in the formal assessment of the different memory processes impaired as a consequence of TBI. 13-16 However, since these instruments were not designed to measure errors in naturalistic settings or to formulate meaningful aims for therapy, their usefulness to assess difficulties in activities of daily living (ADL) in patients with memory impairments has been questioned. 17 It is now recommended that a wider range of outcome measures be used in cognitive rehabilitation. 11 Tests that seem highly sensitive to the detection of memory impairment secondary to brain dysfunction correlate poorly with performance in ADL and with family descriptions of memory difficulties. 18-21 Accordingly, other measures such as the number of compensatory aids used, 22 the range of ADL the patient is able to complete independently, 23,24 the global amount of help required, 25 and ecological instruments such as the Rivermead Behavioural Memory Test 26 have been suggested.
Patients' and relatives' self-reports of memory performance need to be considered separately. This type of measure focuses upon awareness of memory deficits and difficulties in ADL. Zelinski et al 27 found only moderate correlation between memory questionnaires and neuropsychological tests, and other investigators concluded that these instruments target different aspects of memory. 28,29
This study aimed to assess the effectiveness of a memory rehabilitation program on patients with TBI and, in addition, to compare different instruments such as neuropsychological tests and memory failure questionnaires as outcome measures. 20,21,30