Making the most of memory
April 16, 2014
There are some techniques that can help the following aspects of memory — getting information into memory more efficiently, storing information more efficiently, and recalling information more efficiently
In order to remember something we must get the information into memory first before it can be stored away. This can be very difficult after a brain injury, especially for someone who has difficulties with attention and concentration. Some simple rules to follow when giving information to someone with memory impairment are:
• Concentrate on relevant material that the person wants or needs to remember
• Simplify information and written instructions
• Reduce the amount of information that has to be remembered and just concentrate on the essentials
• Divide the information into small chunks
• Give the chunks one at a time
• Encourage the person to take their time and pay close attention
• Ensure that the information has been understood by having the person repeat it back in his or her own words
• Encourage the person to make associations by linking the new information to something that is already familiar
• Use the little and often rule – it is better to work for a few minutes several times a day than for a longer period once a day
• Encourage the person to organise the information – for example, grouping items on a shopping list into distinct categories
• Use two or three different methods to improve learning of one piece of information – for example, if you want to teach someone with memory impairment the way to the local shops, you could either draw a map; describe the way verbally, or accompany the person along the route
• Choose a good time to practise – information will be taken in more efficiently when the person is fresh and alert.
There are three further main systems used in order to get information into memory efficiently. These are: errorless learning, mnemonics and PQRST.
Errorless learning
While many people learn from their mistakes, this is not the case with people with memory impairment – they tend to repeat the same mistakes as they cannot remember making them. This can be very frustrating, and a more efficient approach is to prevent them from making mistakes when learning new information. This approach is known as ‘errorless learning’.
One way to do this is to guide the person with memory impairments through a task several times, and then gradually decrease the amount of help given. Alternatively, provide written instructions to follow and then gradually decrease the amount (e.g. by missing a word out here and there).
The following steps can be used as part of an errorless learning program for use with someone with memory impairments:
• Adjust your expectations – don’t ask for responses until you are at least 90% sure the person will give a correct response
• Make sure the person is completely clear what is expected of them – if they don’t understand what they have to do in the first place then mistakes are inevitable
• Complete the task together – saying “let’s do this together” is a better way of starting an activity than “let’s see if you can do this”
• Make the task do-able – this can be done by breaking the task down into smaller parts and teaching the parts separately
• Anticipate problems and correct in advance – e.g. if the person is reading and a difficult word is coming up, say something like, “I see a tricky word in the next sentence so let me know if you need help”
• Provide cues, such as an entire answer (e.g. “I think the answer is 22, what do you think?”) or a sentence completion cue (e.g. “The president at the time was Abraham. . . that’s right, Lincoln.”
• Ensure large amounts of successful repetitions – this will reinforce the new knowledge and help with retention.
Errorless learning can be a difficult technique to use without training. If the person with memory problems is working with a neuropsychologist they will be able to advise as they will be trained to use the method. There is also an excellent tutorial and video on the subject on the Brain Injury Association of New York State’s LEARNet project website at www.projectlearnet.org.
Mnemonics
Mnemonics are verbal and visual aids to learning, such as sayings, rhymes or drawings, which help us to remember things more easily. For example, the rhyme ‘Thirty days in September. . .’ helps us to remember the number of days in each month. Mnemonics can help people with memory impairments (e.g. one memory-impaired woman learned to remember the name Stephanie as a picture of a step and a knee). However, it is unrealistic to expect them to devise and remember to use them themselves. For this reason, the following guidelines for relatives and carers might help:
• Devise the mnemonic yourself and then teach it to the person with memory impairment
• Use mnemonics to teach a specific piece of information, such as people’s names or addresses
• Take account of individual preferences and styles – not everybody likes the same strategy.
PQRST
This is a way of helping yourself to remember something you are reading, such as a newspaper article. This can be very useful for anyone to try as well as people with brain injury. PQRST stands for:
• Preview – scan the information to get a general idea of the content
• Question – identify some questions you want to be able to answer after you’ve read it and write them down
• Read – read the material closely
• State – repeat the main points to yourself by stating them in summary form
• Test – test your knowledge by seeing if you can answer the questions you wrote down earlier.
New information is most likely to be forgotten within a relatively short time after it is learned. The rate of forgetting slows down after this initial period.
Once information has been taken into memory, it helps to practise or rehearse it every so often. This is best done by testing immediately after learning, then testing again after a slight delay, then again after a slightly longer delay and so on. This process is known as ‘expanding rehearsal’.
For people with memory impairments, the intervals used should be very short, as immediate memory is usually relatively undamaged so needs to be taken advantage of. You could start by asking the person to repeat the information immediately, then after two seconds, four seconds, eight seconds, etc.
Retrieving information more efficiently
Often information is stored in memory but retrieving it can be difficult. We have all experienced this as the ‘tip-of-the-tongue’ effect. Retrieving information can be particularly difficult for people with memory impairment after brain injury. However, the following techniques can help:
• Provide a cue or prompt, for example, the first letter of a name.
• It is much easier to remember something if recalling it in the same location, situation or mood as when the information was learned. In order to avoid the limitations this can place on memory, it is a good idea to learn new information in a variety of situations and settings whenever possible.
Conclusion
Following the strategies and techniques described should help most people to compensate for memory problems, at least to some degree. However, it must be recognised that they do not offer a cure. In order to help someone with memory impairment, these approaches should be adopted for specific purposes and in a gradual, step-by-step sequence.
It is important to try different things to see what the individual finds most suitable. The ideas should be used according to individual preference, and can be adapted in any way that people find suits them. Ideally, they should be enjoyable and can be a shared activity with family and friends.
This article is an excerpt from a fact sheet, reproduced from www.headway.org.uk
Article originally printed in Synapse Bridge Magazine Volume 14
In order to remember something we must get the information into memory first before it can be stored away. This can be very difficult after a brain injury, especially for someone who has difficulties with attention and concentration. Some simple rules to follow when giving information to someone with memory impairment are:
• Concentrate on relevant material that the person wants or needs to remember
• Simplify information and written instructions
• Reduce the amount of information that has to be remembered and just concentrate on the essentials
• Divide the information into small chunks
• Give the chunks one at a time
• Encourage the person to take their time and pay close attention
• Ensure that the information has been understood by having the person repeat it back in his or her own words
• Encourage the person to make associations by linking the new information to something that is already familiar
• Use the little and often rule – it is better to work for a few minutes several times a day than for a longer period once a day
• Encourage the person to organise the information – for example, grouping items on a shopping list into distinct categories
• Use two or three different methods to improve learning of one piece of information – for example, if you want to teach someone with memory impairment the way to the local shops, you could either draw a map; describe the way verbally, or accompany the person along the route
• Choose a good time to practise – information will be taken in more efficiently when the person is fresh and alert.
There are three further main systems used in order to get information into memory efficiently. These are: errorless learning, mnemonics and PQRST.
Errorless learning
While many people learn from their mistakes, this is not the case with people with memory impairment – they tend to repeat the same mistakes as they cannot remember making them. This can be very frustrating, and a more efficient approach is to prevent them from making mistakes when learning new information. This approach is known as ‘errorless learning’.
One way to do this is to guide the person with memory impairments through a task several times, and then gradually decrease the amount of help given. Alternatively, provide written instructions to follow and then gradually decrease the amount (e.g. by missing a word out here and there).
The following steps can be used as part of an errorless learning program for use with someone with memory impairments:
• Adjust your expectations – don’t ask for responses until you are at least 90% sure the person will give a correct response
• Make sure the person is completely clear what is expected of them – if they don’t understand what they have to do in the first place then mistakes are inevitable
• Complete the task together – saying “let’s do this together” is a better way of starting an activity than “let’s see if you can do this”
• Make the task do-able – this can be done by breaking the task down into smaller parts and teaching the parts separately
• Anticipate problems and correct in advance – e.g. if the person is reading and a difficult word is coming up, say something like, “I see a tricky word in the next sentence so let me know if you need help”
• Provide cues, such as an entire answer (e.g. “I think the answer is 22, what do you think?”) or a sentence completion cue (e.g. “The president at the time was Abraham. . . that’s right, Lincoln.”
• Ensure large amounts of successful repetitions – this will reinforce the new knowledge and help with retention.
Errorless learning can be a difficult technique to use without training. If the person with memory problems is working with a neuropsychologist they will be able to advise as they will be trained to use the method. There is also an excellent tutorial and video on the subject on the Brain Injury Association of New York State’s LEARNet project website at www.projectlearnet.org.
Mnemonics
Mnemonics are verbal and visual aids to learning, such as sayings, rhymes or drawings, which help us to remember things more easily. For example, the rhyme ‘Thirty days in September. . .’ helps us to remember the number of days in each month. Mnemonics can help people with memory impairments (e.g. one memory-impaired woman learned to remember the name Stephanie as a picture of a step and a knee). However, it is unrealistic to expect them to devise and remember to use them themselves. For this reason, the following guidelines for relatives and carers might help:
• Devise the mnemonic yourself and then teach it to the person with memory impairment
• Use mnemonics to teach a specific piece of information, such as people’s names or addresses
• Take account of individual preferences and styles – not everybody likes the same strategy.
PQRST
This is a way of helping yourself to remember something you are reading, such as a newspaper article. This can be very useful for anyone to try as well as people with brain injury. PQRST stands for:
• Preview – scan the information to get a general idea of the content
• Question – identify some questions you want to be able to answer after you’ve read it and write them down
• Read – read the material closely
• State – repeat the main points to yourself by stating them in summary form
• Test – test your knowledge by seeing if you can answer the questions you wrote down earlier.
New information is most likely to be forgotten within a relatively short time after it is learned. The rate of forgetting slows down after this initial period.
Once information has been taken into memory, it helps to practise or rehearse it every so often. This is best done by testing immediately after learning, then testing again after a slight delay, then again after a slightly longer delay and so on. This process is known as ‘expanding rehearsal’.
For people with memory impairments, the intervals used should be very short, as immediate memory is usually relatively undamaged so needs to be taken advantage of. You could start by asking the person to repeat the information immediately, then after two seconds, four seconds, eight seconds, etc.
Retrieving information more efficiently
Often information is stored in memory but retrieving it can be difficult. We have all experienced this as the ‘tip-of-the-tongue’ effect. Retrieving information can be particularly difficult for people with memory impairment after brain injury. However, the following techniques can help:
• Provide a cue or prompt, for example, the first letter of a name.
• It is much easier to remember something if recalling it in the same location, situation or mood as when the information was learned. In order to avoid the limitations this can place on memory, it is a good idea to learn new information in a variety of situations and settings whenever possible.
Conclusion
Following the strategies and techniques described should help most people to compensate for memory problems, at least to some degree. However, it must be recognised that they do not offer a cure. In order to help someone with memory impairment, these approaches should be adopted for specific purposes and in a gradual, step-by-step sequence.
It is important to try different things to see what the individual finds most suitable. The ideas should be used according to individual preference, and can be adapted in any way that people find suits them. Ideally, they should be enjoyable and can be a shared activity with family and friends.
This article is an excerpt from a fact sheet, reproduced from www.headway.org.uk
Article originally printed in Synapse Bridge Magazine Volume 14