Category Archives: Memory

Post-Traumatic Amnesia

In fairy tales the stricken princess lies still on the bed, oblivious to the world around her.  With the prince’s kiss, she suddenly wakes from her stupor and greets the world as if she had just simply been asleep.  Unfortunately, returning to life after a brain injury is no fairy tale and brain injury survivors do not simply wake with all of their skills intact.  For most survivors of serious brain injuries, there is a period of time after they “wake” from their comas in which they are in a state called Post-Traumatic Amnesia (PTA).  PTA contains many unique features and experiences which are important to understand.

Two of the main features of PTA are an inability to make new memories and disorientation.  This inability to make new memories (hence the “amnesia” portion of PTA’s name) manifests itself in many ways.  For instance, a brain injury survivor may report that though a coma suffered lasted for only two weeks, he or she has no memories of his or her first three months of therapy.  Brain injury survivors often relay that they were told  of visits by significant others and acquaintances during the survivors’ hospital stays, but due to PTA the survivors have no memory of these visits.  When PTA is particularly severe, a visitor may simply walk out of the room for a minute and find upon return that he or she is greeted by the survivor as a fresh arrival.  Sometimes family and friends can become unnecessarily upset that a survivor does not remember a visit, not understanding that making new memories is generally beyond the emerging skill level of a survivor in PTA.  Moreover, due to these memory difficulties survivors have significant difficulty learning new information in therapies (though they may still benefit from repetition of desired behaviors).

The second hallmark characteristic of PTA is disorientation.  Survivors in the midst of PTA often have difficulty recalling the month or year when prompted to do so.  They might not be able to accurately relate which city they are currently in or even state their own ages.  It is often helpful to have such information readily available, possibly on a notebook in front of the survivor or on a large board in a survivor’s room (though others may still need to cue the survivor to look at the accurate information).  Sometimes, a survivor may dispute accurate orientation information.  For instance, a survivor undergoing inpatient therapy in Galveston may argue that the therapist is crazy and that he or she is actually in Houston.

While survivors contending with PTA will often have a “deer in the headlights” look, as they improve this look eventually fades.  Families and therapy staff might notice that the survivor’s pupils may be dilated.  PTA is frequently accompanied by agitation.  Survivors often say and do things they normally would not say or do.  This excessive agitation may see expression in threatening or lashing out at loved ones or tearing out tubes and monitors attached to survivors’ bodies. It is not uncommon for a survivor to attempt to remove even an item as critical to his or her continued well-being as a breathing tube when in PTA.  Doctors may put the survivor on medication to help with agitation, though some are wary to do so as this may cause the PTA to take longer to resolve.

Survivors under the effects of PTA may struggle with hallucinations or delusions.  These hallucinations and delusions can take a paranoid flavor, such as believing that doctors are trying to poison them or that nurses are trying to steal their money.  Survivors in PTA may try to escape the hospital or take other unhealthy risks, such as trying to walk to the restroom when they are unable to physically do so.  As survivors with PTA generally have poor awareness of their injuries and can be impulsive, they will usually require 24/7 supervision and careful monitoring.

When survivors are in PTA, it is helpful to reduce the number and intensity of stimuli around them.  Making sure that a room is generally quiet and limiting the number of people in the room with the survivor at a given time can help lessen issues arising from agitation.  All important information should be easy to find, and a good example of a handy way to accomplish this is to put the date and what happened to the survivor on a dry-erase board or on the front of a notebook he or she is using.  Repetition is also important, as survivors with PTA may pick up information after many repetitions.  This can be as verbal repetition (e.g. repeating the year) or physical repetition (e.g. practicing a wheelchair transfer).  There is no way to “rush” a person through PTA nor is there a “magic pill” to cure it.  Families need to be patient as for some survivors, it may take months to emerge out of PTA.  Unfortunately, a few survivors will never quite fully emerge from it.

It is also important not to take negative words or behaviors from the survivor as personal attacks.  Such negativity is generally due to the brain injury and is not reflective of how a survivor really feels.  When brain injury survivors become healthier and are no longer in PTA, they often feel embarrassed by their PTA behaviors.  The survivors did not intend to be rude or mean, but their injuries were not yet healed enough to allow them to behave in a normal fashion.

Hopefully this post helped to clarify the symptoms of Post-Traumatic Amnesia.  Feel free to leave a comment below with any questions!

Learn about brain injury treatment services at the Transitional Learning Center: http://tlcrehab.org/

Using Unique Characteristics to Help Memory

Following a brain injury many survivors face great struggles in the realm of memory.  This can be especially embarrassing when a brain injury survivor has difficulty remembering the name of a person with whom he or she is already well acquainted.  Utilizing techniques that make use of unique characteristics can make it far easier for survivors to remember important names in their lives.

Each person possesses many different characteristics.  These can include height, weight, eye color, tone of voice, expressed clothing preferences, etc.  Trying to remember a person’s name while matching it with all these disparate features can be a daunting task.  When meeting someone for the first time, it is often easier to find the one unique characteristic of the person that stands out most and pair that with the person’s name (e.g. “Paul is the tall guy” or “Susie has a rainbow tattoo on her neck”).  In this way the survivor only has to remember one characteristic in order to recall a person’s name rather than contend with the confusion that would accompany recalling many characteristics.  Unique characteristics can include aspects of physical appearance, dress, voice and behavior.  Let’s give a few examples in each category, using celebrities as examples, to demonstrate how one might execute this technique.

Physical appearance can include height, hair, size/shape of facial features, scars and tattoos.  For instance, former NBA player Shaquille O’Neal has brown eyes, a shaved head and a bright smile.  None of these features necessarily make him stand out.  However, if you were to meet him on the street and were picking one unique characteristic to match with his name, you would likely pick that he is over seven feet tall.  The pairing between height and name would clearly provide a more memorable association than anything involving those other  mentioned characteristics, and would make it far easier to recall Shaq’s name at a later time.  Similarly, comedian Carrot Top is of medium height with fair skin.  Again, these common features would not be useful to pair with his name as an aid to memory.  However, his striking red hair is quite unique and by pairing this unique characteristic with Carrot Top’s name, a survivor would be more likely to later recall his name.

Some people dress in a manner that is simply different from everyone else.  These differences in dress can also be paired with a person’s name in order to make it easier to recall that name.  Michael Jackson was known for wearing one white glove.  No one else was known for effecting that particular fashion choice.  If a survivor would have met Michael and wanted to remember his name, he or she could have paired Michael’s name with the one white glove.  Another example of this can be found in former United States Secretary of State Madeleine Albright.  Albright always wore pins on the upper left shoulders of her jackets.  A survivor could pair the pin with her name in order to better recall her name, rather than attempt to utilize any number of additional characteristics she possesses.

Just like a unique physical characteristic or a unique manner of dress, a unique voice can be paired with a person’s name to help remember him or her.  A voice might be recognized as unique due to a distinct tone, a particular accent or use of a singular delivery.  Actor James Earl Jones has a baritone voice which makes him a favorite choice for voice-over work in commercials and the like.  By pairing his deep voice with his name, a survivor could more easily identify him by name at a future meeting.  Similarly, actress Fran Drescher has an unmistakable New York accent which she played up in the television show “The Nanny.”  If a survivor was to meet her for the first time, the survivor could pair her accent with her name to help remember her at a later time rather than trying to remember any other likely more common of her features.

Sometimes, a new acquaintance may demonstrate a behavior that is so different from that of others that it can be used as one of these unique characteristics to aid in memory.  This can sometimes prove a little harder to use for memory unless the person in question demonstrates the identified behavior all of the time.  For instance, Elvis Presley often had a lip twitch/snarl when speaking which other people do not have.   In a different vein, John Wayne walked with his legs spread in a wide gait.  Both a constant lip twitch/snarl and idiosyncratic pattern of walking can be paired to names to more easily remember a person at a later time.

Survivors should not worry about whether the characteristic being used is complimentary to the other person.  If pairing the name “Julie” with “giant nose” helps the survivor remember Julie later, then this is fine.  There is no need to share with the other person that this technique is being used to aid memory.  The key is whether the characteristic is so memorable to the survivor that pairing the characteristic with the name will make it easier for the survivor to remember.  Further, this technique does not prevent the survivor from adding other, more mundane characteristics to his or her memory of the other person.  This technique is primarily designed for when a survivor is first trying to learn the other person’s name.

Hopefully this method will help survivors remember others’ names and be spared the embarrassment of forgetting!

Learn about brain injury treatment services at the Transitional Learning Center: http://tlcrehab.org/

 

Using Stories To Aid In List Memory

The human brain is fascinating for so many reasons.  One of these reasons can be seen in the expression of its preference for different styles of memory.  The brain generally has a preference for remembering stories as opposed to random lists of information, even though there are many more words in a story to remember than there are in a list.  It can be demonstrated though that this preference for stories can in fact be used to help bolster the memory for lists of items.

Individuals generally encounter lists of items in areas of daily life related to shopping, school, work, and other like activities.  You may have a list of items that you need to buy at a supermarket.  Your boss may ask you to pick up a list of items from the stockroom to place on shelves.  A teacher may ask you to bring in certain items for a class project.  Although it is of course advisable to write down or record in some manner any such list of items, you may not always have a pen and paper or other recording device available.  If you take such a list of items and turn it into a brief story though, you might be surprised by how much easier it becomes to remember.

Let’s say you have three items to remember to buy at the store: milk, cookies and napkins.  You can use to your advantage the brain’s natural preference for having these items organized as components of a story over simply having them listed one after the other.  It takes little effort to come up with a brief, one-line story that uses these words.  For example, the story in this instance could be “I like to dip my cookies and milk and then wipe my mouth with napkins.”  Most people will find it easier to remember this short story than to remember those same three words in list form.  A similar scenario could be encountered working at a large store like Wal-Mart or Target.  Your  boss may ask you to bring out light bulbs, toilet paper and paper cups.  This is a pretty random list of items which may be difficult to remember in its current form.  Turning this list into a short story may be beneficial.  For instance, the story here could be “There is no light bulb in the bathroom so he tripped over the toilet paper and knocked over the paper cups.”  Again, by putting the list of words into a brief story, the brain will find it easier to remember the information.

There are a few handy pointers to keep in mind when turning a list of items into a story.  First, the story should be relatively brief.  If you are trying to remember three or four words, the story should not be much longer than a single complex sentence.  Five or six items may require a story to be two to three lines long.  A story cannot be so long that it becomes itself difficult to remember.  The story should also create a visual image in your mind.  If you can “see” the story in your mind, then chances are that you’ve succeeded in creating a story useful in achieving the objective of bolstering memory in this way.  Using one of the previous examples, you may be able to imagine someone in a dark room tripping over toilet paper and knocking over cups sitting by the sink.  If you can see this happening in your mind, then the story worked for you.  It is very important that the story be one that is functional for you.  You should not concern yourself about whether others would like your story or find your story odd.  Too often, brain injury survivors using this method will self-censor their stories because they feel that others might not like those stories as they initially occur to the survivors.  These stories exist only to aid our memories.  The opinions others might hold of them therefore are not truly relevant.

This method of improving memory takes practice but once you get comfortable with the method, it can be very useful!  Please leave me a comment below with any questions, thoughts or ideas!

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

Visual and Verbal Memory

Most information that we try to remember usually comes through only two of our five senses, vision and hearing.  Interestingly, the memories we make for this information is generally stored in two separate parts of our brain.  We tend to store verbal memories from the information that we heard in the left side of the brain.  We tend to store visual memories from the information that we saw in the right side of the brain.  One way that we can help our memory is by using both sides of our brain during memory tasks.

We can help our verbal memory by taking the information that we hear and creating pictures in our mind  of the information.  For instance, you might be told three items you need to buy in the store.  While trying to remember the words, you can imagine what those three items look like while sitting in your shopping cart.  In this way you both have verbal memories from when you heard the items told to you and visual memories from imagining yourself with those items in your cart.  Similarly, you can bolster your visual memory with your verbal memory.  For instance, you could try to remember where you parked your car at a store and at the same time you were visually looking at the parking spot, you could also verbally describe to yourself where you were parked.  In this example, you might look at the spot while telling yourself, “I am parked by the red pole, two spaces from the large concrete block.”  Your sight would provide the visual memory and the words would add  the verbal memory.  In these ways, both sides of your brain can be involved in helping you to remember information.  The more places you have information stored in your brain, the more easily you can later access that information.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

A Regular Routine

People are creatures of habit.  We operate at our best when life is predictable and structured.  Predictability and consistency allow us to organize our lives smoothly.  They invariably bring about greater effectiveness at work and at home and put us in a better position from which to allocate our time more intelligently and to accomplish more goals.

After a brain injury, the survivor’s life often loses the routine it had before.  He or she loses the daily rhythm that the survivor had grown accustomed to prior to the injury.  Rather than having a schedule based on school/work activities, social plans and home responsibilities, many survivors come home to a life without any set schedule.   This can be a big mistake.  A lack of a routine often increases disorientation and decreases the ability to track day-to-day activities.  Without a set routine, important activities may be pushed off to a later time or ignored altogether and forgotten.  Some survivors even become more agitated and aggressive when their days lacks predictability.  Further, a lack of a set schedule often causes greater stress on family and caregivers.  For instance, without a set schedule a survivor may argue with a spouse about when they should practice walking skills, since there is no agreed upon time to practice.

It is highly advisable for survivors and their family members to create a daily schedule to help incorporate routine back into the survivor’s life.  The daily schedule should be written and placed in a prominent location in the home, such as on a refrigerator door or on a dry erase board.  Creating the schedule should be a joint activity between the brain injury survivor and his or her family.  Mealtime, personal hygiene tasks, taking medication and wake/bedtimes should be at approximately the same time each day.  A set time each day should be created for activities such as physical exercises, cognitive exercises and recreational activities.  Doctor’s appointments, therapist visits and family events should be written on the schedule.  Schedules should be made for the entire week, including the weekend.  Although some brain injury survivors will initially try to rebel against a set schedule (“I am a grown man, how dare you tell me what to do!”), survivors generally get into the new schedule without too much difficulty.  Survivors with memory deficits or disorientation tend to take more time to get used to the new schedule.  Once the schedule is in place, survivors often show improved overall functioning.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

You Should Remember

“You should remember.  I told you this an hour ago!”  “You should remember.  We’ve been talking about this for the past week!”  When a family member or friend speaks in this manner to a brain injury survivor, it is often a sign of annoyance.  They are expressing frustration at the survivor forgetting what was told him or her.  However, the word “should” implies a value judgement.  The survivor “should” remember and if not, he or she failed at something that “should” have been done.

Before family or friends attempt to discuss what a survivor “should” do, the first question that needs to be addressed is whether or not the survivor CAN remember the information in question.  If due to deficits left in the wake of a brain injury survivors are simply not able to remember information, it is unfair to say that they “should” remember.  As an analogy, we would not say to a young child that he or she “should” be able to complete a calculus problem the child has worked on for a week.  We can all recognize that calculus is simply beyond a young child’s skill level.  A “should” statement does not make sense in this situation.  Similarly, we need to ask whether completing a given memory task falls within the brain injured survivor’s skill level.  If the memory task is beyond the survivor’s abilities, clearly the survivor will not remember the information.  In this case, stating that the survivor “should” remember is unfair.

The next logical question is whether anything could be done to further facilitate the survivor’s efforts to improve his or her memory.  Perhaps information needs to be written down on a note so the survivor can check the note later for the information.  Some patients benefit from constant repetition or association techniques to help bolster the memory.  There are many different methods to help memory.  In some cases though, a family member or loved one will just need to remember important information for the survivor if doing so proves truly outside of the range of the survivor’s abilities.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

Confabulation Vs. Lies

Every so often a patient’s family will report to the Transitional Learning Center that since the patient’s injury, the patient makes up false stories all of the time.  They state that they correct the patient but that the patient will argue and insist that the story in question is true.  This often upsets the family as they feel that the patient is deliberately telling lies.  In most cases, the patient is not deliberately telling lies.  The patient has a difficulty called confabulation.

Confabulation  is a term describing the brain’s act of creating false memories after a brain injury.  These false memories feel completely real and there is no way for the survivor to easily discern the difference between a confabulation and an accurate memory.  There is no way for the survivor to stop the brain from confabulating.  This is quite different from a lie, in which the liar has full control over the information and total understanding of its context.  Most people are accustomed to the concept that the memory of an event having happened serves as evidence of its truth.  The idea that our memories can be false is a completely foreign, sometimes hostile concept.  When a patient has a confabulation, it will not occur to them to doubt the confabulation any more than it would to doubt any real memory.

Imagine if you started to talk about your personal life and someone told you that your recollections were completely wrong.  This would probably frustrate you.  After all, it is your life.  How could someone know your life better than you?   This is the conundrum faced by survivors with confabulation.  Other people are constantly telling them that they are incorrect regarding their personal memories of their own lives.

Keep in mind that they have clear memories of these false events.  Again, they are not deliberately fabricating these memories.  This is not a psychological issue but a brain injury issue.  Survivors with confabulation need to constantly check to ensure whether a memory is real or confabulation.  This may mean checking with significant others or a planner/memory book.  It may require that a lot more information needs to be written in their planner/memory book than is typical for other brain injury survivors.  They have to get used to the idea of not trusting their own memory.  How unnerving must it be when someone else knows your own life better than you?

Sometimes confabulations have a clear starting point while other times they seem to come out of the blue.  Some confabulations are more logical than others.  An example of a more logical confabulation is when a former church choir member thinks that they have a practice session at church in an hour, despite the fact they have not sung in church for many months.  As you can see, it is not terribly odd to confabulate a false choir practice when this has been part of the person’s history.  An example of a more bizarre confabulation is when a survivor thinks that their psychotherapist previously did brain surgery on them in a hospital, while the patient was awake.  It is much harder to make the connection on this second example.  In both cases, the patients believed their confabulations completely.

Confabulation cannot simply be cured by memory exercises or medication.  Often they will fade as the patient’s health improves.  However, persistent confabulations can be one of the most disabling conditions of a brain injury.  If a person has a persistent confabulation that there is a meeting on the other side of town and subsequently wanders from home due to the confabulation, then he or she will need constant supervision to ensure safety.

Hopefully this clarifies the experience of confabulation and how it is differs from the telling of a lie.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org