Clinical Management of Memory Problems (2nd Edn) (PLE: Memory)

Barbara Wilson, Nick Moffat

• Publisher: Taylor & Francis
• Year: 2014
• Print ISBN: 9781848724211
• eBook ISBN: 9781317685524
• Edition: 1
• Topic: Psicología
• Subtopic: Psicología cognitiva y cognición

Many patients with stroke, head injuries or dementia suffer severe memory impairment and in many cases improvement may fail to occur.

This book, first published in 1984 followed by this second edition in 1992, offers practical guidelines to the problems and is supported by a discussion of theory about memory systems and functioning. It should enable therapists and psychologists to recognize, understand, assess and manage memory problems arising from injury, accident or infection of the brain.

The authors are well-known for their interest in memory and memory therapy. Topics covered in this text include: the relationship between memory and practice, assessment, methods for improving memory, organization of memory therapy, selection of appropriate treatments for individual patients, role of the microcomputer in memory rehabilitation, use of drugs in stimulating memory, development of programmes to improve attention and the treatment of the memory-impaired in groups. This second edition has an update on drugs, electronic aids and assessment procedures, with further evidence of the effectiveness of memory therapy. This book would have been an asset for those professionals involved in the rehabilitation of the impaired memory at the time and can still be of value today.

Chapter 1

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Memory theory and memory therapy

ALAN D. BADDELEY

The present chapter began life as a paper presented at a workshop on memory retraining. The workshop sprang from discussions between research workers primarily concerned with the theoretical understanding of human memory, and practical clinicians concerned with the task of helping particular patients cope with their memory problems. Given such origins, it seemed sensible to begin with a consideration of current theories of memory, and then go on to discuss their application in practice – and I agreed to give the theoretical introduction. I did so, presenting an overview of current approaches to human memory. Having given it, I had very mixed feelings. On the one hand I felt I had made a reasonably competent attempt at the difficult job of surveying the vast amount of research that has gone on in the area of human memory over the last decade. I believe this to be an intrinsically interesting area, and one which is at least of background relevance to anyone working with patients suffering from memory problems. On the other hand, I felt that I had completely fudged the issue of how and why such theoretical research is relevant to the therapist trying to help an individual patient.

The task I avoided was a difficult one, not least because I knew so little of the characteristics of the audience I was addressing, or of the practical problems of memory therapy. Even with the benefit of hindsight, writing about the relationship between theory and practice in an area as new and diverse as this presents substantial problems. I do however believe that it is extremely important to maintain strong and healthy links between theory and practice. What follows attempts to explain why.

THEORY AND PRACTICE

It is sometimes claimed that ‘there is nothing so practical as a good theory’, a comforting adage for the academic, but is it justified?

There is no doubt that in some situations a really good theory can be extremely useful. Let us take a very obvious case such as the role of Newtonian mechanics in structural engineering. It is inconceivable that a structural engineer’s education these days would not include an understanding of mechanics. So much so that it is easy to forget that the concepts underlying this are essentially theoretical in nature. A theory is like a map that can help you understand where you are and help you get from one place to another. Scientific theories can be helpful but are not essential; one can find one’s way across country without recourse to a map given enough experience, and people were of course building bridges using techniques that were consistent with Newtonian mechanics long before Newton produced his theory.

Like a map, a theory can be useful but requires intelligent interpretation. A theory is not like a recipe giving you a list of things to do in order to achieve a particular aim, although recipe books may in time develop from a theoretical understanding of the field. To go back to our bridge-building, a treatise on mechanics would not tell you how to build a bridge, although it might contain a great deal of extremely useful material if properly applied. What then can the practising clinician expect to get from theories of memory? I would suggest three things, a general orientation and understanding, suggestions as to particular therapeutic techniques, and finally methodological help in evaluating such techniques.

A THEORETICAL OVERVIEW

While a good therapist will always be aware of the particular characteristics of each individual patient, if he or she is to learn from experience, then it is essential to be aware of what different cases have in common. A good theory, like a map, provides suitable landmarks for identifying where you are at present and helping you reach a specified goal. Consider for example the question of diagnosis; one of the clearest cases of global amnesia due to brain damage that I myself have encountered was a woman who had attempted suicide though coal-gas poisoning. She had the classic amnesia combination of normal immediate memory coupled with a grossly impaired ability to learn new material. She was for some time categorized as a hysteric amnesic simply because her particular pattern of symptoms was inconsistent with her psychiatrist’s totally incorrect concept of the structure and breakdown of human memory. In the absence of explicit theory, we all tend to apply our own implicit theories, which can be all the more dangerous for being applied unthinkingly.

THEORIES AND STRATEGIES

A second way in which theoretical work can be useful is in suggesting new approaches to practical problems. The whole area of behaviour modification in clinical psychology is an offshoot of theoretical approaches to the study of learning, initially in animals. Although the area of memory therapy is still in its infancy, there are already many obvious examples of borrowing techniques devised, or at least explored in the laboratory. These will be discussed in more detail subsequently (Chapters 4 and 5), but examples include distribution of practice, and the manipulation of coding during learning by such strategies as the use of visual imagery and encouraging deep rather than shallow processing.

EVALUATION OF TECHNIQUES

In the case of memory therapy, this is an area of future importance rather than current achievement. Until techniques are developed and explored, they are obviously not suitable for evaluation. It is however essential that such evaluation does take place. Brain-damaged patients tend to recover spontaneously, and the observation that patients enjoy a particular therapeutic procedure and appear to improve is not by any means an adequate justification for continuing that procedure. The appropriate question is whether such improvement would have occurred anyhow, and if not whether the amount and generality of the improvement is sufficient to justify that degree of expenditure of therapists’ and patients’ time.

Evaluating the success of memory therapy is likely to prove difficult since it is of course important not to assume that the improvement of patients on laboratory tests of memory will necessarily generalize to everyday memory tasks. However academic psychologists are increasingly aware of the need to study memory outside the laboratory, and should provide potentially useful allies in tackling this difficult problem. The development of the Rivermead Behavioural Memory Test, described in Chapter 5 is a good example of the blending of the experimental control of the laboratory with the richness of the everyday world to provide a test that is both sensitive and realistic.

Most laboratory studies of memory use procedures in which a comparison is made between two or more large groups of similar subjects. The therapist on the other hand is often confronted with the problem of evaluating a technique based on a relatively small number of subjects with widely differing problems. It seems probable that the single case approach to the evaluation of therapy will prove most useful here. The technique, which was originally developed in the animal laboratory by psychologists influenced by the techniques of B. F. Skinner, has been subsequently applied most effectively to the evaluation of treatment methods in connection with behaviour modification (Hersen and Barlow, 1976), but has subsequently been applied very successfully to the treatment of memory problems, most notably by Wilson (1987a, 1987b).

In this chapter I will be primarily concerned with the first two applications of memory theory, namely the provision of an overview together with the suggestion of possible strategies, although these will not be described in any detail since they are covered in Chapters 3, 4 and 5. It goes without saying, however, that if the field is to develop, then the application of new strategies should go hand-in-hand with their evaluation.

AN OVERVIEW OF HUMAN MEMORY

Suppose a therapist were to accept what I have just argued, and attempt to obtain an overview of current theories of memory, what should he or she do? Start reading current memory journals perhaps? This would be, I suspect, a puzzling and rather dispiriting experience. Journals, and indeed often textbooks, are primarily concerned with points of disagreement and tend to give the bewildering view of any field that it comprises far more controversy than agreement. The reason for this is obvious; people do not write papers about what everyone agrees about, and what is already established does not require further experimentation. However, beneath the controversies and disagreements there is a surprisingly large amount of common ground. The present section will attempt to summarize this and link it to the specific problem of memory therapy. Any overview as brief as this however is inevitably fragmentary. A more extensive account of current views of memory for the non-specialist is given in Baddeley (1982a).

HOW MANY KINDS OF MEMORY?

This is a question that has preoccupied psychologists quite extensively over the last 30 years. It has been, and remains, an area of controversy. The non-specialist attempting to understand this area is likely to be puzzled not only by theoretical differences between different authorities, but also by a wide range of different terms often used to refer to very similar concepts. However, since I myself would regard the conceptual distinctions underlying this controversial area as being very important in evaluating and understanding memory breakdown, I shall discuss the area in some detail.

In talking about remembering or forgetting, we tend to refer to ‘my memory’, as if it were a single organ like the heart or liver. Over the last 20 years, however, it has become increasingly obvious that memory does not represent a single system, but is rather a complex combination of memory subsystems. The available evidence argues very strongly against the idea of a single unitary organ. Some psychologists still argue for what they describe as a unitary system, but when looked at in detail it is a system of such complexity that it could equally well be described as a multiple memory system. To revert to our analogy of theories as maps, it is as if early cartographers were arguing about whether Europe, Asia and Africa should be regarded as one continent or several. What follows represents a simplification of some complex issues. However, although I am sure my colleagues would disagree in detail, there would I think be broad agreement on the functional distinctions underlying the classification system described.

I shall begin by dividing memory into three categories, broadly based on the length of time for which they store information. The division was probably expressed most clearly by Atkinson and Shiffrin, and is presented most convincingly for the general reader in their Scientific American article (Atkinson and Shiffrin, 1971). They assume a very brief set of sensory stores, followed by a limited capacity short-term store which in turn feeds information into a long-term memory store. In what follows we shall use this as a framework, while pointing out the ways in which the Atkinson and Shiffrin model has proved to be oversimplified.

SENSORY MEMORY

The various sensory systems such as vision, audition and touch are all assumed to be capable of storing sensory information for a brief period of time. The most extensively investigated component of this system is the very short-term visual store sometimes known as iconic memory. It is this system that makes cinematography possible. A series of separate and discrete still pictures, each separated by a blank period is perceived as a single moving figure since the information is stored during the blank interval and integrated into a single percept. In the case of the auditory system a very brief sensory store sometimes termed echoic memory allows us to perceive speech sounds. In the case of both vision and hearing, the systems are relatively complex, almost certainly involving more than a single sensory memory trace. A breakdown in such a system would however almost certainly manifest itself as a perceptual difficulty rather than a memory problem, and as such is beyond the scope of the present chapter.

SHORT-TERM WORKING MEMORY

The second system described by Atkinson and Shiffrin is one which they refer to as the short-term store or STS. They assume this system to be responsible for temporarily holding information while learning, reading, reasoning or thinking. They assume a distinction between this and a long-term memory system – the long-term store (LTS) which preserves information for anything ranging from minutes to years.

The distinction between these two systems, LTS and STS, evoked a great deal of controversy during the late 1960s and early 1970s. This particularly concerned the question of whether it was necessary to assume a separate temporary or short-term storage system. Anyone attempting to read about this particular controversy should be warned of two pitfalls connected with the term ‘short-term memory’. The first of these is to be aware of the fact that experimental psychologists use this term to refer to memory extending typically over a few seconds only. This is potentially very misleading since the public in general, and many medical practioners, tend to use the term to refer to memory extending over minutes, days, weeks or months, reserving the term ‘long-term memory’ for memory for events happening many years before. The available experimental evidence suggests that the most appropriate temporal distinction occurs between a few seconds and a few minutes. Nevertheless the term short-term memory is clearly potentially highly misleading and hence will not be used subsequently in this chapter. Other terms that have been suggested in place of short-t...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Table of Contents
• Contributors
• Preface
• 1 Memory theory and memory therapy
• 2 Assessment for rehabilitation
• 3 Ways to help memory
• 4 Strategies of memory therapy
• 5 Memory therapy in practice
• 6 Computer assistance in the management of memory and cognitive impairment
• 7 The psychopharmacology of human memory disorders
• 8 Disorders of attention: their effect on behaviour, cognition and rehabilitation
• 9 The development of group memory therapy
• 10 Self-help groups
• Author index
• Subject index