Strategies to Enhance Memory and

Organization for Persons with Cognitive-

Communicative Challenges
Roberta DePompei, PhD
Distinguished Professor
School of Speech-Language Pathology
The University of Akron, Akron, Ohio 44325-3001
rdepom1@uakron.edu
330-972-6114
Lives and Dreams
are Shattered in a
Split Second
PET Scans: New Learning

•  Initial Learning: Widespread activation

•  Practice results in newer, more efficient
pathways
•  Pathways rewire to accommodate new
learning
New Learning: New Connections

•  Research Study: Normal & Mentally

Retarded (MR) adults played Tetris
•  Initial Learning: Global areas
•  Practice for Normals: Fewer pathways
•  Practice for MR: Global areas
New Learning: New connections

•  Intelligent Brains:
Use fewer, more
efficient neural
circuits
•  The greater the
decline in neural
activity with
practice:
•  The higher the IQ
Strategic Learning

!  One of most important brain

functions that underlies learning
!  Extracting important information
while inhibiting unimportant
information
!  The brain is most effective at
abstracting meaning and not
storing detail
(Brainert & Reyna, 1998; Gabrieli, 2004)
Strategic Learning

!  NOT about how much you learn

!  But rather,
–  how efficiently you extract the main
point of the central meaning
(Gabrieli, 2004)

–  how efficiently you exclude irrelevant

information so not to use up vital
storage capacity
(Vogel et al 2005)
Strategic Learning Abilities

!  Individualsshow a bias toward “seeing the

forest instead of the trees”
–  Verbatim details fade rapidly
–  Abstracted learning persists over long intervals
!  The is a severe impairment in strategic
learning after TBI
–  Tasks like summarization, finding main idea,
interpretive statements are impaired
 Strategic Learning Concepts

!  High capacity individuals are more

efficient at learning only relevant items
!  Low capacity individuals (TBI)
inefficiently encode and learn
irrelevant information
!  People with TBI may actually store as
much or more information in memory
than high capacity people-just the
wrong “stuff”.
Strategic Learning Starts Early

!  Little children should be provided with the tools to

begin strategic learning throughout the
developmental preschool years
!  If there is an acquired brain injury (ABI), more
specific interventions may be needed.
 Cognitive Impairments Which
May Affect Language-Learning

•  Impaired attention, perception, and/or

memory
•  Inflexibility, impulsivity, and/or
disorganized thinking, or acting
•  Inefficient processing of information:
Rate, amount, & complexity
Cognitive Impairments Which May
Affect Language-Learning

•  Difficulty processing abstract

information
•  Difficulty learning new information,
rules and procedures
•  Inefficient retrieval of old or stored
information
Cognitive Impairments Which May
Affect Language-Learning

•  Ineffective problem solving and judgment

•  Inappropriate or unconventional social
behavior
•  Impaired “Executive” Functions:
Self-awareness of strengths and
weaknesses, goal-setting, planning, self-
initiating, inhibiting, monitoring & evaluating
INTERVENTION
STRATEGIES
 Benefit of Interventions to
Improve Brain Functioning
Performance

Growing Up
 Context
Work with people
in daily environments
and situations of
competence that
are personally relevant.
Intervention

!  Attention
–  Task analysis
–  Task completion
Attention and Concentration
Strategies

!  Reduce distractions in work area

!  Divide work into smaller sections
!  Have person summarize new information
!  Use cue words to alert person to pay
attention
!  Develop a nonverbal cueing system
Intervention

!  Memory
–  Internal aides
–  External aides
Memory Strategies: Internal

!  Repeat information often and summarize it

!  Rehearsal
!  Categorize or chunk information
!  Link new information to prior knowledge
!  Give examples with instructions
Memory Strategies: external

!  Carry an assignment sheet for each class

!  Pre-teach vocabulary
!  Use devices as self-reminders: watches,
computers, PDAs, smartphones, day
planners
Intervention

!  Organization and Planning

Organizational Strategies

!  Extra time for review

!  Written checklist of steps for complex tasks
!  Instruction for checking each step when done
!  Written schedule of daily routine
!  Person to meet with at start and end of school/ work
day
Organizational Strategies

!  Practice sequencing material

!  Outline to match lectures with notetaking
sections
!  Color coded materials for each class
!  Practice organizing activities
Intervention

!  Strategic Learning
Provide Strategic Learning Skills

!  Identify main idea

–  Find 2-3 supporting pieces of
information
–  State main ideas and supporting
facts/ideas
–  Highlight main ideas and supports
if reading information
–  Discuss main ideas if verbal
–  Demonstrate main directions/
ideas
Interventions with Young Children

!  Play, Play, Play!

!  Introduce social interactions
with other children and family
!  Stimulate receptive and
expressive vocabulary
!  Start vocational transitions
–  Teach turn taking
–  Teach responsibility
!  cleaning up, organizing toys
Why Care about Research on Thursday
Afternoon?

!  Evidence based research is asked for in

order to fund generic devices
!  This research can be used to justify best
clinical practices
!  This information can be used to advocate for
policy change and for third party payers to
provide devices.
 What are Electronic
Organizers?
–  Personal data assistants
(Palm, Pocket PCs)
–  Wearable/handheld
computers
–  Pagers
–  Smartphones
–  Portable voice organizers
 Why study electronic
organizers?
•  At school: Improved independence, follow schedule, stay on
task, and move between tasks (Epstein et al 2001)

•  At work: Increased accuracy and performance in complex tasks,

improved scheduling and time management, decreased use of
external prompts, and easily integrated into work place (Davies et
al 2002; Furniss et al 1999)

•  Independent living skills including medication and oral hygiene

(O’Hara & Davies, 2002)
 Why Focus on Memory and
Organization?
!  Problems with memory and attention are clearly linked to difficulty
learning in school, performing activities of daily living, and
participating in community activities for these iindividuals.
!  Organization does not develop as a part of executive functioning.
!  Support personnel in functional environments report considerable
amounts of time are spent in providing reminders for functional tasks
required during the daily activities of these individuals.
!  The desire to foster independence for functional activities is
increasing.
!  If memory and organization can be enhanced with electronic devices
such as PDAs or smart phones at a young age, independence might
be fostered.
 Purpose of the Collaborative
!  Explore electronic organizers re: cognitive disabilities
in memory and organization
!  Conduct surveys with potential users
!  Determine potential adaptations of devices Present
findings to developers of personal data assistants
(PDA’s)
!  Conduct user trials to identify best practices in
implementation
!  Inform consumers and other stakeholders as they
make technology decisions
 Why “Generic” Assistive
Technology?

!  Itis in the public domain-we all use it

!  The prices are more reasonable for purchase
and replacement
!  The adaptations needed and that should be
recommended to manufacturers will aid all of
us
!  These devices are more socially acceptable
 Collaborative Partners

University of Akron, School of Speech-Language

Pathology and Audiology
Temple University, Institute on Disabilities
Spaulding Rehabilitation Hospital
Brain Injury Association of America, Inc.
 What Have We learned?
!  Electronic aids are useful for some persons
with memory/organization problems as a
result of cognitive challenges.
!  Evidence based studies are emerging to
support use.
!  Generic devices may be most accessible and
useful
–  Handhelds (Mobile Devices): PDAs, smart
phones
What Have We learned?

! Generic
devices have appeal
because
– Sociallymore acceptable
– Prices are lower than “dedicated
devices”
– General public understands use
more easily
What Have We learned?
!  PDAs and smartphones provide the most support for
memory and organization
!  Success is related to the beep and vibration of the
device
!  Day planners were the least effective-even less than
simple lists
!  Persons do not have to learn to program the devices
—responding consistently to the alarm is more
important
!  Social benefits are an added bonus!
Clinical Applications from
this Research

!  Brochure for Manufacturers

!  Brochure for Consumers

!  Brochure for Clinicians

Our future is bright because of the
professionals who share their research
and clinical work

!  We stand on the shoulders of giants!

!  Our gratitude goes especially to our colleague
Mark Ylvisaker, philosopher, thinker, planner,
innovator, writer, organizer, executive functioning
champion, situational context champion, father,
and friend. His efforts will live on in all who were
taught by him and our future is bright because of
him and others who are so willing to share their
work.
 Web sites that are useful to you

!  http://www.projectlearnet.org

!  http://www.free.braininjurypartners.com
It’s Not
Over
‘til It’s
Over
A New International Group is Forming

!  International Pediatric Brain Injury Society

(IPBIS)
!  www.ipbis.org
!  Dr. Jane Gillett
Web Sites with Information About TBI

!  www.biausa.org
!  www.nashia.org
!  TBISERV.NIH.gov

!  www. lapublishing.com
!  www.cdc.gov
Community Based Web Sites

!  http://www.cdc.gov/ncipc/tbi/physicians_tool_kit.htm
!  http://www.cdc.gov/ncipc/tbi/Coaches_Tool_Kit.htm
!  http://www.helpingkidsbrains.com/
!  http://www.mitbitraining.org/
!  http://www.cdc.gov/ncipc/tbi/FactSheets/
VictimizationTBI_FactSheet4FriendFam.htm
References

!  Bilbao, Alvaro, et al, 2003. The ICF: Applications of

the WHO model of functioning, disability and health
to brain injury rehabilitation, NeuroRehabilitation, 18,
239-250
!  Singer, B., & Bashir, A. (1999). What are executive
functions and self-regulation and what do they have
to do with language-learning disorders? Language,
Speech and Hearing in the Schools, 30(3), 265-273.
References

!  Blosser, J.,& DePompei, R. (2003) Pediatric

Traumatic Brain Injury: Proactive Interventions. New
York: Delmar.
!  Gabrieli, J.D. (2004). Memory: Pandora’s
hippocampus? Cerebrum, 6 (4) 39-48.
!  Vogel, E.K., McCollough, A.W., Machizawa, M.G.
(2005). Neural measures reveal individual
differences in controlling access to working memory.
Nature, 438/24, 500-501.
References

!  Gillette, Y. & DePompei, R. (2004). The potential of electronic

organizers as a tool in the cognitive rehabilitation of young
people. Neurorehabilitation, 19(3), 233-243.

!  Hart, T., Buchhofer, R., & Vaccaro, M. (2004). Portable

electronic organizers vs. memory and organizational aids after
TBI: A consumer survey study. Journal of Head Trauma
Rehabilitation, 19(5), 351-365.
References

!  Gillette, Y. & DePompei, R. (2008) Do PDAs

Enhance the Organization and Memory Skills
of Students with Cognitive Disabilities? Psychology in
the Schools: 45(7) 665-677.

!  DePompei, R., Gillette, G., Goetz, E, et al (2008)

Practical applications for use of PDAs and
Smartphones with children and adolescents who
have TBI. Neurorehabilitation, 23(6) 487-500.
 References

!  Carey, A.C., Friedman, M.G., & Bryen, D. (2005).

Use of electronic technologies by people with
intellectual disabilities. Mental Retardation, 43(5),
322-333.

!  Friedman, M., & Bryen, D, (2007). Web accessibility

design recommendations for people with cognitive
disabilities. Technology and Disability, 19 (4).