Clinical Managem.ent of Mem.ory Problem.s Second edition Edited by Barbara Wilson Senior Scientist MRC Applied Psychology Unit Cambridge and Nick Moffat Top Grade Psychologist Branksome Clinic Poole Dorset Springer-Science+Business Media, B.V.
First edition 1984 Second edition 1992 Barbara Wilson and Nick Moffat 1984,1992 Originally published by Chapman & Hall in 1992 Typeset in 10 on 12pt Palatino by Falcon Typographic Art Ltd, Fife, Scotland St Edmundsbury Press, Bury St Edmunds, Suffolk ISBN 978-0-412-32250-1 ISBN 978-1-4899-4523-5 (ebook) DOI 10.1007/978-1-4899-4523-5 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed on this page. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library
Contents Contributors vi Preface vii 1 Memory theory and memory therapy Alan D. Baddeley 1 2 Assessment for rehabilitation Nadina B. Lincoln and Neil Brooks 32 3 Ways to help memory John E. Harris 56 4 Strategies of memory therapy Nick Moffat 83 5 Memory therapy in practice Barbara Wilson 117 6 Computer assistance in the management of memory and cognitive impairment Clive Skilbeck and Ian Robertson 151 7 The psychopharmacology of human memory disorders Michael D. Kopelman 186 8 Disorders of attention: their effect on behaviour, cognition and rehabilitation Rodger L. Wood 213 9 The development of group memory therapy Barbara Wilson and Nick Moffat 240 10 Self-help groups Deborah Wearing 271 Author index 305 Subject index 316
Con tri bu tors Alan D. Baddeley, Director, Medical Research Council Applied Psychology Unit, 15 Chaucer Road, Cambridge. Neil Brooks, Professor of Clinical Psychology, University of Glasgow, Department of Psychological Medicine, 6 Whittinghame Gardens, Great Western Road, Glasgow. John Harris, Proprietor of Cambit, 1 Rowan Close, Bottisham, Cambridge. Michael Kopelman, Senior Lecturer, Academic Department of Psychiatry, United Medical and Dental School, St Thomas's Hospital, Lambeth Palace Road, London. Nadina B. Lincoln, Research Clinical Psychologist, The Stroke Research Unit, The General Hospital, Park Row, Nottingham. Nick Moffat, Top Grade Clinical Psychologist, District Psychology Service, Branksome Clinic, Layton Road, Parkstone, Poole, Dorset. Ian Robertson, Senior Scientist, MRC Applied Psychology Unit, 15 Chaucer Road, Cambridge. Clive Skilbeck, District Clinical Psychologist, Newcastle Health Authority, Royal Victoria Infirmary, Newcastle upon Tyne. Deborah Wearing, Development Manager, AMI, Grafton Manor, Grafton Regis, Towcester, Northampton. Barbara Wilson, Senior Scientist, MRC Applied Psychology Unit, 15 Chaucer Road, Cambridge. Rodger Llewellyn-Wood, Consultant Neuropsychologist, St George's House, 56 Billing Road, Northampton.
Preface Since the first edition of this book appeared in 1984, assistance for memory-impaired people has improved a little. The Amnesia Association was founded in 1986 and a number of local Amnass groups meet regularly throughout the United Kingdom. Although help is still hard to find for most patients and their carers, it is now probably a little easier for some memory-impaired people and their families to obtain advice that might enable them to come to terms with the problematic changes that take place in their lives. What is certain is that interest in the rehabilitation of memory problems continues to grow, and this has led to further developments in memory therapy in recent years. The second edition of this book has been compiled in response to this growth of interest and reflects the latest developments and debates within the field of memory therapy. Memory problems are common after such conditions as severe head injury, progressive degenerative disease, cerebral vascular accident (stroke), chronic alcohol abuse, intracranial infection and certain other conditions. Although this list means that vast numbers of people throughout the world suffer from varying levels of memory impairment, their predicament is largely ignored and remains untreated. It is hoped that this book will stimulate greater interest in their problems and at the same time offer ideas for treatment. The commonly observed advertisements in the press offering to improve memory are of no practical use whatsoever for the great majority of brain-injured people, who need a protective environment and assistance from competent workers in the field of rehabilitation. Most speech therapists, occupational therapists, clinical psychologists, social workers, doctors,
viii Preface nurses, teachers and physiotherapists are given little guidance as to what methods are available or which methods are suitable for helping individual patients to cope with their memory problems. We said in the first edition that therapists who turn to previous publications on memory were unlikely to obtain much in the way of relevant or practically useful information. Fortunately the situation has improved here as more text books on memory are beginning to address the question of management of memory problems. However, this book remains the only comprehensive guidebook for those working with memory-impaired people. In 1991, as in 1984, we do not provide medical solutions, easy answers or make promises about restoring memory, but we do attempt to give a better understanding of the difficulties faced by people with memory problems and we offer suggestions on how to handle, by-pass or reduce memory difficulties. Alan Baddeley's chapter serves as an important foundation for the rest of the book in that it describes the fundamental relationship between theory and practice as far as memory and memory therapy are concerned. A clear account of the psychological structure of human memory is provided by the author who himself has done more than anybody else to ensure that there is a thriving two-way communication between theory and therapy in the field of memory rehabilitation. Before beginning any remediation of memory impairment, an appropriate assessment of the nature of that impairment is required. In Chapter 2 Nadina Lincoln and Neil Brooks describe procedures for carrying out such an assessment. The emphasis is on assessment for rehabilitation rather than for research purposes or for routine administration of tests. The chapter indicates that assessment for rehabilitation is inseparable from treatment and that in order to evaluate the effectiveness of treatment it is necessary to carry out assessment of treatment outcome. The chapter discusses reasons why assessments should occur, who should assess, and when assessments should be made. The authors also include descriptions of some new tests not available in the first edition. In Chapter 3 John Harris describes methods for improving memory that were available at the time of writing this
Preface ix chapter. He discusses internal strategies, repetitive practice, physical treatments and external aids. Because of the rapid development of some computerized external aids, however, Harris recognizes that some of this chapter will inevitably be out of date by the time the book is published. Harris provides explanations of ways in which various methods seem to work, and offers his own views on their respective strengths and weaknesses. Nick Moffat begins Chapter 4 with a consideration of variables which may affect memory performance and then discusses the organization of memory therapy. Moffat explains in detail the application of reality orientation training and discusses several methods for improving memory previously described by Harris, examining these within the context of rehabilitation of brain-injured people. Moffat describes a number of recent memory rehabilitation studies reflecting the interest in this topic since the first book appeared. In Chapter 5, Barbara Wilson discusses memory therapy in practice. She provides some general principles for helping memory impaired people to encode, store and retrieve information before going on to examine specific strategies for particular problems. She discusses ways of teaching memory-impaired people to use strategies, and points out that it is unrealistic to expect most memory-impaired people to use these strategies spontaneously. It is the therapists, relatives and carers who use strategies to help memory-impaired people learn. When this book first appeared in 1984, microcomputers in rehabilitation were fairly new. In 1991 they are very much in evidence in most rehabilitation programmes. In Chapter 6 Clive Skilbeck and Ian Robertson discuss the advantages and disadvantages of microcomputers, and provide a summary of studies evaluating the use of computers in rehabilitation. The authors suggest that microcomputers should not be expected to restore or significantly improve memory functioning in and of themselves. They should be regarded, rather, as adjuncts to treatment programmes. Chapter 7 by Michael Kopelman, on the psychopharmacology of human memory disorders, replaces Steven Cooper's chapter on drug treatments, neurochemical change and
x Preface human memory impairment that appeared in the first edition. Kopelman discusses Korsakoff's syndrome, Alzheimer-type dementia and Huntington's disease. He also reviews studies of the effects of agents modulating neurotransmitter systems in healthy subjects and clinical trials of 'replacement' therapy in amnesic or dementing patients before concluding that most benefits seem to be small and fickle and of little clinical importance. Attention and speed of information processing are often compromised after brain injury, and in Chapter 8 Rodger Wood considers disorders of attention, alertness, selectivity, effort and memory. He refers the reader to several studies which attempt to identify processes involved in the operation of these skills. During rehabilitation a patient will have to revert to a more conscious and controlled form of information processing, and the second half of the chapter concentrates on various ideas, suggestions and tasks for developing attention-training programmes. Memory impaired people may benefit from interactions with others sharing similar disabilities. In Chapter 9 Wilson and Moffat discuss several possible advantages to be gained from treating memory-impaired people in groups. Descriptions are provided of group therapy for in-patients, most of whom are young and who have had a severe head injury, and for out-patients with mixed ages and aetiologies. Perhaps the major benefit of memory group therapy is that it reduces anxiety and negative emotions associated with memory impairment rather than improving memory per se. Another advantage of groups, perhaps, is that brain-injured people may be more willing to use compensatory strategies if they see their peers using them. The final chapter of this second edition was not included in the first. It is written by Deborah Wearing, the wife of Clive Wearing, a musician who became densely amnesic in 1985 following herpes simplex encephalitis. Deborah Wearing is co-founder of the Amnesia Association and did a great deal to bring the plight of amnesic patients to the attention of the general public. Her chapter is on self-help groups and is written from a relative's point of view. At the end of the day relatives bear the brunt of coping with a memory-impaired person. For this reason
Preface xi we would encourage all professionals involved in braininjury rehabilitation to work closely with relatives in order to increase their understanding of the day-to-day problems encountered by memory-impaired people and their families.