What to Do When Memory Impairment Therapy Isn’t Working?

In cognitive rehab for individuals with acquired brain injury, memory is often a primary remediation goal. It’s important to work with patients and their families to develop and meet these agreed upon therapy goals. Goals should be framed within the context of their relative memory-related strengths and weakness.

However, sometimes a patient’s progress may be slower than anticipated. This could be due to patient-related reasons (e.g., lack of insight or motivation), or therapy approach/process reasons, or sometimes for both. When this happens, we can use the treatment adjustments described below to improve patient responsiveness to therapy.

Treatment Adjustments

Depending on the patient’s progression, the following therapeutic adjustments may help your patient return to steady improvement to meet their goals:

• Spend more time with the patient on the Acquisition Phase of learning a strategy/skill. (Patient learns and remembers all aspects of the memory approach/strategy being taught)
• If the patient has acquired the targeted strategy/skill, spend more time on the Application Phase of learning the strategy/skill. (Patient begins using memory approach/strategy in role play and real life situations)
• If the patient is applying the targeted strategy/skill, spend more time on the Adaptation Phase of learning the strategy/skill. (Patient works on generating use of the approach/strategy independently)

If you’re using an error-full learning approach, changing to an error-less learning approach may make the difference. With this change, the patient is prevented from making any incorrect responses to questions or requests.

Revisiting Goals

Another tweak is re-visiting a patient’s therapy goals with them. Consider breaking down the goals to the point that ANY improvement the patient makes may be objectively measurable and be obvious to the patient.

For example, instead of a goal being, “Use external memory strategies to remember important content of academic reading assignments,” a sub-goal towards the goal might be “Increase use of colored highlighting to increase attention to important content of class reading assignments.” In this case, increasing the specificity of a goal like this may facilitate increased patient insight or motivation.

A Needed Boost

Patients don’t always make progress in therapy at the rate expected. Re-evaluating the therapy process and the patient’s performance may give therapy a needed boost.