VIRGINIA COMMONWEALTH UNIVERSITY

NATIONAL RESOURCE CENTER
FOR TRAUMATIC BRAIN INJURY

Neuropsychology and Rehabilitation Psychology Division Department of Physical Medicine and Rehabilitation.

Cognitive

QUESTION:

I sustained a brain injury approximately 3 years ago. I have regained many functions that were impaired after the injury; however, I continue to experience short-term memory problems. What can I do to improve my memory? Is it possible to fully recover this function?

ANSWER #1

One of the most frequently stated complaints from survivors of brain injury is reduced memory capacity. Statistics suggest that 70% of TBI survivors continue to experience memory problems 1 year post injury. Although the degree and nature of memory impairments varies in each situation, there are common patterns. Early in the recovery many, if not most, survivors suffer from post-traumatic amnesia after a period of unconsciousness. As recovery advances, the survivor will notice continued improvements in recalling events occurring prior to the injury. Short-term memory will generally be delayed in the recovery, with few individuals having suffered moderate or severe brain injuries ever realizing 100% recovery.

Memory rehabilitation programs have been developed around the country and are a part of many inpatient and outpatient cognitive rehabilitation programs. These programs focus on teaching compensatory skills, retraining attention ability, and retraining memory processing. The research has demonstrated that "memory notebooks or logbooks" are the most cost effective ways of enhancing recall. These books act as data banks for all important dates, personal information, and anything else you want to remember. For those with a few more dollars, Neuropager has been assisting many individuals with memory impairments. This is essentially an easy-to-use "programmable" pager system that alerts you of your schedule and other information that you have instructed it to recall for you. You also can attempt to use other memory "tricks" to enhance your recall (e.g., associate names with images). Also, the old standby of rehearsal or repetition still has its place. No one strategy works for everyone.

ANSWER #2

Memory is usually one of the first problems people experience after a head injury, and it is one of the last of the cognitive functions to return. However, there are a number of things you can do that will substantially improve your memory in a short amount of time. Many of these things are simple but they require changing your lifestyle which may seem difficult at first.

First, you must get enough sleep and change your diet so that you are avoiding stimulants and nicotine. Regular exercise also will improve your memory quickly. Putting yourself in a position where you are using your memory every day also will help. For example, taking non-credit courses at a community college will improve memory. Other forms of mental activity also may help like doing crossword puzzles, playing computer games, or reading books. Learning new ways to remember also can help. For example, learning how to form mental pictures of things you want to remember or using other memory tricks such as "mnemonics" can be useful. This usually requires some amount of training and you may have to substitute these new memory habits for some older, less efficient ones. This may take time and can be frustrating.

Probably the best way to train your memory is to use the TRRAP mnemonic. These letters will remind you of all the things you need to do to enhance your memory.

T ranslate into your own words. When learning something new, say it your way.
R ehearse (repeat at least five times) immediately.
R elate the new event to something you are familiar with.
A picture is worth a thousand words. Try to picture what you hear, see, or read.
P ractice output. Practice explaining, doing, or teaching the new thing to someone else.

Memorize the Memory TRRAP mnemonic and use it to remind yourself of the things that you need to do to remember effectively. Most importantly, however, practice doing these things until they become "second nature."

QUESTION:

Ever since my car accident, I have no recollection of the event itself. I can remember things that have occurred since then and things before. However, all efforts to recall some detail of the actual wreck and the hours following during which I was taken to the hospital have failed. Is this normal? Will memories of the accident appear later in life, or with counseling or hypnosis?

ANSWER

The memory system is very sensitive to trauma, and many survivors of traumatic brain injury suffer severe memory loss. In short, the memory loss you are experiencing is very normal and you will not recover these memories. Unlike memory loss due to emotional trauma, amnesia due to brain injury has not been shown to be treatable by counseling or hypnosis.

QUESTION:

My son has played football throughout high school; he is a senior and is likely to play for a college team. Within the past year he sustained a concussion. At the time of the injury he was dazed but not knocked out. I have heard that repeated concussions are dangerous, and I am worried about my son’s future health risks. Would a second concussion compound the effects of the first injury, or would a second injury be an entirely separate concern? Are concussions which appear to be as mild as this (no loss of consciousness) anything to worry about?

ANSWER

Any concussion, including head injury which results in no loss of consciousness (yet perhaps a change in consciousness or awareness) is of medical/neurological concern. A concussion typically implies a temporary injury to the brain. Such an injury makes the brain more vulnerable to a second injury, which can create more severe impairment and a potentially longer recovery period. An applicable analogy would be the athlete who suffers an ankle sprain which, although not a permanent injury, does impair some functions on a short-term basis. That same ankle is more vulnerable to a second injury while it is healing and a resultant longer recovery curve and possibly more chronic or permanent impairment if re-injured during recovery.

The greatest concern regarding repeated concussions is for what is termed "second impact syndrome." This refers to catastrophic injury resulting from a second concussion in close time proximity to the first. Although this is a rare occurrence and can result in permanent brain injury or death, there is recent neurophysiological data which suggest that the still developing brain (under age 21) is more vulnerable to such a second impact syndrome.

As in the ankle injury scenario, there are several key variables to determining when it is safe to return to contact sports (games or practices). These include the severity of the original injury, the completeness of recovery from the original injury, and the time between first and second injuries. Most professionals agree that any concussion, regardless of severity (even without loss of consciousness), should be completely healed (no neurological, cognitive, or psychological symptoms), before the athlete should be allowed to return to games or practices (see the Cantu and Colorado Severity and Return to Play Criteria). Although there are little scientific data on which to base return to play decisions, most team physicians and high school/college guidelines suggest that risk of catastrophic second impact injury is low if return to play follows complete recovery (no symptoms) from concussion.

If a player sustains three mild concussions in a season, regardless of the fact that he/she may have fully recovered between each of these concussions, there is some limited agreement by health care professionals that the athlete should terminate any contact sports for the rest of that season and should, perhaps, consider terminating involvement in such sports in the future (Quigley’s rule).

QUESTION:

After being seriously injured in car crash, I am unable to recollect several years of my life (the years prior to the accident). Sometimes bits and pieces of memory come back when a certain familiar odor or image stimulates my mind to recall an image from the past. However, there are extensive parts of my life that I cannot recall. Is this normal? Will I recover my memory or parts of it?

ANSWER

Recall or memory problems are a common sequela to head injury. The most common form of memory problems is short-term memory for events post-accident that interfere with executive function or the normal performance of administrative duties. Amnesia for events preceding the accident are less common and more serious in nature.

The first category (short-term memory difficulties following accident) are primarily the result of binocular/ocolo sensory motor decompensation (see FAQ’s on vision). Amnesia for events preceding injury typically relate to cerebral damage and may be identifiable by MRI as a focal lesion. This type of injury is more serious and has a poor prognosis for recovery when identified as a focal lesion. However, the brain has remarkable capability for adaptation. It is always necessary in neurological matters of the brain and information processing systems to think in terms of a hierarchical model. While each of our senses contributes to memory and provides its own specific stimulus to recall, visual input to the brain is by far the most powerful and highest leverage stimulus input to the brain .

In all aspects of intellectual and cognitive function, it is essential to first re-establish the highest possible efficiency in binocular information processing. The visual information processing of the brain is analogous to the DOS system for management of computer processing and file management. Thus, the establishment of clear, single, efficient, comfortable binocular vision provides a stimulus input of lowest stress, thus facilitating more efficient cerebral processing, relieving stress that can secondarily cause memory problems.

Recall, pre-injury memory loss (amnesia), does frequently improve spontaneously with time. All such neuro-processing defects are enhanced by rehabilitative therapies that minimize cerebral processing stress, re-establishing the highest degree of normal executive function.

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