Welcome to the TBI-HELP Live Chat

Today's topic is: "Memory Problems and Treatments for Traumatic 
Brain Injury"

Our Guest is: Dr. Jennifer McCaine, Psychologist, Jamaica Hospital Medical Center, TBI Unit

[19:01:33] Mod: Good Evening and welcome to our chat session. Tonight we are please to have as our guest speaker Dr. Jennifer McCain, Psychologist from Jamaica Hospital. Welcome Dr. McCain.
[19:03:14] DrMcCain: Good evening to all of you who are joining us on this live chat session. It is truly a pleasure for me to be able to participate in this chat
[19:03:47] Mod: Rail: Dr. McCain- what are the most common issues that come up in TBI?
[19:04:07] DrMcCain: Rail, this is an excellent and commonly asked question. Actually, your question is very pertinent to our topic tonight. Memory problems are the most common complaint mentioned by survivors of TBI and their faimilies up to 7 years after head injury. Along with slowed informatin processing, impaired memory is one of the strongest predictors of unemployment 7 years after injury
[19:07:45] Mod: What are some methods of memory rehabilitation?
[19:08:10] DrMcCain: Rehabilitation of memory dysfunction henerally focuses on one of two goals: 1) repair of damaged memory processos of 2) alleviation of functional disabilities.  The first goal assumes that if damaged processes are repaired, general memory ability will be reestablished and memory functioning will return to normal. The second goal is less ambitious--to overcome problems caused by memory deficits and improve performance on specific everyday memory tasks. The assumption here is that performance might be improved even though the underlying memory ability remains unchanged. Although both goals represent desirable outcomes for therapeutic intervention, the bulk of the successful remedial work has been in the area of functional improvement.
[19:11:12] Mod: Rail: Is the long term effect of memory loss attributed to the TBI injury or to the more subtle aspects of memory that are secondary to the injury?
[19:11:46] DrMcCain: Rail, can you clarify your question? What do you mean by secondary memory deficits?
[19:12:03] Mod: Melanie: Old memories are sometimes intact but it is new information that takes repetition to process and remember. How can family help the process?
[19:12:37] DrMcCain: Melanie, it depends on how confused the person is. At home, if a person is chronically confused, the family can do some of the following things to help the individual learn new information: maintain the individual in familiar surroundings. Trips and visits to new places may produce anxiety. Avoid ambiguity, and do not present unnecessary choices or decisions. Try to maintain a daily routine that features well-established landmarks, such as regular meals. Make life predictable. Understand that fatigue will be poorly tolerated, so do not schedule several hours of unbroken activity. Limit confusion and confusing stimulation.
[19:15:17] DrMcCain: Be alert for indications of change in physical or mental status (e.g., prolonged agitation, changes in sleep or eating patterns). And most importantly, make sure that you take time to do things for yourself. Caregivers who are burned out do not take care of their relatives as well as those who take some time to look after themselves every once in a while. Memory books can also be very helpful as a type of compensatory strategy to maximize a person's ability to remain as autonomous as possible. Memory books are usually comprised of the following sections: orientation, memory log, calendar, things to do, transportation, feelings log, addresses, and a place to record names of new people
[19:18:20] Mod: Rail: What I meant to ask is there direct memory damage from the trauma or is the primary result localized and leads to "bad connections" the distort or mis-associate memories- secondary to the trauma?
[19:19:13] DrMcCain: Rail, generally speaking, the damage to memory can be a consequence of damage to the memory structures (e.g., medial temporal lobes; hippocampus) or via damage to other structures (e.g., frontal lobes)that have an influence on memory. Typically in head injury, memory problems are related to damage to both memory areas as well as to the frontal region of the brain.
[19:22:19] Mod: Melanie: So cognitive ability and memory can be increased by artificial aides as structure, lists, etc.
[19:22:27] DrMcCain: Melanie, much of the rehabilitation that is done with brain injured individuals uses external aids. We usually begin to use such aids in the acute setting and work with the families so that the external memory aids can be carried over into their post-rehab. life. However, many people who have TBI's require assistance from caregivers to utilize such aids. This is because many TBI survivors do not actively initiate goal directed behavior because of poor organization, planning, and appreciation of the ramifications of their cognitive weaknesses.
[19:25:57] Mod: What is retrograde amnesia?
[19:27:51] DrMcCain: Mod, retrograde amnesia is the loss of memories prior to an injury. For example, it is the inability to recall your address, or who was the president of the US when you were injured. Retrograde amnesia usually has a temporal gradient. What this means is that events that occurred closer in time to your injury (e.g., a day or week before) are more prone to be forgotten, while your most remote memories (e.g., where you went to elementary school) will typically remain the most preserved. Retrograde amnesia does occur after TBI, but can clear up to some extent.
[19:31:08] Mod: Melanie: Has there been any studies that you know of connecting Ginko Biloba or other herbs and memory loss due to TBI?
[19:31:52] DrMcCain: Melanie, I am not aware of any research that has studied Ginko Biloba or other herbs with memory loss due to TBI. I know that both Ginko and Vitamin E have been used in some cases of memory loss, usually with dementia. However, if one chooses to go the homeopathic route, it is advised that it is done under the supervision of a physician, as there have been some cases of negative side effects when people take such herbal remedies in excess.
[19:33:28] Mod: Rail: I've seen that Ginko and a few other non-traditional supplements have some good effects cited for mental activity - do these help with TBI memory?
[19:34:26] DrMcCain: Rail, just as I told Melanie, I have heard some anecdotal reports regarding the use of herbal supplements, but I am not personally aware of any controlled studies using them.
[19:34:56] Mod: Rail: You mentioned retrograde amnesia-is there anterograde amnesia?
[19:34:58] DrMcCain: Rail, anterograde amnesia is extremely common following head injury. To simplify, anterograde amnesia is the inability to learn new information. In head injured individuals, after the person regains consciouness, one observes posttraumatic amnesia. Following the end of PTA, the memory performance of TBI survivors may be differentiated from that of normal individuals by an increased rate of forgetting and an increased susceptibility to interference.
[19:38:30] DrMcCain: TBI also disrupts more qualitative aspects of memory. Two aspects in particular appear to be affected by TBI: reduced implementation of organizationsl mnemonic strategies, and impaired memory for contextual factors (e.g., information about the time, frequency, and source of the material). For example, one might forget the content of a phone mesage but remember that the message was received between two other messages at approximately 3 PM. TBI survivors are also impaired in their ability to establish links between names and faces, which they interpret as an impairment in "memory for source"
[19:41:38] Mod: Is there any new "genetic" research associated with amnesia - I've seen some non specific references in the news recently?
[19:43:07] DrMcCain: Rail, there is constantly ongoing research into treating memory disorders. Genetic research is usually not related to TBI patients, since the injury incurred in the TBI population is acquired and not necessarily related to familial transmission or other genetic factors.
[19:45:19] Mod: Rail: WOW - anterograde sounds like "locked in syndrome" but with no input. How frustrating for the family that the dear person can not adapt to the new circumstances - does this have severe psychological consequences for the individual and the family?
[19:44:31] DrMcCain: Rail, anterograde amnesia is not like 'locked in syndrome'. In locked syndrome, a person is unable to respond to those around them, though it appears that they are able to comprehend what is going on--they just can't respond back. Locked in syndrome usually results from damage to the brain stem.
[19:46:31] DrMcCain: Anterograde amnesia, on the other hand, is a condition where a person may have 'normal' cognitive functioning in many other domains, and may talk to others in very coherent ways, so that some may not even know that they have a memory problem. The problem happens when the person is required to remember things that have occurred two minutes, two hours, two days, etc., ago.
[19:47:44] DrMcCain: You are right about the impact on the family, though. Such memory deficits can have such a devastating effect on family. Depending on the severity of the memory problems, some TBI survivors may not be able to stay at home alone, because they may leave the stove on and harm themselves. Others with more mild memory deficits may only need reminders (e.g., a phone call from a family member) to take medications or remember important appointments.
[19:49:52] Mod: Sydney: For the family - are there any specific things that can help a person compensate for memory problems?
[19:50:45] DrMcCain: Sydney, family members are often the main people who will be helping the TBI survivors compensate for their memory problems. I already touched on this in the beginning of the chat, but to briefly summarize:
[19:52:30] DrMcCain: Since TBI survivors have problems with executive functioning (e.g., organization, execution of goal directed behavior, appreciation of deficits), family must act as an 'external' organizer and planner for the individuals (though it is the hope that with time and therapy, some of this can be tapered off). For example, family should provide consistent and reliable routines for the individual--this acts as an 'external' organizer. Families should also encourage, reinforce, and facilitate the use of compensatory strategies. Memory books, pagers, palm pilots, and similar divices are often quite helpful. Unfortunately, in my experience, TBI survivors will require lots of reminders and reinforcement to use these devices. Once in practice of using them, though, some individuals become quite proficient of independently using external memory aids.
[19:55:58] Mod: Sydney: Is the family the best measure of memory - or are there objective measures that can also help evaluate the degree of deficit?
[19:56:24] DrMcCain: Sydney, the family provides invaluable information regarding memory problems in the TBI survivor. I always attempt to include family perceptions of the memory issues, as they know the individual the best, and can provide a tremendous amout of information that can best be derived through observation in naturalistic, real-life situations. However, this information should most certainly be combined with quantitative date, such that can be provided through a formal evaluation of memory.
[19:58:45] DrMcCain: Neuropsychologists are usually the most proficient (of course there is no bias here!!) at providing a comprehensive evaluation of memory funcitoning. THe advantage in have a neuropsychological evaluation is that the person's performance is compared with peers and based on standardized norms, which in combination with family observations, gives us the best measure of memory.
[20:00:11] Mod: Well I see that we are out of time for this evening. I want to thank Dr. McCain for an interesting evening and hope that she will return in the future. Thanks to all of our viewers also and have a good night, see you next week and be safe!
[20:00:40] DrMcCain: Good night to all of you who joined us tonight. It was a pleasure to chat with you all!