Ask Kathy M. Archives
A Collection of Questions and Answers from TBI Advice Expert - Kathy Moeller

Topic: Memory - Strategies for Improving Memory

Question:

Dear Kathy M.,

A couple of things really bother me when they happen. Repeating myself is one of them. When that happens, I just feel awful! I have a nephew who seems to take great pleasure in catching me asking him something more than once because I can't remember that I've already told him something. Forgetting what I've purchased and buying things twice (or more) is another one. Forgetting to do IMPORTANT (like PROMISING to pay the phone bill, and truly INTENDING to pay it,and then getting the phone turned off because I spaced it).

I've tried and tried and tried to improve my memory (have even bought whole memory improvement courses). A speech therapist gave me memory exercises on the computer that were supposed to help, but they didn't. What are some strategies you use to improve memory?

Brandy J.


Kathy's Response:

Dear Brandy,

You've just described several of the most common frustrations and problems I hear from people who have had brain injuries. Let me try to re-frame this and break it into a couple of different subject areas.

Re-framing the problem, focusing on functional goals
First, what I'm hearing you say is that there are three life functions you are no longer able to perform automatically, and this lack of functional ability doesn't set well with you.

If I were to rephrase this, with a functional goal focus, it would look something like this:
"I want (1) the ability to know that I have communicated something so I don't repeat myself, (2) the ability to know that I have purchased something so I don't buy it again, and (3) the ability to follow through on my commitments."

It's appears that you and your speech therapist thought that working on improving your short-term memory would be the key to being able to do these things. Yet, it also appears that neither the strategy of trying to improve your short-term memory nor the strategy of applying more effort worked very well. Note that the issue of memory, per se, is not included in the way I have re-framed the issues. There is a good reason for this!

Benefits of focusing on "functional goals"
I avoided using the terms "forgetting" or "can't remember" when I re-framed the goals because including references to "forgetting" or "not remembering" both clouds the issue and implies that the core reason for the inability to perform certain functions is due to impairments in what I call "organic" (or un-aided) memory. Your last question sums it up. You appear to continue to want strategies to "improve your memory," thinking that will solve the problem. This is misguided, in my view.

Please don't misunderstand. Short-term memory impairment is the culprit all right! But, focusing on regaining so-called "organic" memory is NOT the solution! The core problem is "repeating one's self" and "double-buying," not forgetting, per se. I have found that focusing on acquiring strategies for KNOWING is a better line of defense, overall. Focusing on the question, "How can I know this or that, and get access to this knowledge in the future when I need it?" is far more solve-able problem than trying to regain or improve one's short-term memory.

You see, it is possible to know that you've done or said something without being able to "remember" it. Now, this may sound very strange at first, but it's true! How we frame (or word) the problem, helps point us toward more effective strategies. Here are some I have used successfully.

Strategy for not repeating myself
I use several tools and skills. The primary tool is something I call a "TALK TO" section in my planner. This is used in conjunction with something else I call a "Memory Notes page," which is in my "SCHEDULE" section.

I always write my "Memory Notes" for the day on the right side of my "SCHEDULE" section (which is the heart of my planner), so when I talk to a person, I am already primed to write a "Memory Note" that tells me when I talked to them, and refers back to the "TALK TO" page I used. This description will make the most sense to people who are familiar with what is called a "two-page-per-day" system (in day planner talk).

"TALK TO" section
I keep all my "TALK TO" pages in a clearly marked section (the section is labeled "TALK TO"). I have one page for each person I interact with on a regular basis. Their name and phone number and "memory cue" (if needed) is clearly written on the top.

I have pages for all my family members, my physician, my counselor, my insurance agent, my students and others. When I think of something I want to say to the person, I write it on that person's "TALK TO" page.

Just before I call or meet with the person, I look at the "TALK TO" page with their name on it so I can prepare myself for talking to them. Depending on the situation, I might have my "TALK TO" page in front of me the entire time. And when I'm done speaking to the person about a particular topic, I mark though the part of the "TALK TO" page that contained the topic, with a code for "done" (I use an orange highlighter for all "done" items).

By relying on a universal code for all "done" items ("done" tasks, "done" communiations," etc. are all coded with an orange highlighter mark), I have replaced remembering with looking! Because I code each topic I'm finished with as "done" with my orange marker, even if we get interrupted or if we run out of time, I can look back and know which topics we covered and which ones we did not.

This combination of tools and strategies is sometimes called having a "prosthetic memory system." The effect is like "remembering," but it's not what people normally think of as memory. It is a strategy for knowing! The steps I take to get to "the knowing place" is different from the steps persons without memory impairment take.

The bottom line is that if something is marked through in orange in my book, it's "DONE," whether I remember doing it or not!

"Memory Notes" page
As soon as I am done with a conversation, I write a "Memory Note," capturing the result of the conversation. My "TALK TO" pages are cross-referenced to my "Memory Notes" pages so I can alway link what I had wanted to talk to the person about with the results of the conversation (what they said back).

By learning to look at a person's "TALK TO" page before speaking to them, I avoid repeating myself. This is particularly important in the workplace! It's one thing to repeat yourself to your family; it's quite another to repeat yourself to a busy boss or unsympathetic co-workers. It takes practice and a willingness to operate in the world of "prosthetic memory," but it makes a dramatic difference in one's ability to communicate effectively.

Interestingly, I am still tempted to repeat myself because my memory continues to fail me. I will often forget that I've already talked to someone about something, but because I have learned to stop myself and look at their "TALK TO" page, I am able to know that I have already discussed the topic. The result is I don't repeat myself, even though the temptation is there.

Strategy to avoid "double-buying"
I have a "SHOPPING" section in my planner too. It contains pages with categoy headings such as "Shopping List for Groceries", "Shopping List for Household Items," "Shopping List for Clothing," etc. When I think of something I want to purchase, or notice I'm out of something, I can immediately go to the appropriate page, and see what I've already planned to purchase, and also what was recently purchased, so I won't buy it again (there is a place for writing the date of purchase, which is pre-printed on the top of the page).

I avoid double-buying because I keep several week's worth of pages in the "SHOPPING" section so I can look back on past purchases (all "oranged out" of course). This makes it possible to check to see if what I think I want to buy has been purchased. Guess you could say, if I see an orange mark through an item on a past list, I know it's "done bought").

As an aside, many persons with brain injury also have difficulty locating things (visual scanning problems, remembering where things are stored, not remembering to put things back in the same place each time, etc.). I know I have these problems, and double-buying can stem from either forgetting you bought something or not being able to find it, or both! By looking at a past "SHOPPING List" page, if I see that something I don't think I have has been recently purchased, I can take some extra time to locate it, if I wish. It all starts with knowing what you do and do not have.

I keep older Shopping List pages in a Storage System in my office that has a section clearly marked "SHOPPING." It is set up in precisely the same way the "SHOPPING" section in my planner is set up (same color, same location). With all my past pages accessible to me, whenever I plan to go shopping, I can look at past pages as far back as I wish to go and be confident that I have looked though as many past pages as I need to. I could go back a year or longer, if I needed to. When questions like, "Did I buy a barbeque last summer, or did I just forget where I stored it?" are now answer-able -- by looking, not "remembering."

Strategy for following through on commitments
I am a scheduler. I schedule EVERYTHING! Appointments with others, "appointments with myself." Shopping, cleaning, phone calls, recreation, resting time, starting a load of laundry, taking it out of the dryer, you name it! I only use "To Do" lists to brainstorm things I want to schedule, and then the "To Do" list gets tossed.

Scheduling things you want to do helps with follow-through. And when I say "schedule" I mean specific days and times!

If a person is in the habit of looking at their "SCHEDULE page" every day, things that used to get spaced magically get completed. When I complete something I have scheduled, out comes the orange pen (it's automatic). My planner is open all day to my "SCHEDULE" section, in plain sight. It goes with me to the store, to work, to the livingroom, to the TV room. When the phone rings, I reach for my book before I reach for the phone. I use it to cue myself throughout the day, and practially consider it part of my body (I call it my "paper brain" if that tells you anything). This automaticity is important!

This habit means that everything I need or want to do is visually available to me at all times! I no longer attempt to "remember" to pay a bill, call someone or anything else. I have developed the procedural memory (habit) of writing down what needs to be done on a "SCHEDULE" page, and because my book is always open to the current day's page, if it got written down, it's in my face, and that tends to mean it will get done (or worst case, it will get rescheduled).

Choices
We are in the "Dark Ages" of brain injury rehabilitation, in my view. Twenty or thirty years from now, I am confident that persons with brain injury will not be coached (or even encouraged) to spend much time practicing "memory exercises" in order to regain functional abilities. We will have learned that this approach is more akin to exercising a sprained ankle than it is to exercising weak back muscles.

Instead, we will be taught that "forgetting" is not the problem as much as "knowing" is the issue. We will understand that although it may seem natural and logical to try to (or want to) improve one's memory, these efforts are less effective than others which are focused more intently on compensation. Until this changes, we need to be aware that we have other choices.

Analogies to other disabilities may be useful here. I think about it like this: If a person has profound and permanent hearing impairment, "hearing exercises" would be considered ridiculous! If a person lost the use of their legs, it would be unthinkable to counsel them to "try harder" to walk. And if a person had vision impairment, we wouldn't coach them to "adjust" to living a limited life. Instead, we focus on providing compensatory tools, skills and strategies. Some might say that brain injury is different. I don't think so!

Focusing on functional goals, we offer persons with hearing impairment hearing aids, amplifiers and TTY machines. And they are taught skills, such as how to read lips and body language. We provide people who cannot walk wheelchairs and lift vans and teach them how to operate them. We give persons with blindness talking computers and printers that output in braille, perhaps. In short, we focus on sharing tools and strategies with these individuals that help them outsmart or "end-run" the impairments in order to execute a desired function (communicate, get around town, read, whatever).

These KINDS of options are not the norm for brain injury! Compensation tools and skills for brain injury impairments are trickier than they are for dealing with other disabilities. They are more complex, more learning-based, and more time-intensive! Specialists in compensatory skills training are few and far between, and as such, we do not yet have a compensation mind-set when it comes to brain injury rehabilitation.

Also, there are more gray areas. Yes, "organic" memory can, and does improve, but that does not mean the holes left behind won't trip you up eventually (personally or at the workplace). Even if the exercises worked to "improve" memory, incremental increases on memory assessments may or may not contribute significantly to functional success! The bottom line is that much of the therapy we are offered is modeled after physical therapy (exercise), and although there are supporters of the "compensatory model," compensation for brain injury impairment is not nearly as commonplace, nor is it as sophisticated or as comprehensive as it is for other kinds of disabilites.

In Summary
Brandy, the short answer to your question is that I have specific visual tools and learned skills that compensate for short-term memory impairments. They don't "improve" my memory, but rather, they give me effective ways of LIVING WITH an impaired memory -- outsmarting it, basically! I don't have strategies for remembering, as much as I have strategies for knowing.

The tools are specific visual aids, such as "TALK TO" and "Memory Notes" pages in clearly marked sections of my dayplanner. The skills are massed-practiced until they become automatic ("overlearned"), and mastery is achieved. To acquire the skills, I used procedural memory strengths (in my eyes and my hands), to support my "organic" memory, which is less reliable.

In a nutshell, I have regained functional skills by (1) focusing on functional goals, (2) using residual strengths, and (3) not worrying about the broken parts! Hope this helps!

Kathy M.

P.S. If you would like to read an article I wrote on the subject of using procedural memory as a residual strength, see "Using Our Memory as a STRENGTH!" (published in the Brain Injury Connection newsletter).

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