Nancy Chiaravalloti, PhD
WASHINGTON — Exercises that have proven effective in improving the cognitive skills of multiple sclerosis patients also may be useful in treating symptoms of TBI.
Researchers using a memory-rehabilitation tool that has helped MS patients improve memory and cognition are conducting clinical trials using this technique on people with TBI.
Using Stories to Improve Cognition
More than 1.7 million Americans sustain a traumatic brain injury annually, whether in the military or other areas, Nancy Chiaravalloti, PhD, director of neuropsychology at the Kessler Research Center, told fellow researchers at the Federal Interagency Conference on TBI held here last month. “Over 90% of those people require lifelong treatment. It’s our responsibility as researchers to identify the most efficacious treatments.”
Patients with TBI have hard-to-treat cognitive deficits, including memory deficiencies, executive function deficiencies and an overall slowness in processing information. Those are the symptoms that can most greatly impact a patient and can lead to depression, anxiety and decreased participation in life, researchers said.
Both MS and TBI patients learn more slowly, and it takes more repetitions of information for them to remember information. However, for 70% of TBI patients, once that information is initially learned, it can be recalled at will. MS patients show similar effects.
For several years, Chiaravalloti has been working with MS patients on improving their cognitive function using a modified story-memory technique (mSMT). The treatment involves 10 sessions, with two per week during a five-week period. During the first four sessions, the patients are presented with a written story. Many of the key words in the story are capitalized. For example: Mr. Jones PULLED a fresh APPLE from a TREE.
“This is a very odd story, and it’s odd for a reason,” Chiaravalloti said. The story, aside from containing capitalized words, is heavy on imagery, which makes it easier for patients to remember.
After they are first presented with the story, patients are asked to remember as much of it as they can. Following their first attempt at remembering, the therapist gives them tips on better ways to memorize the story. The same story is repeated twice in each of the first four sessions.
During the next four sessions, the patients are presented with a list of words. They are then told to put these words into a story as a way of better memorizing the list. Where the first sessions taught the patients to recognize imagery and how it can be used in storytelling, these sessions teach skills for putting new information into a context.
The last two sessions involve the therapist talking with the patient about how such skills can be used in everyday life. Page 2