Memory rehabilitation post-stroke
Table I. Commonly described memory goals and example baseline attainment
Everyday memory goal Example baseline attainment
To
To
To
To
To
To Forgetting
Forgetting
Forgetting
Forgetting
Forgetting
Forgetting
improve my memory for names
improve my recollection of conversations
reduce the number of times I am forgetting birthdays of friends and family
reduce the number of times that I forget to take my medication at the prescribed time
reduce the number of times I miss or am late to an appointment
reduce the number of items that I forget while out shopping
Alfred Prospective Memory Test (RPAProMem) (24) was used
to explore prospective memory. This measure consists of 2
time- and event-based prospective memory tasks, assessed at
short (i.e. within the assessment session) and long (i.e. after
the session) time intervals. Responses were scored out of 3 for
each task (maximum total score of 12). Parallel forms of all
aforementioned measures were used across sessions to mini-
mize practice effects. Finally, the Symbol Span subtest from the
Wechsler Memory Scale–IV (WMS-IV) (25), and Digit Span
Backward subtest from the Wechsler Adult Intelligence Scale-
IV (WAIS-IV) (26) were used to examine spatial and verbal
working memory, respectively. Raw scores were converted to
age-scaled scores using manual norms.
Subjective memory. Subjective memory failures were mea-
sured using the Everyday Memory Questionnaire- Revised
(EMQ-R) (27) and Part A of the Comprehensive Assessment of
Prospective Memory (CAPM) (28). The EMQ-R is a 13-item
scale developed as a self-report measure of memory failures in
everyday life, evaluated with a 5-point Likert scale with higher
scores representing greater memory complaints. The CAPM
part A is a 32-item questionnaire designed to evaluate everyday
prospective memory lapses in individuals with acquired brain
injury. Each item is rated on a 5-point Likert scale, with higher
scores representing more frequent memory failures. Both par-
ticipants and a significant other completed the CAPM. On both
subjective memory questionnaires, raw scores were summed
to derive a total score reflecting the frequency of everyday and
prospective memory failures. Lastly, total number of internal
and external strategy use was examined using a questionnaire
of strategies implemented in daily life (29).
Procedures
Following informed consent, enrolled participants completed
baseline assessment and were randomized into 1 of 3 treatment
arms; MSG, CCT or WC. Waitlist participants were offered a
memory intervention of their choice following project comple-
tion. Randomization was performed with an online random
sequence generator (http://www.randomization.com) in advance
of the study and transcribed into randomly permuted fixed
block sizes of 6 by an independent researcher. Participants were
assessed immediately following intervention and at a 6-week
follow-up by a researcher independent of intervention delivery
and blinded to treatment arm allocation. Assessment occurred
at participants’ homes.
Interventions
345
Making the Most of your Memory: An Everyday Memory Skills
Program (29). An adapted version of this manualized memory
group was selected as the compensatory intervention. The group
programme involved 6 2-h sessions (including breaks) held
weekly at a university psychology training clinic (see Table SI 1
for session outline). Sessions were facilitated by an experienced
20–25% of all new names
4–5 conversations per day
3 birthdays per month
to take medication 5–6 times per week
to attend 3 appointments per week
5–6 items per shopping outing
neuropsychologist (DW) with the assistance of 2 provisional
psychologists. Groups included a minimum of 3 and maximum
of 8 participants and all sessions were video-recorded. Group
facilitators were blinded to participants’ individual GAS results
and the manualized intervention was not modified to specifically
address these goals. Treatment fidelity was assessed using a
checklist of key objectives for each session, with all treatment
objectives achieved across groups.
Lumosity TM was selected as the computerized cognitive
training intervention due to its popularity (30) and adaptability
for research. Lumosity TM is a commercially available CCT
programme accessible online (www.lumosity.com). Game
complexity increases and decreases systematically based on the
individual’s performance (i.e. is adaptive). Training materials for
the current research were prepared and funded by Lumos Labs
in collaboration with researchers. Only those games targeting
memory functioning were selected (see Table SII 1 for game
description). The order in which games were presented was
varied across training days to maximize engagement. Participant
compliance was monitored remotely through weekly examina-
tion of total days trained. To maximize compliance, researchers
were in weekly phone contact with participants. Dose was set
at 30 min a day, 5 days a week for 6 weeks (31).
Data analysis
In line with Consolidated Standards of Reporting Trials
(CONSORT), analyses were conducted using an intention-to-treat
approach. Data analyses were conducted using Stata Statistical
Software v14.2 (StataCorp., Texas, USA). Demographic, prog-
nostic, and baseline memory performance across all outcome
measures were compared across groups using 1-way analyses of
variance (ANOVAs), and χ 2 analyses. Random-effects regression
was used to compare the trajectory of change in outcome measure
performance over time between groups. Models were fitted with
assessment time-point and group allocation as fixed effects, while
participants were modelled as a random effect. A 2-sided alpha
value of less than 0.05 was considered statistically significant.
Pairwise comparisons and ANOVAs with Bonferroni correction
were computed to explore between-group differences at each
time-point. Treatment effect size, defined as the magnitude of
change from baseline within groups, was estimated with Cohen’s
d, based on output from regression models (32).
RESULTS
A total of 136 individuals responded to the advertise-
ment (30% recruited via AuSCR, see Fig. 1). Seventy-
one individuals were excluded from participation (52%
exclusion). The remaining 65 individuals consented to
http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-2540
1
J Rehabil Med 51, 2019