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Factors to Consider in Choosing Appropriate External
Memory Aids and Strategies
for People with Acquired Brain Injuries
An external memory aid is anything that is outside of the individual that serves to aid memory. They are designed to store information externally to cue individuals to take action. Examples include reminders from others, lists, address books, alarms and timers, stringers around the finger, calendars, appointment books, memory books, computers, signs, etc.
External memory aids are widely used by clients with acquired brain injury (ABI) to tackle memory problems. They are tangible and more familiar to the community, and their usage is widely accepted even by people without a cognitive problem. According to literature, external memory aids are viewed as more dependable
and more accurate, and are preferred over internal memory aids. They also
have a wider scope of application in everyday life. Successful use of external
memory aids as a compensatory strategy contributes to independence in daily activities for people who do not have the mental ability to use internal memory strategies. Individuals with ABI vary in their severity of their injuries and residual disabilities, socio-cultural backgrounds, physical and social environments and experience and knowledge of memory aids/strategies. In addition, memory aids differ in terms of their operational characteristics. It is therefore crucial to
consider the needs of the users and to match them with memory aids/strategies
Personal factors to be considered in selecting appropriate memory aids
It is important to consider the age, education level and previous knowledge and skills of the individuals. For example, some memory aids may involve the use of written language and operation of electronic devices that require a certain level of cognitive skills. Physical disabilities such as sensory or motor loss also limit the choice of memory aids. In addition, the severity and pattern of memory loss, in particular the extents to which past knowledge and skills have been lost, are important. Moreover, the extent to which new skill learning and implicit memory are preserved needs to be considered.
Intactness of cognitive skills other than memory is crucial. The success of prospective memory (memory of planned tasks) is closely linked to the elements of initiation, planning, and ordering, plus inhibition of
inappropriate actions, all of which are necessary to activate the intention to perform the remembered task only upon appearance of the target context.
iii) Behavioural / motivational characteristics
Behavioural or motivational problems that a patient has also affect the choice of memory aids. The personality characteristics of patients affect their willingness to engage and develop in therapeutic programmes aiming at improving their memory performance. Their use of various methods of memory compensation is also affected.
iv) Social support / influences
Regarding the social aspect, supportive and
possible negative influences that the patient’s
family/carer may bring to bear on the therapeutic
programme are crucial to the success of the
memory aids/strategies. In addition, the
patient’s current daily routine and the demands
which this places on his or her memory also
The premorbid habit of using a memory aid and the ease of habituating to the use of a new aid/strategy were dominant factors determining the success of an aid/strategy. The habits of using external memory aids in the past and what types have been used are crucial. External memory aids may be used successfully provided they are consistent with the methods used by the individuals prior to the injury.
ii) Myths on using memory aids
Some patients may be ashamed of using memory aids with other people around. They should be reassured that such aids are increasingly being used by the normal population. The worry that using external memory aids would make them become lazy or cause their brain waste away through lack of use should be clarified by appropriate health professionals. However, it should be pointed out that there is no evidence that using such aids would prevent or slow down recovery of memory.
iii) Involvement of clients
Clients should be involved in choosing what memory aids are best for them, as external memory aids or cueing devices, such as timers, diaries, alarms and electronic memory aids, require active participation from the injured person in their application.
Memory cues provided by memory aids must be active, timely and specific. For example, a calendar is a passive cue because the user has to take initiative to consult it, while an electronic reminder can be set to an alarm to remind the user about important events. External cues have to be timely. They must be available immediately to prevent forgetting. Secondly, the cues must come to one’s attention at the critical time when remembering is needed. An external aid has to be specific. For example, a specific note is more useful than a general note.
The storage capacity and cost of purchase and maintenance of memory aids
are important factors to consider in choosing appropriate memory aids. In addition, the physical and environmental constraints that may affect the
application/operation and accessibility of memory aids by the users should also be considered.
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