A Place to Share

MEMORY SKILLS

-Which have proven to be very useful to me.

Let me just start out by writing a little about the event that qualifies me to write about this topic, at all. My life-altering event occurred the day after Christmas of 1996, real nice present isn’t it. I was involved in an automobile accidentwhile wearing my seat beltwhile the driver was almost completely unharmed, as was my sister. I was almost totally fine visually, in that I sustained no broken bones, only minor lacerations that were “fixed” by a couple of stitches. That was not the main concern however, the big deal was my brain, which upon the mini van I was traveling inat a speed of about 30 mph (in a 50 mph zone)slid on ice and hit a pole. My head impacting the van window damaged my brain, since it only was equipped with lap belts. This occurrence left me unconscious and most likely immediately comatose. Therefore, I sustained a left-hemisphere contusion, which affects the right side (my dominant one), and has left that side virtually uncontrollable.

A little background information that I am including because it will illustrate where all my motivation comes from. Thankfully, I was 99% finished with college, majoring in Biology and minoring in Chemistry. Thusly, I have read numerous books concerning brain injury, but they are all extremely scientific and quite high-tech, therefore, I wrote this booklet to help anyone who has experienced the same, or similar situation, with a desire to learn of the explanation behind their circumstances.

After the accident, I was acting rather inappropriate for roughly one year, and not quite my age of 21½, for roughly another year. I attribute the majority of my recovery to: my therapists, doctors, parents, friends, and the help that I’ve received from the three Marianjoy facilities. Subsequent to the accident, which occurred in Lafayette, Indiana, I went to CCRC (Community Convalescent Rehabilitation Center) in Naperville, Illinois. Of this place I have no actual memories, as I was still in a comatose state. About a month later, l went to Marianjoy in Wheaton, Illinois; in this facility I came awake, both literally and figuratively. At first, I was still rather docile and really quite unmotivated. Then, after about four months of in-patient therapy, I went to the outpatient facility, run by Marianjoy; in St. Charles, Illinois, the Community Reentry Program, a big reason behind my writing this booklet.

I am well aware that many people were either hurt before this place was readily available or were not fortunate enough to have this offered to them. However, my speech therapists, at the Marianjoy in St. Charles, probably contributed the most to my rehabilitation, even though I definitely was not aware of it at the time. I was, not passive, well probably a bit passive but that doesn’t exactly explain it, I was rather indifferent: I believed that I never had a problem with memory. So, in memory group, I did not even really try, but I am very grateful that they ran this group, although, I was certainly not the most attentive patient.

Let me add that through the assistance: of my parents; therapists; doctors; and good friends, I feel that I have come completely full circle from where I started, and perhaps a bit further. Even from before this accident, sure there are certainly some activities that have been taken from me, but there have been activities given to me, as well. While I was well on my way to securing a very lucrative career, a physician assistant, it would probably not have been as rewarding or as fulfilling as helping others, in this manner. Although, I certainly do not contend that I am innately smarter, I do believe that I am more knowledgeable, concerning the ramifications of brain trauma, from my experience and from the help I have received from the three Marianjoy facilities.

MEMORY SKILLS

Brain damage will occur when there has been demyelation and subsequent death of a nerve cell within the brain, or a neuron; which may be focused on an specific area of impact, diffuse or both, as is the case in almost all Traumatic Brain Injuries (TBI). This occurs in a myriad of cases from as many causes, including but not limited to automobile accidents and near drowning. Unlike other nervesnerves of the limbs or trunkthose of the brain or spinal cord do not replicate, nor can they. There is evidence, however, that nerves that have always been there, but doing something that is not necessarily productive can take over and subsequently be reprogrammed to perform a completely different, but useful task. It is not known exactly how this task is carried out, despite all of the research in this area. But, it is known, that the amount of recovery a person makes, along with the severity of the injury, is otherwise dependent upon the determination or motivation of the patient.

Memory skills are strictly aids, which take much effort and thought. These skills can either be: external or internal, general or specific, or both general and specific. External and both general and specific, as in viewing a visual cue, which will remind you to do one thing, but not necessarily immediately. Another instance is picking up your dry cleaning or even the gas indicator, which will alert you when the car will eventually require gas.

These examples are partly general, rather than totally specific, since these cues are intended only to be reminders that something needs to be followed through with, eventually. This gas example, is however, partly specific because a specific thing needs to be done, but not necessarily at this moment. The indicator light will “alert” you to take notice that your car needs something specific soon, or it will stop working altogether. An example of a cue, which is not visual, but still an external and specific one, is that of either a timer or an alarm clock. They specifically alert and remind you to do one specific thing, now. Written reminders and timers are used a lot and can be a list or a buzzer, but are only useful if this note or device is remembered when it is needed. An alarm clock could alert you to ‘get up’ and a timer could be used to ‘beep’ when it is time to turn off the oven. A cue, which is completely general, could be that of someone or something reminding you to get a present for a friend who will shortly be celebrating a birthday.

Internal cues are inborn facts which are well known and which are used bring to mind a completely different, but usually useful fact. You all know the alphabet, so it is very useful to utilize that ‘fact’ in order to remember other complicated items. Because of this, I easily recalled an enormously useless fact, but not at the time: The base pairs of DNA (GCAT), without refreshing my memory, and I certainly have not come across that fact in years. You just take the first letter of each word in order to use that to make it into a synonym, or a more familiar term. This is helpful because it is a known fact that it is quite a bit simpler to recall known letters, to eventually come up with the actual information. Another example of an internal memory skill is imagery, in which you use either a mental picture or a sound, in order to recall something more ornate. This is a simple example, one in which a memory skill isn’t really at that necessary; but you all know that salt (NaCl) will dissolve in water, however, I needed to recall that simple fact in order to know that different elements, combined with Chlorine, will perform in relatively the same manner.

Memory can be divided into three main subdivisions or requirements: registration, retention, and recall. Primarily, in order to have a “good” memory-increase your memory abilities-you must always concentrate and look around at your physical location. I know this sounds rather silly but it will help when you try to ‘retrace’ your steps: Attention and concentration can be more important than motivation, because if you do not follow closely, to what is happening around you and your whereabouts, meaning it is not or does not seem to be that important for you to ever recall it, then you will certainly not register nor retain this information correctly. These skills, which come partly from concentration, involve perception and understanding, crucial requirements for remembering any new information. Soon these newly practiced skills will become second nature to you and you will improve your other abilities, like general overall concentration.

Shortly after a memory is heard, it becomes available for short-term memory, which is very limited. If information encoded in short-term memory is neither actively repeated, nor otherwise refreshed, it will certainly be replaced by new information: that means, it has not been designated to be saved in the master memory file cabinet, per se. Retention is affected by the context of information you have stored already. For instance, one technique everyone uses is learning how to get somewhere, by using physical directions: If you have successfully done it at least once before, then the subsequent instances will be much simpler, and you can probably even accomplish it without any written directions. When short-term memory is transformed in to long-term memory, by the memory skills that have been written about here, in the subconscious mind, then, at will, the information will be available for recall in the conscious mind. The accuracy of recall is almost completely dependent upon the accuracy of the registration, of the new information. Perhaps you realize the importance of association, as new information directly relies upon “linking” it, with some type of previous knowledge.

I have become very accustomed to various internal skills; nothing ever occurs in which I am not naturally thinking of which skill fits best. There are certainly skills, I have learned to use, all of the time, which would have been very useful when I was in college studying Biology and Chemistry: There were complicated words that I was required to be explicitly knowledgeable in for an exam; after the exam, these terms went out much sooner than they went in. I obviously was not very successful at retaining that information. I virtually always now utilize associationconnecting new information with old information.

1. Association- One that most all memory is based upon. It is helpful because it draws upon knowledge that is already designated to long-term memory, in order to make the new information more meaningful, understandable, and accessible. There are three ways to associate, you can; link thoughts that are similar, thoughts that are opposite, or thoughts that are closely connected in time or place. Perhaps this one will help, as it has proven to be very useful to me. When I was an inpatient at Marianjoy in Wheaton, I had a great nurse, Darcy, and in order to remember her name I drew upon the innate knowledge that I had already designated to long-term memory, my mother’s best friend’s name, Marcy, hence, just by switching a letter, I realized that I already knew it!
a. Cross-referencing- Information can be “joined” together that has something in common, thus saving space; if something is similar to that which is already known, at least you have less to remember, and recalling that information is much simpler. For instance, one way that I have utilized this skill is by recalling the common fact that hot air rises; in turn, I have utilized that information to figure out why it is so hot upstairs, and cold downstairs. This is quite a simple idea, but effective nonetheless.
b. Context- Information is easier to recall, if there is something to connect to, which is common to that which is already known. For example, time that an event took place, can be applied to every bit of information needed to be called upon, again. It is considerably simpler to recall something if you know when it occurred. For instance, I was unable to find my credit card, but I knew that I had not left it in a store, so I had figured out the pants I was wearing last: I then found the card exactly where I had figured it was, in the pocket of the pants from the previous day.
c. Envision- Information can be most effectively called upon if more senses that have been incorporated. Perhaps this can be thought of as partially utilizing sight. However, it is quite different because you do not actually “see” something that reminds you of what is neededbut the thought process occurs entirely within yourselfwithout the physical involvement of sight. For example, when it is time to go to a doctor, one can be reminded (internally) that it is about time to see an altogether different doctor. Or, for me, I need to have blood drawn before I see one of my doctors, so I “envision” the laboratory when I see that first doctor, so as to remind myself, that time has been allocated, to see the other doctor. All of this occurs entirely within my head and there is no ‘help’ from notes; I need only to look at my calendar to recall when that appointment was made.

2. Environment- When possible, try to put yourself in the same environment or surroundings you were in when you first ‘learned’ the information (i.e. a telephone number, address, name, etc.), in order to have the same surroundings, to “reacquaint” or refresh yourself to the ‘missing’ information. An example, one in which you surely utilize, is grocery shopping. Items or an item that you see prompt you to decide whether it’s needed, at all. It also gives you ideas of whether you want to have it for a meal or for a snack.

3. Conditioning- A strategy which can be utilized in order to accomplish many tasks with considerably more ease. One example is simple, but it helps me to indicate that you use it every day. You are used to hearing loud sounds; as an automobile or a vacuum cleaner, so that when you hear these sounds, you can expect them to occur for a while and not to be frightened, not that these sounds would necessarily frighten you, but you get the point. This also applies to tasks like errands: Things that need to be done every day, or so, and soon you will become accustomed to performing them more efficiently. Another instance, I used to study after class, every day, and I soon became accustomed to using that time only for studying.

4. Utilizing other senses- It is well known, by professionals, that the more senses utilized, the more readily you will recall it. If I hear a phone number from someone or something (on the Television or radio), I visualize it on the telephone keypad; so I can incorporate sight, not only hearing. By writing that information down on paper, you have also utilized another sense, and you have it down on “hard copy”, which gives your brain a much-deserved break. This allows you to forget details about the new information, because you have something to refer back to, at a better time. I use notes quite frequently by always keeping a pad of paper, and a pen, by each phone, because often times a phone number or directions are given over the phone. And information recited in this manner, is given much too quickly, for it ever to be expected to be learned. Even if it is given slowly, or even repeated, you can easily be distracted, and by having it written down, there is a way for you to “re-learn” it at a more convenient time. Additionally, you can say it aloud, to involve speech, by repetition, in your resources for recalling the new information.

5. Grouping/chunking- Information can be grouped or chunked together that have at least one quality in common. I like to “put” items together that have at least one commonality, that explains why phone numbers are seven digits long. It is a known fact, by professionals, that you can designate seven singular facts to short term memory. Thus, you can remember a group of three digits (or seven singular items), quite a bit more easily than ten, with the area code, that is way too many items! That is an example of grouping numbers, however, this strategy can also be applied to words: You can categorize details (text), to further reduce the quantity of items you must remember. One way that I utilize this is by first knowing how many items I must accomplish, that day, in one stop, when I wake up in the morning. For example, if I know that I need to: accomplish grocery shopping; visit the bank; and stop by the hardware store, I group tasks together that I need to accomplish at each stop. Then, I utilize a different strategy in deciding what place I am going to visit next, or which building is “on the way”. Once I’ve decided which building to visit, and in what order, I then can plan which tasks to accomplish next. I have just illustrated how you can group items within groups, or sub-categorize. Items like food versus banking can be grouped together to accomplish that task all at once. This helps me to be more efficient with my time, and to be sure to accomplish all of the tasks that I need to do that day.

6. Lists- They are only are useful if the list is recalled when it is appropriate. One example of how I, along with many, utilize this ‘cheating’ skill is with coupons. By using coupons, at the grocery store, you not only save money, but are more efficient, as there is a “hard copy” of what you are intending to purchase. This way you can be sure to buy everything that you need, and nothing extra. Also, you can write the items down to give your brain a break, by having details down on paper. One rationalization for using lists is, with time everyone is somewhat expected to forget details of everything. Probably no one can remember phone numbers (more than two), for longer than a few days, unless they are extremely efficient, at skills such as association. By utilizing lists regularly, am considerably more efficient.

Disorders or inaccuracies in memory can be derived from disturbances in any of these three stages: registration, retention, and recall. Usually, the problem seems to be in recall, but that is actually secondary to retention. Part of the explanation of why this is so is that primarily in recalling any information is the feasibility or simplicity, of retention. If that information is not encoded in a “simple” or clear manner, it will not be readily available for recall, when it is necessary.

People with brain injuries often have difficulty in retention because there is simply too much going on in their brain and in their surroundings; hence, their need for quiet places, when available. This explains why there is a direct correlation with a deficit in recall. You are positively not aware of a problem involving retention, until something is forgotten. Retention; therefore is primary to recall and if there is a deficiency in retention, there will be an inability or error in recalling that information, because it has been stored either; incompletely, partially, or it’s inaccessible. When it is not possible to have a quiet environment, try to mentally clear out your brain in order to kind of ‘make room’, this is an odd way to just say concentrate more “especially” on the item to be recalled.

When you are concentrating on one specific item, you can easily be distracted and lose your train of thought. To avoid this, you can be disciplined enough to ignore it, however, often you cannot simply do this; if a pencil and paper are available, jot down a few major phrases, so as to remind yourself at a more convenient time. Organization leads to a good memory and especially this skill.

Many researchers and neurologists believe that memory is not registered in one specific area of the brain, but rather, encoded throughout the entire brain, and incorporated by the hypothalamusa division of the brain. Neither is it known why some people have good or bad memories, when intelligence in other areas are completely differing. To some extent, memory is thought to be genetic, and there is little actual control over it: However, there is possibility to improve the innate ability you have been given. Your memory is more governed by your ability to incorporate all of these memory aids, which will eventually become inherent in your subconscious self. A good memory is thought to be an indicator of high IQ, although, some people have extraordinarily exceptional memories even though they have other, unrelated difficulties.

One of the possibly, temporary problems inherent in people with brain trauma is aphasia-loss of language abilities. I have read that this problem can be improved upon if it is worked on by these skills. This is known to affect mostly people with left-hemisphere losses; however, this is not the case in me at all. I am obviously not sure, but I believe that I perhaps had a bit of aphasia, but by using all of these techniques, it is now obsolete; if that is possible, and I now believe I have the opposite of aphasia.

You should not think of memory as a ‘tool’ to use just for school and tests, as I used to, but incorporate it every day, and soon it will become second nature for you.

Elizabeth Hornbeck, a patient of CCRC in Naperville, Marianjoy in Wheaton and St. Charles, wrote this document after a stay, from 1/97 to 10/97.