Concussion Care Centre of Virginia

Medical Psychology Service

Compensatory Memory Logbook Protocol

©1994: M.F. Martelli, Ph.D - Memory Logbook Protocol:

I. Facilitating Acceptance and Use of A Memory/Organization Logbook

• The Book Must Be Personalized - i.e. Presented and Adopted as Personally Meaningful

1. The book can be named, identified and labeled in a personally salient manner that promotes both individuality and acceptance. Some examples might include:
2. "Roster" or "PlayBook" for a sports enthusiast
3. "Plan of the Day" for an ex-Navy man
4. "DateBook" for young man or women interested in dating
5. "Fifth Lobe" for someone with a biology background
6. "Executive Schedule" for someone who is embarrassed by deficits
7. Use of The Book Must Allow Demonstration of Utility - i.e., Allow Successful Accomplishments in Personally Important Areas Where Failure Was the Previous Rule
8. The Book must facilitate desirable outcomes & successful accomplishment in ways that are both demonstrably apparent & personally important to the individual. For example, it might:
9. Assist with remembering & attending desired events or participating in desirable activities that are otherwise missed (e.g., important appointments, social activities in the community, dates or scheduled get-togethers, etc.)
10. Assist with remembering personally important names, phone numbers, details, etc. (e.g., names, phone numbers, details about: interesting new persons met during community activities; friends, potential dates; family members)
11. Facilitate demonstration of increased competence with relevant peers & others
12. The Proposal to Use a Logbook must be done from a standpoint of strengths and bolstering abilities (e.g., "You have so many strengths and abilities and using special strategies would better enable you to..."(reach desirable goals)

II. Essential Components of a Successful Memory/Organization System

• Fail-safe checklist system that replicates a task analysis system (i.e., it breaks down complex tasks into simple checklists which are easy to follow!)
• Balanced Positive / Negative Reinforcement components (i.e., experience reward for using it versus anxiety for not using it, generalizing to anticipatory or facilitative anxiety that increases likelihood of use)
• Rationale and encouragement that could relate using the logbook to wearing eyeglasses or dressing and not using the logbook to leaving home without glasses or leaving home naked
• Education and understanding of rationale and components by all staff and family members to afford consistent, repetitious and structured interactions
• If Divided Sections are employed, Divider Tabs are Clear, Easy to Find, and Very Logical to the Patient/Client.

Also, it will ideally:

• Reinforce consistent use of an efficient compensatory organizational memory strategy (e.g., Who, what, when, where, how, why?") that usually involves:

1. Repetitious (e.g., hourly) report (i.e., "Who, what, when, where, how & why?") and recording via log book entry (i.e., summary) of ongoing events in a manner that promotes anticipation of log entries and facilitates the kind of internal organization and dialogue that builds incidental and automatic memory
2. Flexibility, such that when written entries are not possible or practical, oral recordings are made into Prospective Memory Exercises (e.g., "Please write this entry in you log book when there is a break.... what can you do to try to remember this event and try to remember to enter it later?... rehearse ...repeat/"three-peat" etc.), with provision of cues (using as few cues as needed, building to as many as needed) during the break to make the entry (e.g., "Was there anything that you were going to remember...was it to make a log entry...was it anything about ___", etc.)
3. Graduated progression from external cues for logbook use, to increasingly internal cues
4. Graduated progression from external organizational systems to increasingly internal organizational strategies)

• Reinforce Consistent Use & Reliance on Schedule and "ToDo" list, Beginning by checking Schedule & "ToDo's" consistently (e.g. every Hour), using a chime watch as a self-cue

1. Provide Cues to set chime using escalating cues (e.g., "Is there anything that you do with your watch...don't you set it to chime...etc.). Using progressive approximations, Provide praise for initial recognition for any recognition that the chime has significance, with more and stronger reward for greater recognition and initiation.
2. Provide Cues to check logbook and "ToDo's" when the alarm goes off, again using the minimal cueing necessary, but adding as many cues as are needed (e.g., "Did your alarm just go off...what do you do...what do you check besides schedule?...etc.)
3. Provide activities to be scheduled and "ToDo's" to be completed to facilitate increasingly reliable and efficient use of this system

• Facilitate and Reinforce recall of events throughout the day. For example:

1. Randomly, throughout day and evening, Ask for Attempts at Independent Recall of One Event From the Current Day. If he cannot, begin providing the minimal escalating cues necessary (e.g., "okay, where can you look to find it?"...if needed...can you look in your date book?"... "where in it?...etc.)
2. Randomly, throughout the day and evening, provide Cues for Recalling an Event (activity or detail) which cannot Initially be Recalled, via provision of minimal escalating cues (e.g., "okay, what did you do today with Linda (Who cue!)?...if needed, "it happened outside the clinic?" (Where cue!)?..."just before lunch?" (When cue)..."it involved some form of exercise"...etc.

• Reinforce end of the Day "ToDo" Completion and Checking off the Boxes at the Bottom of the Logbook Page:

1. Check regular appointment schedule and make/review schedule for tomorrow
2. Transfer any unchecked (non-competed) "ToDo" items to the next day (or another day), and then check the box (in the log book at the end of page 1)

• Facilitate Recall For Names of Staff, Patients, New Acquaintances, and Others:

1. Demonstrate Consistent Use of Compensatory Strategies from the TRS Memory for Names Protocol (i.e., Repetition, Self-cueing, Association, Notebook) to Improve Recall for Names (Recall for names will be monitored & graphed - e.g., # of cues required for recall, total # of names recalled)

SAMPLE Memory Rehabilitation Program for Dale X

8/19/94

TARGET: Every Hour, Dale will record a log entry in his logbook (back page), per:

• "Who, what, when, where, how, why", which are reported orally This facilitates organization and initiation, as well as automatic memory...when he begins to reliably anticipate log entries, he will begin the kind of internal self-dialogue that rebuilds incidental and automatic memory
• "Write a summary...the main points"

TARGET: Throughout the day, Dale will demonstrate Improved cued Recall for Daily Events

• Randomly, throughout day and evening, Ask Dale to Attempt Independent Recall of One Event From the Current Day. If he cannot, begin providing the minimal escalating cues necessary (e.g., "okay Dale, where can you look to find it?"...if needed...can you look in your date book?"... "where in it?...etc.)
• Randomly, throughout the day and evening, Cue Dale to Recall an Event (activity or detail) which He Initially Cannot Recall, via provision of minimal escalating cues (e.g., "okay Dale, what did you do today with Linda (Who cue!)?...if needed, "it happened outside the clinic?" (Where cue!)?..."just before lunch?" (When cue)..."it involved some form of exercise"...etc.

TARGET: Dale will Consistently Use & Rely on his Schedule and "ToDo" list, Beginning by checking his Schedule & "ToDo's" every Hour using his chime watch as a self-cue

• Cue Dale to set his chime using escalating cues (e.g., "Dale...is there anything that you do with your watch...don't you set it to chime...etc.). Praise Dale when he make any recognition that his chime has significance, with more and stronger reward for greater recognition and initiation.
• Cue Dale to check his logbook and "ToDo's" when his alarm goes off, again using the minimal cueing necessary, but adding as many cues as are needed (e.g., Dale, did your alarm just go off...what do you do...what do you check besides schedule?...etc.)
• Provide Dale with "ToDo's" to be completed to facilitate his increasingly reliable & efficient use of this system

TARGET: At the end of the Day, Before Retiring, Dale will Complete and Check off the Boxes at the Bottom of the Logbook Page:

• Check regular appointment schedule and make/review schedule for tomorrow
• Transfer any unchecked (non-competed) "ToDo" items to the next day (or another day), and then check the box (in the log book at the end of page 1)

TARGET: Dale will improve Recall of Names of Staff, New Acquaintances, Others:

• Dale will demonstrate Consistent Use of Compensatory Strategies from the TRS Memory for Names Protocol (i.e., Repetition, Self-cuing, Association, Notebook) to Improve Recall for Names (Recall for names will be monitored & graphed - e.g., # of cues required for recall, total # of names recalled)

TARGET: Dale will improve Patience, Frustration Tolerance & Self-Pacing:

• Dale will employ self-pacing exercises 4x/day- scheduled in book & reviewed by staff

RATIONALE & PROCESS: Frequently Remind Dale that his mechanical skills are above the 99th %tile (i.e., better than 99 of 100 people), that he is very pleasant socially, & that by adopting an effective organization, memory & goal direction system, he will be DEVASTATINGLY Effective in LOVE, WORK & PLAY!! Remind him of how these efforts support His goals of resuming normal activities & returning to dating. Provide Lots of praise for participation & cooperation & express plenty of personal appreciation.

DATE BOOK:

Daily Recorder: _______________________ Day: Date:

SAMPLE INTERVENTION FOR PATIENT XXX

(Initial/Rough Draft: 11/16/93)

1. ASK XXX TO PROBLEM SOLVE HOW TO ANSWER QUESTIONS HE/SHE ASKS. Ask/cue him/her about how he could find the answer, giving the minimal amount of cuing necessary to derive the answer (e.g. "How could you find out?", "Where could you look?". If these don't work, "Have you looked in your log book?", "Do you have a regular appointment list?", etc.

2. WHEN XXX ASKS QUESTIONS, ASK HIM/HER TO REPEAT THE ANSWER-

ASK HIM/HER TO MAKE ASSOCIATIONS TO FAMILIAR, OLD INFORMATION AND TO REPEAT THE ANSWER FIVE TIMES - This will help

3. AT LEAST TWO TIMES A DAY, ASK XXX:

• The day__, date__, time__,
• What appointment's he has today__,
• Information about family___, current activities___, recent sports events___.
• Ask if he has: worked on _____ (...scheduled activities, etc.)

4. ONCE A DAY ASK XXX IF HE/SHE HAS READ ANYTHING...

ASK HIM/HER TO TRY TO RECALL:

• The type of headline story in newspaper or T.V. news
• Any interesting details about the headline story
• Any other interesting information from newspaper
• If he/she has used a "Who, What. When, Where, How, and Why?" strategy to help him/her remember things.

5. CUE XXX TO TRY TO INCREASE ENCODING/STORAGE OF NEW INFORMATION BY:

• REPEATING/ REHEARSING AND MAKING ASSOCIATIONS
• USING A "WHO, WHAT, WHEN, WHERE, HOW, AND WHY?" STRATEGY

6. ONCE A DAY ASK XXX IF HE/SHE HAS READ DONE ANYTHING FROM THE ACTIVITY LIST IN HIS LOGBOOK. ASK HIM TO DO SOMETHING IF HE/SHE HAS NOT ALREADY!

7. CHECK WITH HIM/HER TO ENSURE HE IS ACCURATELY CHECKING OFF ACTIVITIES IN LOGBOOK (e.g. meds, walking, etc.) AND WRITING NEW INFORMATION, ETC.

Note: This protocol is based on a program designed for XXX (a 59yo amnestic patient secondary to anoxia [CARX5] who lived at home with a very supportive family for whom this intervention was devised.)

SAMPLE:

NECESSARY RECOMMENDATIONS:

MARK D'S PROSTHETIC MEMORY PROGRAM

(11/19/93)

• 1. Add #23 (Michael Jordan's #) with Basketball Insignia to Log Book Cover and Entitle this LogBook "GAME PLAN - ROSTER (Log Book)"
• 2. Need Clearly Meaningful and Labeled (typed, large) sections in PLAY BOOK: Sports Information section; Family Information; Therapy Information, etc.
• 3. FIRST GOAL: TAKE MEDS INDEPENDENTLY. Will need a Task Check List, consisting of component steps required for medication taking, including filling a pillbox for the week, scheduled on Wednesdays,
• 4. Will NEED CHIME/ALARM WATCH (OR weekly chime Set On His Watch, if it has one) with setting for hourly chime/perpetual cuing to check logbook each chime (i.e. on the hour) for scheduled activity/Meds/Etc. Perpetual Cueing to check log book...decide what time it is, where he is supposed to be, etc. Schedule news. Schedule reading newspaper with SQR3 memory strategy and taking notes.
• 5. PLAY BOOK - ROSTER has LISTED ASSIGNMENT (checklist, to be CHECKED OFF WHEN COMPLETED), AT END OF DAY of: A) Making tomorrow's schedule and writing in appointments for that day in the appropriate time blocks. This is based on regular weekly appointment schedule (Weekly schedule in notebook) i. - This must be in the very front of ROSTER, in order to be easy to find) ii. - This must be accurate (e.g. YMCA was not in there!!) B) Writing (Carrying over) to next day any non-completed (i.e. nonchecked) items listed under Things to Do; C) Folding page over (right hand corner) when A and B are done at end of day (To mark this day as over - will indicate first non-folded page as current day on following day!)
• 6. HANG UP THE "EQUALIZER POSTER" in several visible places
• 7. SEE ADDITIONAL RECOMMENDATIONS SHEET and follow
• 8. CUE MARK TO CHECK OFF "TO DO" items as completed!!!