Memory Impairment and Occupation

Jonathon O’Brien, SROT, PhD, is a lecturer in occupational therapy at the University of Liverpool, UK. Prior to this, he was employed by the National Health Service for fifteen years, working as an occupational therapy team leader in stroke and complex rehabilitation for several years. He maintains an honorary contract to work in the National Health Service and has also been a member of the editorial board of the British Journal of Occupational Therapy.

Preface xi

Acknowledgements xiii

1 Concepts of Memory 1

Defining Learning and Memory 1

Neurophysiological Mechanisms of Learning and Memory 2

Long-Term Potentiation 4

Occupation and Neural Plasticity 5

Historical Theories of Memory 6

Associationism and Occupation 6

Schema Theory 6

Information Processing Approaches 8

Levels of Memory Processing 11

The Case of Henry Molaison 13

Taxonomies of Memory 17

Tulving’s Hierarchy of Procedural, Semantic and Episodic Memory 18

The Relationship Between Episodic and Semantic Memory 20

Vulnerability of Episodic Memory 21

Episodic Memory and Human Occupation 22

Working Memory 22

The Atkinson and Shiffrin Model of Working Memory 22

The Multicomponent Model of Working Memory 24

Prospective Memory 27

Towards a Culturally Situated Understanding of Memory 34

Conclusion 35

Points for Discussion 36

Activities 36

References 37

2 Memory and Occupation Across the Lifespan 43

Memory in Infancy 44

Implicit Memory in Infancy 46

Ecological Model of Infant Memory: The Task of Crawling and the Development of Memory 46

Autobiographical Memory in Infants 48

Infantile Amnesia 48

Episodic Memory in Children 54

Source Memory and Infantile Amnesia 55

Working Memory from Ages 5 to 1256 Development of Declarative and Procedural Memory 60

Environmental Factors Affecting Declarative Memory 64

Memory in Adolescence 65

Development of the Neocortex and Hippocampus 65

Development of Prospective Memory in Adolescence 66

The Use of Memory Strategies 66

The Growth of ‘Metamemory’ 68

Declarative Metamemory 68

Procedural Metamemory 69

Memory in the Ageing Person69

The Centrality of Occupation 69

Working Memory in Alzheimer’s Type Dementia 69

Selective Impairment of Divided Attention: Implications for Occupational Performance 71

Cognitive Decline with Age in Pre-industrial and Industrial Societies 73

Changes in Prospective Memory: Implications for Occupational Performance 74

Evidence from the ‘Enriched Environments’ Paradigm 76

The Socio-economic Gradient in Dementia 77

Conclusion 83

Points for Discussion 83

Activities 84

References 84

3 Memory Impairments 89

Amnesia 90

Post-traumatic Amnesia 91

Retrograde Amnesia 92

Temporal Gradient in Retrograde Amnesia 92

Explaining Retrograde Amnesia 94

Anterograde Amnesia 97

Explaining Anterograde Amnesia 97

Key Characteristics of Amnesia 98

Alzheimer’s Type Dementia 99

Prevalence 99

Aetiology 99

Treatment 102

Memory in Alzheimer’s Type Dementia 103

Post-traumatic Stress Disorder 111

‘Dual Representation’ Approach to Memory in Post-traumatic Stress Disorder 111

Conclusion 113

Points for Discussion 114

Case Study Vignette 114

Activities 114

Activity 1 114

Activity 2 115

Activity 3 115

References115

4 Occupational Therapy Assessment, Goal Setting and Action Planning with the Person with Memory Impairment 119

Assessment of Memory Impairment and the Philosophy of Occupational Therapy 120

Conceptual Practice Models 121

Model of Human Occupation 121

Ecological Systems Model 122

Person-Environment-Occupation Model 123

Canadian Model of Occupational Performance 124

Kawa Model 124

Functional Information Processing Model 25

Allen’s Cognitive Levels 125

Functional Information Processing Model Assessment Tools 125

Language Issues and the Functional Information Processing Model 127

Frames of Reference 127

General Principles of Memory Assessment 128

Informant-Based Measures 128

Carer Burden 129

Cognitive Rehabilitation in Occupational Therapy 136

Memory Checklist: An Occupation-Focused Approach to Assessment of Memory Impairment 137

Goal Setting for the Person with Memory Impairment 138

Goal Attainment Scaling 141

ABCDE Approach 142

Conclusion 145

Activities 146

Case Study Vignette 1 146

Case Study Vignette 2 147

Case Study Vignette 3 147

References 147

5 Occupational Therapy Action Planning and Treatment Implementation for Children and Adolescents with Memory Impairment 151

Working Memory Impairments in the Classroom 152

Working Memory in Mathematics Performance 159

Attention Deficit/Hyperactivity Disorder and Working Memory Impairments 163

Oppositional Defiant Disorder and Working Memory 164

Memory and Stressful Life Events in Children and Adolescents 168

CaR-FA-X 169

Conclusion 172

Activities 172

Case Study Vignette 1 172

Case Study Vignette 2 173

References 173

6 Occupational Therapy Action Planning and Treatment Implementation for Adults with Memory Impairment Following Acquired Brain Injury 177

Traumatic Brain Injury and Acquired Brain Injury 178

Post-traumatic Amnesia in Traumatic Brain Injury 182

Task Analysis in Traumatic Brain Injury 185

Errorless Learning 188

Situated Learning in Traumatic Brain Injury 190

Adaptations in Acquired Brain Injury 191

The Nature of Memory Impairment in Traumatic Brain Injury 192

Cognitive Rehabilitation 194

Use of Assistive Technology 197

Method of Loci 198

Conclusion 200

Activities 201

Case Study Vignette 1 201

Simulation Task 1 201

Simulation Task 2 202

Case Study Vignette 2 202 References 202

7 Occupational Therapy Action Planning and Treatment Implementation for Older Adults with Memory Impairment 207

Memory Impairments and Occupational Performance 208

Occupational Therapy as a Non-pharmacological Treatment in Dementia 209

Old and New Cultures of Dementia Care 211

Home Environmental Skill-Building Program, Care of Persons with Dementia in Their Environments and Tailored Activity Program 211

Gaps Between Evidence and Practice 216

Reduced Awareness, Anosognosia, Lack of Insight and Social Cognition in Memory Impairment 217

Cognitive Rehabilitation in Dementia Treatment 219

Cognitive Rehabilitation, Cognitive Training and Cognitive Stimulation Therapy 222

Error less Learning in Dementia 224

Treatment of Behavioural and Psychological Symptoms Linked to Dementia 224

Impact of the Environment on People with Dementia 226

Conclusion 230

Activity 230

References 231

Index 235