Patient Resources : Common Questions

The Memory Book: A Useful Tool

Most survivors have memory problems and many cannot remember to do things planned later in the day. Survivors with memory problems often benefit from learning to use a Memory Book. This useful tool is built on the principle that practice produces new habits over time.

Imagine a female survivor who has recently returned after an aneurysm and several months of living in a rehabilitation facility. She has recovered enough to stay at home during the day while her husband goes to work, but gets little accomplished while he is gone. She has trouble getting organized and gets distracted if she tries to do too many things at once. It is not unusual for her husband to return home from work and find the laundry still wet and in the machine because she did not remember to move the clothes to the dryer. She has trouble taking her noon dose of medications and on a few occasions has taken it twice.

If her husband is uninformed about why this is happening, he might become frustrated and angry because his wife “just doesn’t try,” or “just wants me to do it all.” After returning home to chaos, he might speak harshly to her, suggesting that she is not working at recovery or that she is “lazy.” Hearing these words, she might conclude that he is correct and that she is worthless. As neither understands why she is having these problems, no solution to the problem emerges, and frustrations and distress build.

Contrast the uninformed husband to one who knows that his wife’s disorganization and poor memory are the result of the aneurysm and who has some ideas about how to teach her systematically to use a Memory Book to carry out various tasks while he is gone during the day. The informed husband first shifts his explanation from an emotional one (“she just isn’t trying”) to a behavioral one (“she can’t remember to do what she has planned”). He shifts his ideas about why she is making these mistakes from a blaming attitude (“she’s doing this on purpose”) to an informed attitude (“she has memory problems because of damage to her brain from the aneurysm”). Armed with information, the husband is better able to design a treatment plan that will help his wife learn how to spend her time at home in a more productive, safer, more satisfying way. He is less frustrated, less harsh, and more forgiving of her errors. The survivor, encouraged instead of criticized, makes a better effort, and feels more positive in the process.

With a basic understanding of behavior principles, the husband can design a plan to systematically teach his wife to use a Memory Book. First, he needs to analyze the problem. Simply giving her a list of things to do will not be effective, as she will forget to consult the list during the day. The husband must help his wife build a new habit of looking at the Memory Book frequently throughout the day and using lists in the book to organize what she wants to accomplish while he is away at work.

The treatment plan used by the husband or caregiver to encourage the development of future memory skills with a Memory Book is built on the principle that practice produces results. Once the habit is established, the survivor is more and more capable of planning and following through on her plans without help. The plan started with active involvement from the husband, and as the wife practices the skill, it turns into a habit. This process is repeated with new tasks to learn until the recovery process to be complete.

In this case, the key skill learned by the wife is to consult her Memory Book on an hourly basis and to follow the plans she and her husband established the day before. By using cues to prompt repetitive practice, the husband helps the wife learn to use a list to get things done.

There are many systems that have been designed to assist memory–impaired persons remember to do what they have planned. Below is a simple template for learning to use a Memory Book. The need or ability of a survivor to use the suggestions below depend upon the degree of impairment as well as the degree of support that is available.

This template is offered as an example of a way to develop new habits to deal with impairments.

  1. Plan the next day and write down goals.
  2. Break the day into one to two hour segments.
  3. Write goals for each segment.
    • 10:00am “Put laundry in machine and start”
    • 11:00am “Take wash from machine and place in dryer”
    • 12:00pm “Take wash from dryer, sort and fold”
  4. Set a watch to beep at two-hour intervals. It is helpful for the caregiver to call every two hours to make sure the Memory Book is available and was consulted at the right time.
  5. At each time interval, the survivor records the activities for the previous hour and carries out the tasks designated for the next hour.
  6. At the end of the day, the caregiver and survivor review the day’s progress. Adjustments are made until the survivor can follow the schedule independently. In our example, phone calls and the beeping watch would not be needed after the habit of using the book is established.

 

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