In her book Tell Me Everything You Don't Remember, author Christine Hyung-Oak Lee recounts what it felt like to have a severe short-term memory impairment:
At one point during my hospital stay, my friends from work, from the software company Adam had started, visited me. Just two weeks prior, I had been a touchy, take-no-prisoners colleague.
There I was, in the bed. And they greeted me by saying, “You look completely normal!”
There was, I suspect, relief in their voices. That they didn’t have to look at someone whose face resembled melted wax. That I didn’t talk like someone whose mouth was full of marbles- that they didn’t have to translate.
We made small talk, like any other small talk. Thank you for the flowers how are you wow you look great work’s good how are you how are you how are you how are you?
Ant then my neuropsychiatrist stepped in, mid-visit. The room went quiet.
“Do you know who I am”
“No but it’s nice to meet you.”
“Open up your journal.”
I opened up my Moleskin.
“What time is it now? What is the time of your last entry?”
“It’s ten thirty-five. Oh wow! I met you twenty minutes ago! Oh You’re my neuropsychiatrist. That’s who you are.”
“Fuuuuuck,” said my friends, breaking their silence. “Wow.”
Later, one of those visiting friends said, “I thought you were fine until that moment. Until then we didn’t realize you couldn’t remember anything.”
And really, at that early point in recovery, neither did I.
I didn’t know what I didn’t know. What I couldn’t do.
How do we functionally address severe memory impairments, like these? (P.S. For some fresh ideas and thoughts about that word functional, check out the work of Sarah Baar at Honeycomb Speech Therapy.) Ultimately, we need to find ways that are meaningful and accessible for each individual patient. Memory can be one of the most challenging impairments to address because everyone benefits from different strategies. Spaced retrieval training may work for some, but others may never latch onto information, no matter how frequent the intervals. Impairments in vision, hearing, reading, and writing can all impact how we functionally approach memory treatment.
Using memo pads can be an effective strategy for some. It is a tangible object that can be placed in a front shirt pocket. It's a familiar strategy, as many people carry notebooks with them throughout their lives in order to jot down lists and remember ideas. It naturally promotes independence with memory strategies because it is highly accessible to the person and can be adapted to meet a variety of individual needs. Here are some ideas of what can be included in a memo pad memory book:
- Photos and names of family members
- Phone numbers
- Emergency contact information
- Mini low-tech AAC cards
- Orientation information
- Staff names
- Facility schedules
- Countdowns to discharge day
- Therapy goals
- Step-by-step instructions for ADLs or preferred activities like listening to music on a device
The options are many. Our templates are meant to get you started and provide a graphic for the notebook cover as well as mini calendars that run from August 2019 through December 2020. If you like this idea, take it and run with it. How can you best adapt it to meet the individual needs of each patient? How can you set it up in a way so that they are able to manage and add to the notebook as independently as possible?