factors influencing the uptake of memory compensations following acquired brain injury

330 Pages·2012·2.51 MB·English

FACTORS INFLUENCING THE UPTAKE OF MEMORY COMPENSATIONS
FOLLOWING ACQUIRED BRAIN INJURY

by

VICTORIA NOLA BALDWIN

A thesis submitted to the
University of Birmingham
for the degree of
DOCTOR OF PHILOSOPHY

School of Psychology
College of Life and Environmental
Sciences
University of Birmingham
April 2012
University of Birmingham Research Archive

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Abstract

The use of memory strategies can promote independence in people who have an
acquired brain injury but people often do not take readily to using such strategies.
Certain demographic variables have been associated with the use of memory strategies
these variables cannot be changed through therapeutic interventions. The aim of this
thesis is to explore variables that may be modifiable through rehabilitation e.g. health
beliefs and perceptions of aids, to see whether they help us understand factors
influencing the uptake of memory strategies.
The thesis consists of three studies. The first uses Interpretative
Phenomenological Analysis to explore how people feel about using memory strategies.
The second is a cross sectional questionnaire design exploring the predictive power of
variables identified in the first study to predict the use of strategies together with
demographic variables. The third is a single case study utilising findings from the first
two studies to help an individual use a mobile phone and Google calendar as a memory
aid. A key factor in the use of memory compensations is the need to ‘fit’ the aid to an
individual’s lifestyle. Consequently, there is greater optimism for those who may
otherwise be regarded as unlikely to use aids.

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Dedications
This thesis is dedicated to:
John, my fiancé who has supported me through the highs and lows.
My parents, Carole and Henry, who have always believed in me.
My sister, Emma, my dancing partner!
Ann and Gordon (soon to be my parents-in-law), the food packages came in
very handy!
And to those who have also journeyed with me whilst completing their PhDs.
Thank you all for your support.

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Acknowledgements
I would like to thank the following people:
Dr Theresa Powell, my internal supervisor, for giving me the opportunity to undertake
this PhD and for her unwavering support over the last three and a half years. Your help
and guidance has been very much appreciated.

Dr Louise Lorenc, my external supervisor, for also giving me the opportunity to
undertake this PhD and for her help and support . Thank
you.

To all of the staff at
centres. Thank you for all your help and
support throughout the recruitment process. I’d also like to thank all the staff at
for making my time there enjoyable.

I would like to thank Divya Chadha, who carried out the role of independent reviewer.
Thank you for your time and help.

Most importantly, I would like to thank all those people who participated in the
research, without your help this thesis could not have been completed. Thank you for
sharing your experiences with me, it was a pleasure meeting all of you.

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TABLE OF CONTENTS

CHAPTER 1 LITERATURE REVIEW
1.1 Introduction: brief overview 1
1.2 Definitions 2
1.3 Rationale for the thesis 3
1.3.1 The extent of the problem 3
1.3.2 Quality of life and memory 5
1.3.3 Cognitive Rehabilitation for memory problems 8
1.4 Studies carried out in this thesis 11
1.5 Overview of thesis 12
1.5.1 Chapter 1 12
1.5.2 Chapter 2 12
1.5.3 Chapter 3 13
1.5.4 Chapter 4 14
1.6 Literature Review Chapter 2 and Chapter 3 14
1.6.1 Chapter 2 and Chapter 3 Literature review strategy 14
1.6.2 Methodology 16
1.6.3 Search terms 16
1.6.4 Inclusion/exclusion criteria 17
1.6.5 Results 21
1.7 Literature Review Chapter 4 28
1.7.1 Chapter 4 Literature review strategy 28
1.7.2 Methodology 28
1.7.3 Search terms & Inclusion/Exclusion Criteria 29
1.7.4 Results 31
CHAPTER 2: A QUALITATIVE ANALYSIS
2.1 Introduction 38
2.1.1 Demographic and injury related variables 40
2.1.2 Health beliefs 42
2.1.3 Stigma and Attitudes towards assistive devices 46
2.1.4 Study aims 50
2.2 Method 50
2.2.1 Epistemology 50
2.2.2 Considerations when interviewing people with brain injury 52
2.2.3 Participants 53
2.2.4 Measures 57
2.2.5 Procedure 58
2.2.5.1 Data collection procedure 58
2.2.5.2 Interview schedule 60
2.2.6 Data analysis- IPA 61
2.2.7 Credibility, bias and personal reflections 63
2.2.8 Ethical approval 64
2.3 Results 65
2.3.1 Emotional barriers preventing acceptance of memory
compensations 66
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2.3.2 Reverse effects 71
2.3.3 Beliefs about memory 72
2.3.4 “It’s not in my nature” 74
2.3.5 Type of information 75
2.3.6 Back up strategies 76
2.3.7 Characteristics of memory aids 77
2.4 Discussion 79
2.4.1 Limitations 88
2.5 Implications 90
2.5.1 Implications for future research 92
2.6 Summary 92
CHAPTER 3: A QUANTITATIVE ANALYSIS
3.1 Introduction 93
3.1.1 Beliefs about memory 95
3.1.2 Awareness following ABI 96
3.1.3 Threat appraisals 98
3.1.4 Lifestyle fit 100
3.1.5 Study aims 101
3.1.5.1 Research questions 101
3.2 Method 102
3.2.1 Design 102
3.2.2 Participants 102
3.2.3 Measures 103
3.2.3.1 Memory assessment 103
3.2.3.2 Revised Everyday Memory Questionnaire (EMQ-r) 104
3.2.3.3 Memory Strategy Questionnaire 105
3.2.3.4 Beliefs about Memory Aids 105
3.2.3.5 Additional Information 111
3.2.4 Procedure 111
3.2.5 Ethical Approval 112
3.3 Results 112
3.3.1 Demographic Data 112
3.3.2 Reliability of measures and descriptive statistics 114
3.3.3 Memory strategy use 115
3.3.4 Aims 1 & 2: Which of the belief variables are the best predictors of the
uptake of memory compensations and do any of the belief variables add
to the predictive value of demographic and injury related variables 118
3.3.5 Aim 3: Do inappropriate beliefs about memory and memory
compensations mediate the relationship between personal control beliefs
and memory strategy use? 120
3.4 Discussion 120
3.4.1 Which of the belief variables are the best predictors of the uptake of
memory compensations? 122
3.4.2 Do any of the belief variables add to the predictive value of demographic
and injury related variables? 128
3.4.3 Limitations 129
3.5 Implications 130
3.6 Summary 132
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CHAPTER 4: SINGLE CASE EXPERIMENTAL DESIGN STUDY
4.1 Introduction 134
4.1.1 NeuroPage 136
4.1.2 Personal digital assistants 138
4.1.3 Voice organisers 141
4.1.4 Mobile phones 142
4.1.5 Google Calendar 145
4.1.6 Study aims 146
4.2 Method 148
4.2.1 Participant 148
4.2.1.1 ‘TK’ 148
4.2.1.2 TK’s cognitive problems 149
4.2.1.3 Neuropsychological assessment 149
4.2.2 Study Design 152
4.2.2.1 Outcome Measures 153
4.2.2.2 Procedure 154
4.2.2.3 Choosing a memory aid 155
4.3.2.4 The Memory aid: Google Calendar 157
4.2.3 Data collection 158
4.2.3.1 Baseline Phase 158
4.2.3.2 Training 158
4.2.3.3 Intervention Phase 160
4.2.4 Ethical Approval 160
4.3 Results 161
4.4 Discussion 169
4.4.1 Limitations 174
4.5 Implications for future research 175

4.6 Summary 177
CHAPTER 5: SUMMARY
5.1 General summary 178
5.1.1 Chapter overview 178
5.1.2 Methodology Overview 181
5.2 Implications for future research 182
REFERENCE LIST 187

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LIST OF TABLES
Table 1.1 Comprehensive list of search terms 17
Table 1.2 Literature search strategy 19
Table 1.3 Brain injury studies most relevant to the study for Chapters 2 & 3 25
Table 1.4 Non Brain injury studies deemed most relevant for Chapters 2 & 3 27
Table 1.5 Key search terms used for Chapter 4 29
Table 1.6 Search strategy for Chapter 4 30
Table 1.7 Assistive device research deemed most relevant for Chapter 4 36
Table2.1 Master and sub-themes reflecting participants’ experiences of using
memory aids/strategies 66
Table 3.1 Example of extracts forming subscales: treatment control and personal
control for the Beliefs about Memory Aids Questionnaire (BMQ) 108
Table 3.2 Example of extracts forming subscales: inappropriate beliefs;
lifestyle fit & threat appraisals for the Beliefs about Memory Aids
Questionnaire (BMQ) 109
Table 3.3 Frequency table for Education data 113
Table 3.4 Frequency table for Occupation data 113
Table 3.5 Descriptive and reliability data (n=58) 115
Table 3.6 Mean and standard deviation of items from the memory strategy
questionnaire 117
Table 3.7 Correlation matrix of AMQ subscales, EMQ difference (awareness)
and MSQ total 118
Table 3.8 Standard multiple regression of predictors of memory strategy use
with MSQ total as the dependent variable 119
Table 4.1 Neuropsychological assessment results 151
Table 4.2 Design Phases 152
Table 4.3 Total BMQ sub-scale scores and EMQ-r pre and post intervention 167

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LIST OF FIGURES

Figure 4.1 Google Calendar Interface 157
Figure 4.2 NAP analysis and hand calculation for percentage of target events
forgotten 164
Figure4.3 NAP analysis and hand calculation for percentage of events forgotten
if not reminded 165
Figure 4.4 NAP hand calculation for percentage of events forgotten if not
reminded 165
Figure 4.5 Displays the percentage of control events forgotten or lost at baseline
(phase A) and at intervention (phase B) 166

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