Memory, a strength? We are talking about persons with brain injury here, right? Right! Yes, memory in persons with brain injury can be used as a strength. This is a foreign concept to some. After all, much of what the medical model teaches is about deficits and impairments — measuring this “deficit” or fixing that “impairment,” (should we be so lucky that there were only one or two).
Little wonder focusing on strengths is an alien concept. This is understandable because most of what doctors and therapists do is fix things — broken bones, ailing organs, stubborn muscles and “damaged” brains (gosh I hate that word). This “repair model” climate creates a string of assumptions that sets the tone for rehabilitation which may actually interfere with the objective of helping us regain the ability to function well again. If there us an undue focus on repairing and fixing whatever isn’t working, the effect may be to frustrate and discourage us. The road is, after all, a long and hard one either way, and the practical reality of living day-to-day constantly “fixing” the multitude of things that don’t work any longer may be more than many of us can bear.
On the other hand, “compensation models” focus our attention in the right direction. I suggest we take this several steps further and see what wonderful things happen when we empower ourselves with the model of taking responsibility for consciously learning about, and focusing on our strengths.
I’ve used this approach in my own rehabilitation, and it works well. By directing our focus and energy on residual strengths, we can learn to empower ourselves to achieve more than anyone would have predicted. The journey becomes less arduous and all the little accomplishments along the way keep us energized and motivated.
There are many different kinds of memory: short-term memory, long-term memory, memory for facts and figures, memory for images and faces, auditory memory, visual memory, prospective memory, memory for skills, memory for procedures — and probably several others I’ve missed. How familiar are you with the kind of memory called “procedural memory”? Some people call it muscle memory.
Procedural memory is the kind of memory we use when we have learned how to press a certain sequence of keys to get the computer up and running (but perhaps cannot recite the steps unless the keyboard is in front of us or underneath our fingertips). Procedural memory is the kind of memory we use to weave a basket or to build things. It’s a doing kind of memory. Procedural memory is a profound strength that most all persons with brain injury have retained. It is the kind of memory that makes it possible for us to achieve much of what we want and need in our lives.
Procedural memory is also something we retain from our pre-injury lives. This is a double edged sword. If we think we can rely on old skills alone we soon learn that procedural memory by itself is not enough. Another factor is the powerful, inherent desire to look inside our heads for everything we need to function — which doesn’t work either. The trick is to figure out what skills or procedural memory should be used, and when it is appropriate to use something else.
The reason this is so tricky is that in our pre-injury lives we were able to unconsciously switch back and forth between different kinds of memory. Our pre-injury brain picked out the memory we needed and used it — without telling us it was doing this. If we needed a phone number, one kind of memory was used and it would just pop in to our head, If we ran into an acquaintance in town, another kind of memory kicked in, and if we were lucky the name would pop up too. If we were in the store and had ten bucks on our pocket we could go through the aisles and add up the prices of the items we put into our cart and go to the checkout counter fairly confident that we had selected about ten dollars worth of stuff.
After injury this kind of “selection” doesn’t work that way any more. When our injuries are fresh, or if we haven’t learned how to make different kinds of memory and skills work together, we are not fully conscious of what kind of skill or memory to reach for. Phone numbers escape us, names and faces don’t always match up or conversations and contexts get confused. As for estimating dollar amounts… well, anybody who has had trouble post-injury with their checkbook knows that this skill is no longer a strength. However, procedural memory was there all the time, even though the other kinds of memory glitches interrupted the flow to cause mistakes and frustrations. My guess is that most of us simply weren’t aware that certain kinds of memory “worked” and other kinds didn’t.
I suggest that what we sensed as “memory not working” was really “things not working” because we were trying to use our brains in the old pre-injury way — not distinguishing between situations in which procedural memory or other kinds of memory would be more effective. We were missing the mark because the type of memory we were trying to use was no longer a strength.
The key for me was to figure out how to use the kind of memory skill I had left to outsmart the other kinds that were playing games with my head. To use procedural memory well, you need to understand how it works, learn how to use it and become aware of situations in which the demands of daily living call out for it to be applied.
Early in my rehabilitation program I discovered that I could learn to do things in new ways. For example, if I set out all the things I needed to use in the morning — toothpaste, soap and such, my chances increased for being able to get ready and not forget something. All I had to do was “remember” to set stuff out (along with “what” stuff to set out). Same thing with my clothes. Later on I learned that there were various steps I could take to manage my routines, my bills and even my work tasks. With repetition, these little procedures would become part of me without having to check my notes each time. The key was remembering to use whatever procedure worked for the task at hand.
Replication of cognitive function on paper is the key. By learning how and when to use procedural memory to manage life, we can accomplish far more than we can if we don’t learn these skills. It is not easy, and it takes a while to learn, but it is one way to outsmart the mine-laden journey that is part of living with a brain injury. Learning what works and what doesn’t, and when to draw on our different residual strengths helps us empower ourselves to reach for our dreams again.
Kathy Moeller is a skills trainer and creator of the BRAIN BOOK® Life Management System, a compensatory skill and residual strength building program for persons with brain injury. Kathy experienced a brain injury in 1990.