Using Strategy Training in Cognitive Rehabilitation for MS and TBI

Nancy Chiaravalloti, PhD, director, Centers for Neuropsychology and Neuroscience Research, and Traumatic Brain Injury Research, Kessler Foundation

Nancy Chiaravalloti, PhD

When it comes to cognitive rehabilitation, Nancy Chiaravalloti, PhD, and colleagues have been at the forefront of an effort to use strategy training to improve those with neurological injury or illness—many pieces of which are comprised of tasks rooted in daily life.

Chiaravalloti, who is director of the Centers for Neuropsychology and Neuroscience Research and Traumatic Brain Injury Research at Kessler Foundation, spoke to encouraging patients to engage in practices such as self-tests for memory—similar to how school children are quizzed in class—and spaced learning, which is the separating of time between repetitions of information to maximize retention. As well, she and colleagues are developing cognitive rehabilitation treatment protocols that incorporate strategy training to help rehabilitate patients with traumatic brain injury (TBI) and multiple sclerosis (MS), among other neurologic disorders and injuries.

Chiaravalloti shared her insight with NeurologyLive on these tactics, what everyday life tasks they are comparable to, and how patients are benefitting from them. Additionally, she shared insight into how she and her colleagues at Kessler incorporated strategy training programs into their cognitive rehab, and what steps they took to take these strategies from the literature into practice.

NeurologyLive: Could you provide some insight into these cognitive rehabilitation tactics?

Nancy Chiaravalloti, PhD: So many of the things that we are teaching patients to use are things that we actually implement in our daily lives. As an example, one of the techniques that we utilize within our memory rehabilitation protocols is self-testing. Self-testing is actually used very commonly in the educational system—it's really the premise behind quizzing. As a student is preparing for a larger exam that might happen at the end of the month, they might get weekly quizzes and those weekly quizzes really serve as intermediate testing. That the quizzing is not only telling the teacher what the student knows or doesn't know at any one point in time but it's helping the student retrieve that information and that's helping them learn that information better for that final test.

Another example is spaced learning. We teach patients that it's better to space out repetitions of information than to repeat them several times in a row, and that's something that we see every day also in our educational system. We always tell our children, our students, don't cram for the exam, you can't study the night before, you won't do as well as you would if you had prepared and studied a little bit every night prior to the exam. The reason for that is that if you space out in repetitions of information over time, you remember that information better than if you just try to learn it all at one time.

The techniques that we teach patients who have MS and patients who have traumatic brain injury are techniques that individuals that are healthy use in their everyday lives to maximize their memory functioning—we just don't always know we're using them. Some people are better at using them and more aware that they're using them than others are.

What sort of programs are you and your colleagues implementing with these tactics and others?

We have developed and continued to vote to develop various cognitive rehabilitation programs at Kessler Foundation. We've really put much of our efforts into developing programs that are based on strategy training. Strategy training refers to the application of strategies to help you learn and remember new information. So, as an example, a strategy might be testing yourself on information so that you can remember it better later on.

The reason we focused on strategy trainings to try to incorporate them into treatment protocols is that there is a very robust literature on strategy training in healthy populations. There are hundreds of studies showing that various types of strategy training really do help people learn and remember new information, so we've taken that, we've applied those techniques to individuals who have neurological injuries such as traumatic brain injury or neurological illness such as multiple sclerosis, and we've tested those techniques in those individuals. And we've shown that they do indeed help learning and memory in those populations. As a result, the protocols we develop really focus on taking strategy training and teaching persons who have MS or persons who have had a traumatic brain injury on how to use those techniques in their daily life.

The first step in identifying strategies that we'd like to use in our research is a literature search. The first thing we do is we go back through the literature, not only the literature on people who have neurological illness or injury, but the healthy literature. We look at what's been done in healthy college students over the years and we look at what's really helped people to maximize their memory functioning, and that's how we identify the components of treatment that we want to take and implement in neurological populations. We then take those strategies, we put them together with other strategies, and we build a rehabilitation program around that.

Transcript edited for clarity.