Lomonosov Moscow State University,
Neurology Research Center,
Background. Contemporary rehabilitation of memory impairments relies on the use of external compensatory strategies. In Russian neuropsychological tradition, rehabilitation is understood as a transformation of a higher mental function, based on intact elements of that function and on use of external and internal means. Such a restructuration approach may be applied to memory.
Objective. This article describes the basic principles underlying memory rehabilitation and gives an example of their successful implementation in a clinical case.
Design. A 62-year-old patient was admitted 6 months after severe traumatic brain injury with primary damage to his le frontal and temporal lobes. He faced difficulties in social living and activities of daily life, mainly due to memory impairment. Neuropsychological assessment revealed moderate impairment of different memory types: modal nonspecific impairment with mild but persistent impairments in autobiographic and semantic memories. During a 3-week rehabilitation program, an algorithm involving the use of text was developed in consideration of the structure of memory impairment (impaired selectiveness, excessive inhibition and pathologic inertness of memory traces).
Results. After multiple trials and modifications, the resulting algorithm (written retelling with the use of keywords, self-correction with writing correct variants instead of errors), allowed reproduction of the presented text with 100% recall of significant information and no false memories. The use of the developed memorization technique in everyday life allowed the patient to effectively memorize relevant information.
Conclusion. The described approach—restructuration of memory on the basis of preserved chains—is a feasible strategy of memory rehabilitation.
Keywords: neuropsychological rehabilitation, neurorehabilitation, memory, traumatic brain injury
Background. Alexandria R. Luria’s classic neurorehabilitation methods (“restorative learning”) have now been successfully applied in clinical settings for more than seventy years. It is of interest how Luria’s methods relate to contemporary strategic approaches to effective rehabilitation. One such framework is the International Classification of Functioning, Disability and Health (ICF)—a comprehensive WHO framework for measuring health and disability for diagnostic and rehabilitation purposes.
Objective. To compare Luria’s procedure of restorative learning in aphasia and the ICF. Such a comparison may facilitate the use of the ICF in the work of multidisciplinary rehabilitation teams for diagnosis, planning, implementation, and evaluation of rehabilitation programs.
Design. A systematic comparison of ICF components with specific rehabilitation procedures developed by Luria aimed at speech understanding and production.
Results. Luria’s speech rehabilitation methods pertain to the ICF component “Body Functions and Structures”. Specific correspondences between Luria’s rehabilitation procedures and ICF categories are found, especially for afferent and efferent aphasias. For the aphasias related to speech understanding (sensory and semantic aphasia), such correspondences are rare. This reflects an insufficient differentiation in the understanding of higher cognitive functions in current neurorehabilitation. Luria’s concern for patients’ personality and social status is also explicated.
Conclusion. Although Luria’s “restorative learning” is realized within the ICF domain of “Body Functions and Structures”, his approach also focuses on the rehabilitation of the personal and social status of the patient. This approach is an important condition for clinical and psychological rehabilitation in the ICF domains of “Activities” and “Participation”.
Keywords: International Classification of Functioning, Disability and Health (ICFDH), speech, aphasia, restorative learning, A.R. Luria, neuropsychology, clinical psychology, rehabilitation.