Case series of mTBI patients receiving the modified story memory technique intervention

Abstract

Concussion/mild TBI (hereafter mTBI) prognosis is still a divisive topic in clinical practice. While some continue to subscribe to a “full recovery model,” others note slower recovery with longer-term residual symptoms that may respond well to psychotherapy (CBT) and multimodal rehabilitative care. While evidence for functional gains resulting from mTBI interventions like psychoeducation is accumulating, there is little research and support for cognitive interventions that target learning and memory, despite patient complaints in these domains. We present early evidence of possibly therapeutic gains made by chronic mTBI survivors. Design: participants with mTBI completed a double-blind, placebo-controlled randomized clinical trial, with baseline, post-treatment and 6-month follow-up assessments. Outcomes were compared using non-parametric statistics (Wilcoxon Signed Ranks Test) for related samples given the small sample size in this pilot study. : not-for-profit research organization in a diverse, suburban setting. Participants: 5 out of 9 mTBI patients in intervention group ( n = 9). Interventions: Modified Story Memory Technique (mSMT) aims to improve learning by teaching context and imagery strategies in 10 sessions. Main outcome measure(s): California Verbal Learning Test II (CVLT-II) and Memory Assessment Scale (MAS) - Prose Memory. Treated participants showed improvement in CVLT short delayed free recall (+5/0/0/, Z = −2.04, P = 0.041) and long delayed free recall (+5/0/0/, Z = −2.02, P = 0.043) following the mSMT. No differences were observed for the MAS Prose Memory. Our pilot data provides preliminary evidence for cognitive gains resulting from cognitive rehabilitation targeting acquisition of context and imagery strategies for memory. A full-scale study can better address the mechanisms of change (e.g., depression, anxiety, socialization) since one-on-one interactions introduce confounders.