Abstract

That learning and memory deficits persist many years following mild traumatic brain injury (mTBI) is controversial due to inconsistent objective evidence supporting subjective complaints. Our prior work demonstrated significant reductions in performance on the initial trial of a verbal learning task and overall slower rate of learning in well-motivated mTBI participants relative to demographically matched controls. In our previous work, we speculated that differences in strategy use could explain the differences in rate of learning. The current study serves to test this hypothesis by examining strategy use on the California Verbal Learning Test-Second Edition. Our present findings support the primary hypothesis that mTBI participants under-utilize semantic clustering strategies during list-learning relative to control participants. Despite achieving comparable total learning scores, we posit that the persisting learning and memory difficulties reported by some mTBI patients may be related to reduced usage of efficient internally driven strategies that facilitate learning. Given that strategy training has demonstrated improvements in learning and memory in educational and occupational settings, we offer that these findings have translational value in offering an additional approach in remediation of learning and memory complaints reported by some following mTBI.

Highlights

  • That learning and memory difficulties are an acute consequence of mild traumatic brain injury is well supported

  • Groups did differ on average Chance adjusted (CA) semantic clustering across five trials ( p, .05)

  • Average CA semantic (r 5 0.566; p, .01) and average CA subjective (r 5 0.565; p, .01) clustering was related to overall learning rate

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Summary

Introduction

That learning and memory difficulties are an acute consequence of mild traumatic brain injury (mTBI) is well supported. Examining higher-order ‘‘meta-cognitive’’ learning and memory strategies has particular relevance in patient populations including mTBI where evidence of chronic primary temporal lobe/diencephalic memory dysfunction is not generally supported (Binder, Rohling, & Larrabee, 1997; Cicerone & Kalmar, 1995; Dikmen et al, 2009; Ettenhofer & Abeles, 2009; Iverson, 2005; Schretlen & Shapiro, 2003; West, Curtis, Greve, & Bianchini, 2010). Others have argued that memory deficiencies following mTBI could be influenced by dysfunction in frontal-subcortical networks which may support metacognitive functions (Alexander, Stuss, & Gillingham, 2009; Bruce & Echemendia, 2003; Little et al, 2010). Studies in TBI and other neurologic populations provide evidence that successful recall of items on list-learning tasks is influenced by how well one consistently uses an efficient (i.e., semantic, subjective) recall strategy (Bruce & Echemendia, 2003; Chan et al, 2000; Gongvatana et al, 2007; Gsottschneider et al, 2010; Luek, 1976; Ribeiro, Guerreiro, & De Mendonça, 2007)

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