Modified Story Memory Technique Research Articles

The effects of cognitive rehabilitation combined with aerobic exercise or stretching-and-toning on new learning and memory in persons with moderate-to-severe TBI: Protocol for a randomized controlled trial

This paper describes the protocol for a Phase I/II, parallel-group, blinded randomized controlled trial that compares the effects of 12-weeks of combined learning and memory rehabilitation with either aerobic cycling exercise or stretching on cognitive, neuroimaging, and everyday life outcomes in 60 persons with moderate-to-severe traumatic brain injury (TBI) who demonstrate impairments in new learning. Briefly, participants will undergo baseline testing consisting of neuropsychological testing, neuroimaging, daily life measures, and cardiorespiratory fitness. Following baseline testing, participants will be randomized to one of 2 conditions (30 participants per condition) using concealed allocation. Participants will be masked as to the intent of the conditions. The conditions will both involve supervised administration of an enhanced, 8-week version of the Kessler Foundation modified Story Memory Technique, embedded within either 12-weeks of supervised and progressive aerobic cycling exercise training (experimental condition) or 12-weeks of supervised stretching-and-toning (active control condition). Following the 12-week intervention period, participants will complete the same measures as at baseline that will be administered by treatment-blinded assessors. The primary study outcome is new learning and memory impairment based on California Verbal Learning Test (CVLT)-III slope, the secondary outcomes include neuroimaging measures of hippocampal volume, activation, and connectivity, and the tertiary outcomes involve measures of daily living along with other cognitive outcomes. We further will collect baseline sociodemographic data for examining predictors of response heterogeneity. If successful, this trial will provide the first Class I evidence supporting combined memory rehabilitation and aerobic cycling exercise training for treating TBI-related new learning and memory impairment.

The influence of information processing speed on benefit from learning and memory rehabilitation in TBI: a sub-analysis of the TBI-MEM trial

ABSTRACT Objective This study examined the influence of processing speed (PS) on benefit from treatment with the Kessler Foundation modified Story Memory Technique® (KF-mSMT®), a cognitive rehabilitation intervention shown to improve new learning and memory in traumatic brain injury (TBI). Setting Non-profit research center Participants 62 participants with moderate-to-severe TBI were included, 31 assigned to the treatment group and 31 to the placebo-control group. Design Double-blind, placebo-controlled, randomized clinical trial. The present study represents a post-hoc analysis to examine the role of PS on treatment efficacy. Main Measures Baseline and follow-up neuropsychological assessment including the California Verbal Learning Test, Second Edition (CVLT-II), Memory Assessment Scales – Prose Memory (MAS-PM) and the Symbol Digit Modalities Test (SDMT). Results A treatment effect was not observed on the CVLT-II learning slope in the treatment group relative to the placebo group post-treatment, after co-varying for education, baseline CVLT slope and PS performance. However, performance on a measure of PS, the SDMT, was a significant predictor of post-treatment change following KF-mSMT® treatment. PS was not a significant predictor of benefit from treatment as documented by the MAS-PM immediate or delayed recall score, both of which showed a significant treatment effect. Conclusion Performance on measures of cognitive dysfunction aside from learning and memory impact the benefit from KF-mSMT® treatment. Implications for cognitive rehabilitation for individuals with TBI are discussed.

Efficacy of the Spanish modified Story Memory Technique in Mexicans with multiple sclerosis: A pilot randomized controlled trial.

Memory impairments commonly afflict individuals with MS. While evidence-based cognitive rehabilitation treatments are available in English, the lack of such interventions in Spanish is an important barrier to care for Hispanics with MS. There is class I evidence that the modified Story Memory Technique (mSMT) improves learning in English. This intervention has been translated and adapted into Spanish. To examine the preliminary efficacy of the Spanish mSMT to improve learning in Mexicans with MS. Twenty individuals with relapsing-remitting MS were randomized to treatment (n = 10) or placebo control (n = 10) groups. The Spanish mSMT is a 10-session intervention that teaches imagery and context to facilitate learning. The control condition was matched to the treatment condition in treatment duration, and stimulus content and presentation. Participants completed baseline and post-treatment neuropsychological assessments. Individuals who received the Spanish mSMT showed significant improvements in learning and life satisfaction relative to the control group. Also observed were a near-moderate effect size on perceived memory complaints and a moderate-to-large effect size on the family's perception of the patient's competency. The Spanish mSMT showed preliminary efficacy in improving learning deficits in Mexicans with MS, and such improvements may extend to other domains.

Brain activation patterns associated with paragraph learning in persons with multiple sclerosis: The MEMREHAB trial

The modified Story Memory Technique (mSMT) is a memory rehabilitation program that combines training in visualization and context formation to improve learning and memory. Previous studies have shown improvement in learning and memory in individuals with multiple sclerosis (MS) after undergoing the mSMT, including changes in brain activity related to working memory and word encoding. The current study examined changes in brain activity in 16 individuals diagnosed with MS (n treatment = 6; n placebo control = 10) when they were presented with to-be-remembered information within a meaningful context (i.e. a paragraph) from before to after mSMT treatment. We expected treatment-related changes in brain activation in the language network (LAN), default mode network (DMN), and executive control network (ECN). Consistent with this prediction, fMRI results revealed reduced brain activation in the LAN, DMN and ECN after completing the mSMT treatment in the context of paragraph learning. While no significant behavioral changes were observed, a marginally significant improvement with a large effect size was noted between baseline and follow-up performance on the Rivermead Behavioral Memory Test in persons who completed treatment. Results are discussed in terms of the impact of imagery training on patterns of cerebral activation when learning words presented within a context.

The efficacy of the modified Story Memory Technique in progressive MS

Background: Impairments in new learning and memory are common in individuals with multiple sclerosis (MS), negatively impacting everyday life, including occupational and social functioning. Objective: This study examined the efficacy of the modified Story Memory Technique (mSMT) in a progressive multiple sclerosis (PMS) sample through a double-blind, placebo-controlled, randomized clinical trial (RCT). Methods: Thirty (30) individuals with PMS, naïve to the mSMT, were randomized to the treatment or placebo control group. The Treatment Group completed mSMT training twice per week for 5 weeks while the Placebo Group met with the therapist at the same frequency, engaging in non-training-oriented tasks to control for professional contact and disease alterations. Results: The treatment group showed significant improvements in learning compared with the placebo control group, evident on both objective evaluation of new learning and self-report of functioning in daily life. Increased awareness of cognitive deficits was also noted post-treatment. Conclusion: These data provide Class I evidence supporting the efficacy of the mSMT in PMS. A behavioral intervention, targeted to specifically strengthen new learning, can significantly improve memory performance in PMS, and this improvement in memory performance is maintained 3 months later.

Pilot Outcomes for mTBI Patients Receiving the Modified Story Memory Technique Intervention

Concussion / mild TBI (hereafter mTBI) prognosis is still a divisive topic. 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.

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

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.

Diversity-2Examining the Efficacy of the Spanish Modified Story Memory Technique in Multiple Sclerosis

Diversity-2Examining the Efficacy of the Spanish Modified Story Memory Technique in Multiple Sclerosis

A pilot study of changes in functional brain activity during a working memory task after mSMT treatment: The MEMREHAB trial

BackgroundWorking memory deficits are common in multiple sclerosis (MS). The modified Story Memory Technique (mSMT) has been shown to improve new learning and memory in MS, but its effects on working memory (WM) are currently unknown. ObjectiveThe present study presents a secondary analysis of data from a larger double-blind, placebo-controlled, randomized clinical trial and examines changes in cerebral activation on a WM task following mSMT treatment. MethodsSixteen participants with clinically definite MS were randomly assigned to treatment (n=7) or placebo-control groups (n=9) matched for gender, age and education. Baseline and immediate follow-up functional Magnetic Resonance Imaging (fMRI) was obtained for all subjects. During fMRI participants completed an N-back task, consisting of 0-, 1-and 2-back conditions. ResultsSignificant increases in cerebral activation were noted in the dorsolateral prefrontal cortex, supplementary motor area and inferior parietal lobule at follow-up in the treatment group. No significant changes were noted in the placebo control group. ConclusionDue to the small sample size, results of the current study should be interpreted as preliminary. However, the observed pattern of activation of the frontoparietal network involved in WM found in the treatment group, suggests that mSMT training increases recruitment of attention- and WM-related neural networks. We conclude that mSMT treatment leads to changes in WM-related cerebral activation.

Individual Differences in Working Memory Capacity Predicts Responsiveness to Memory Rehabilitation After Traumatic Brain Injury

ObjectiveTo explore how individual differences affect rehabilitation outcomes by specifically investigating whether working memory capacity (WMC) can be used as a cognitive marker to identify who will and will not improve from memory rehabilitation. DesignPost hoc analysis of a randomized controlled clinical trial designed to treat learning and memory impairment after traumatic brain injury (TBI): 2 × 2 between-subjects quasiexperimental design (2 [group: treatment vs control] × 2 [WMC: high vs low]). SettingNonprofit medical rehabilitation research center. ParticipantsParticipants (N=65) with moderate to severe TBI with pre- and posttreatment data. InterventionsThe treatment group completed 10 cognitive rehabilitation sessions in which subjects were taught a memory strategy focusing on learning to use context and imagery to remember information. The placebo control group engaged in active therapy sessions that did not involve learning the memory strategy. Main Outcome MeasureLong-term memory percent retention change scores for an unorganized list of words from the California Verbal Learning Test-II. ResultsGroup and WMC interacted (P=.008, ηp2=.12). High WMC participants showed a benefit from treatment compared with low WMC participants. Individual differences in WMC accounted for 45% of the variance in whether participants with TBI in the treatment group benefited from applying the compensatory treatment strategy to learn unorganized information. ConclusionsIndividuals with higher WMC showed a significantly greater rehabilitation benefit when applying the compensatory strategy to learn unorganized information. WMC is a useful cognitive marker for identifying participants with TBI who respond to memory rehabilitation with the modified Story Memory Technique.

An RCT to Treat Learning Impairment in Traumatic Brain Injury

Objective. To examine the efficacy of the modified Story Memory Technique (mSMT) to improve learning (ie, acquisition) and memory in participants with TBI. The mSMT is a behavioral intervention that teaches context and imagery to facilitate learning within 10 sessions over 5 weeks. Methods. A total of 69 participants with moderate-severe Traumatic Brain Injury (TBI), 35 in the treatment group and 34 in the placebo control group, completed this double-blind, placebo-controlled randomized clinical trial. A baseline neuropsychological assessment was administered, including questionnaires assessing everyday memory. Repeat assessments were conducted immediately posttreatment and 6 months following treatment. Participants in the treatment group were randomly assigned to a booster session or a non–booster session group after completion of treatment with the mSMT to examine the efficacy of monthly booster sessions in facilitating the treatment effect over time. Results. The treatment group demonstrated significant improvement on a prose memory task relative to the placebo group posttreatment (η2 = 0.064 medium effect). Similar results were noted on objective measures of everyday memory, specifically prospective memory (Cohen’s w = 0.43, medium effect), and family report of disinhibition in daily life (η2 = 0.046, medium effect). Conclusion. The mSMT is effective for improving learning and memory in TBI. Classification of evidence. Based on widely accepted classification systems for treatment study design, this study provides class I evidence that the mSMT behavioral intervention improves both objective memory and everyday memory in persons with TBI over 5 weeks. Thus, this study extends the evidence for efficacy of the treatment protocol to a sample of persons with TBI.

Examining the Efficacy of the Modified Story Memory Technique (mSMT) in Persons With TBI Using Functional Magnetic Resonance Imaging (fMRI): The TBI-MEM Trial.

New learning and memory deficits are common following traumatic brain injury (TBI). Yet few studies have examined the efficacy of memory retraining in TBI through the most methodologically vigorous randomized clinical trial. Our previous research has demonstrated that the modified Story Memory Technique (mSMT) significantly improves new learning and memory in multiple sclerosis. The present double-blind, placebo-controlled, randomized clinical trial examined changes in cerebral activation on functional magnetic resonance imaging following mSMT treatment in persons with TBI. Eighteen individuals with TBI were randomly assigned to treatment (n = 9) or placebo (n = 9) groups. Baseline and follow-up functional magnetic resonance imaging was collected during a list-learning task. Significant differences in cerebral activation from before to after treatment were noted in regions belonging to the default mode network and executive control network in the treatment group only. Results are interpreted in light of these networks. Activation differences between the groups likely reflect increased use of strategies taught during treatment. This study demonstrates a significant change in cerebral activation resulting from the mSMT in a TBI sample. Findings are consistent with previous work in multiple sclerosis. Behavioral interventions can show significant changes in the brain, validating clinical utility.

The influence of cognitive dysfunction on benefit from learning and memory rehabilitation in MS: A sub-analysis of the MEMREHAB trial

Background: This study examined the influence of processing speed (PS) on benefit from treatment with the modified Story Memory Technique© (mSMT), a behavioral intervention shown to improve new learning and memory in multiple sclerosis (MS). Methods: This double-blind, placebo-controlled, randomized clinical trial included 85 participants with clinically definite MS, 45 assigned to the treatment group and 40 to the placebo-control group. Participants completed baseline and follow-up neuropsychological assessment. The present study represents a post-hoc analysis to examine the role of PS on treatment efficacy. Findings: The treatment group showed a significantly improved CVLT learning slope relative to the placebo group post-treatment, after co-varying PS performance. SDMT performance was a significant predictor of benefit from mSMT treatment, beyond group assignment. Post-hoc analysis indicated a significant correlation between the SDMT and overall cognition, indicating that the SDMT may be serving as a proxy for overall cognitive impairment. Interpretation: Performance on measures of cognitive dysfunction aside from learning and memory impact the benefit of mSMT treatment. While the current study focused on PS as a critical factor, PS may be serving as a marker for generalized cognitive dysfunction. Implications for cognitive rehabilitation in MS are discussed.© Kessler Foundation Inc. All rights reserved.

Functional Brain Activity After Memory Retraining in Traumatic Brain Injury: THE MEMREHAB Trial

The current double-blind placebo-controlled randomized clinical trial sought to evaluate the efficacy of a learning and memory rehabilitation protocol, well validated in other neurological samples, in individuals with Traumatic Brain Injury (TBI). Double-blind placebo-controlled randomized clinical trial. Non-profit rehabilitation facility. 18 individuals with TBI were randomly assigned to the treatment group (n=9) or placebo-control group (n=9). Treatment group participants completed 10 sessions of the modified Story Memory Technique (mSMT) during which they were taught to facilitate new learning through visualization (sessions 1-4) and context ( 5-8), and then apply the techniques in daily life (9 and 10). Control group participants underwent memory exercises at the same frequency and duration as the treatment group, but without exposure to visualization and context. Patterns of cerebral activation on functional Magnetic Resonance Imaging (fMRI). In the treatment group, significant decreases in brain activity were observed in fronto-parietal regions and significant increases in activity were noted in regions of the default mode network. Behavioral improvements in prose memory were similarly observed. Results, suggest that encoding is less effortful and requires less cognitive resources after treatment than before treatment.

A pilot study examining functional brain activity 6months after memory retraining in MS: the MEMREHAB trial.

Cognitive impairment in individuals with multiple sclerosis (MS) is now well recognized. One of the most common cognitive deficits is found in memory functioning, largely due to impaired acquisition. We examined functional brain activity 6months after memory retraining in individuals with MS. The current report presents long term follow-up results from a randomized clinical trial on a memory rehabilitation protocol known as the modified Story Memory Technique. Behavioral memory performance and brain activity of all participants were evaluated at baseline, immediately after treatment, and 6months after treatment. Results revealed that previously observed increases in patterns of cerebral activation during learning immediately after memory training were maintained 6months post training.

An RCT to treat learning impairment in multiple sclerosis

To examine the efficacy of the modified Story Memory Technique (mSMT), a 10-session behavioral intervention teaching context and imagery to facilitate learning, to improve learning and memory abilities in persons with multiple sclerosis (MS). This double-blind, placebo-controlled, randomized clinical trial included 86 participants with clinically definite MS, 41 in the treatment group and 45 in the placebo control group. Participants completed a baseline neuropsychological assessment, including questionnaires assessing everyday memory, a repeat assessment immediately posttreatment, and a long-term follow-up assessment 6 months after treatment. After completion of the treatment phase, persons in the treatment group were assigned to a booster session or a non-booster session group to examine the efficacy of monthly booster sessions in facilitating the treatment effect over time. The treatment group showed a significantly improved learning slope relative to the placebo group posttreatment. Similar results were noted on objective measures of everyday memory, general contentment, and family report of apathy and executive dysfunction. Long-term follow-up data showed that posttreatment improvement in the treatment group continued to be noted on the list learning and self-report measures. The provision of booster sessions demonstrated little benefit. The mSMT is effective for improving learning and memory in MS. This study provides Class I evidence that the mSMT behavioral intervention improves both objective memory and everyday memory in patients with MS over 5 weeks, with treatment effects lasting over a 6-month period.

Increased functional connectivity within memory networks following memory rehabilitation in multiple sclerosis

Identifying effective behavioral treatments to improve memory in persons with learning and memory impairment is a primary goal for neurorehabilitation researchers. Memory deficits are the most common cognitive symptom in multiple sclerosis (MS), and hold negative professional and personal consequences for people who are often in the prime of their lives when diagnosed. A 10-session behavioral treatment, the modified Story Memory Technique (mSMT), was studied in a randomized, placebo-controlled clinical trial. Behavioral improvements and increased fMRI activation were shown after treatment. Here, connectivity within the neural networks underlying memory function was examined with resting-state functional connectivity (RSFC) in a subset of participants from the clinical trial. We hypothesized that the treatment would result in increased integrity of connections within two primary memory networks of the brain, the hippocampal memory network, and the default network (DN). Seeds were placed in left and right hippocampus, and the posterior cingulate cortex. Increased connectivity was found between left hippocampus and cortical regions specifically involved in memory for visual imagery, as well as among critical hubs of the DN. These results represent the first evidence for efficacy of a behavioral intervention to impact the integrity of neural networks subserving memory functions in persons with MS.

Increased cerebral activation after behavioral treatment for memory deficits in MS

Deficits in new learning and memory are common in persons with multiple sclerosis (MS), though few studies have examined the efficacy of memory retraining in MS. Previous research from our laboratory has demonstrated that the modified Story Memory Technique (mSMT) significantly improves new learning and memory in MS. The present double-blind, placebo-controlled, randomized clinical trial was designed to examine changes in cerebral activation following mSMT treatment. Sixteen individuals with clinically definite MS were randomly assigned to treatment (n = 8) or placebo-control (n = 8) groups, matched for age, education, and disease characteristics. Baseline and follow-up fMRI was collected during performance of learning and memory tasks. No baseline activation differences on fMRI were seen between groups. After treatment, greater activation was evident in the treatment group during performance of a memory task within a widespread cortical network involving frontal, parietal, precuneus, and parahippocampal regions. All participants in the treatment group showed increased activation in frontal and temporal regions in particular. In contrast, the control group showed no significant changes in cerebral activation at follow-up. A significant association was found between increased activation in the right middle frontal gyrus and improved memory performance post-treatment. The increased activation seen likely reflects increased use of strategies taught during treatment when learning new information. This study is the first to demonstrate a significant change in cerebral activation resulting from a behavioral memory intervention in an MS sample. Behavioral interventions can show significant changes in the brain, validating clinical utility.