Memory problems have a significant impact on the everyday life of individuals with MS…. and we can help!

...memory for real-life situations is at the heart of what defines an individual as a person in society.
— Ernst, 2019

There has been growing interest in the literature about memory impairments in individuals with multiple sclerosis, with a recent focus on autobiographical memory (i.e., our ability to recall personal life events) and future thinking (i.e., our ability to predict future events). This paper provides an excellent overview on what we know from that research! Here are a few highlights:

  1. “Autobiographical memory and future thinking are frequently and early impaired in individuals with MS…and can have disruptive and pervasive effects in many different aspects of daily functioning” (Ernst, 2019, p. 4).

  2. Individuals with MS are generally aware of these memory problems.

  3. An intervention program aimed at boosting mental visual imagery (MVI) is effective at improving autobiographical memory and future thinking in individuals with relapsing–remitting MS.

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In this paper, the author describes one such rehab program, titled the “MVI program”, which consists of six 2-hour sessions. This program has been previously reported in the literature, and the manual is available upon request from the author.  

The bottom line is this, if you’re not already, SLPs should consider treating autobiographical memory and future thinking in individuals with MS… and therapy aimed at enhancing mental visual imagery appears to be an effective approach!

Ernst, A. (2019). Autobiographical Memory and Future Thinking Impairments in Multiple Sclerosis: Cognitive and Neural Mechanisms, Functional Impact and Rehabilitation. Annals of Physical and Rehabilitation Medicine. doi:10.1016/j.rehab.2019.06.006

Two considerations for the FAVRES with bilingual patients

Is the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES) an appropriate test of executive function (EF) for bilingual patients with mild traumatic brain injury (mTBI)? Maybe, but use with caution. Ratiu & Azuma compared “bilingual” participants with and without a history of mTBI on the FAVRES, self reports of EF, and a nonlinguistic measure of EF/ inhibition (the flanker test). The participants were all college students, ranging in language background from fully bilingual non-native English speakers to native English speakers with “at least basic proficiency in Spanish.”

What did they find?

The participants with mTBI performed significantly worse than the controls on the accuracy, rationale, and reasoning portions of the FAVRES. And the scores on the FAVRES were mostly consistent with the results of the flanker test and self-reported symptoms (worse symptoms, worse FAVRES score).

Sounds promising. Why the caution? 

  • 20% of the non-brain injured bilingual controls also fell at or below the FAVRES cutoff for brain injury. Not good. Especially because these are all college students, who are presumably functioning at a pretty high level. Therefore, expect that the FAVRES may make your bilingual patients look worse than they really are.

  • The mTBI group in this study may not have the same kind of bilingual background as your bilingual patients with mTBI. Unlike the bilingual control group, the participants with mTBI were mainly native English speakers with lower Spanish proficiency. Bilingualism and being a non-native speaker of the test language could potentially have two separate effects on EF and test performance. Statistically, the history of brain injury—not the language profile—predicted lower test scores on the FAVRES. But, we don’t know quite how the results might be different with a larger, more diverse bilingual mTBI group.

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Despite its limitations, this study provides enough evidence to support using the FAVRES as one tool to assess EF strengths and weaknesses in your bilingual patients with mTBI. Just remember to think twice before comparing their scores with the monolingual norms—particularly if your patients are non-native English speakers.

 

Ratiu, I., & Azuma, T. (2019). Assessment of executive function in bilingual adults with history of mild traumatic brain injury. Brain Impairment. doi:10.1017/BrImp.2019.17