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Memory Strategies for Veterans with TBI and PTSD

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Memory Strategies for Veterans with TBI and PTSD

Here are some memory strategies that can be used for Veterans with TBI and PTSD.  They are from my 8 years of work with Veterans with TBI and PTSD, and many of the ideas came from Veterans themselves.

  • Remembering _______ I gotta do (healthcare appointments, paying bills, chores, anniversaries, birthdays, or one and the same!)
  • Don’t leave the house without ________ !!
  • Where the bleep did I put my _________ ??

These are challenging because they rely on holding information in the brain’s temporary sketchpad for future use.  If you keep up with the research studies, scientists call this working memory.

Do you ever feel like the only person out there who deals with this?

You’re not alone!  This ability can be compromised by many conditions experienced by a young veteran or service member (such as stress, sleep deprivation).

The goal of these strategies to help you revamp your organizational system and use some more strategies in your environment to remember things, before we add strategies where you can’t do so (internal strategies that rely on your brain alone).

But I Want to Improve My Memory…Why Do I Need a Better Calendar System? 

I Never Needed One Before….and Selecting Habits in Using The System that Don’t Trigger Combat Stress Symptoms

  • A calendar system is Step 1 to improving your memory.
  • It is your parachute or base because it frees up your brain.
  • A calendar system may only be needed temporarily until things stabilize in your life and you get a routine down.
  • It is the most effective way of addressing the 3 memory problems listed above.
  • Until you get to-do items on paper, they are swimming around in your head and using up mental energy to remember things. The calendar system will free up mental energy and will eventually become your backup system.
  • The calendar system has the potential to increase your activity level…may be good for mood and sense of purpose.
  • It adds structure and routine which can help stabilize your life.
  • You may have used a calendar in the past, but this time you’ll be using it for more purposes:
  • To-do list that tracks past, present, and future to-do’s
  • Journal
  • Note-taking: like a Leadership Notebook
  • The calendar works like an organizational system, and we know that material that is organized will be better remembered than material that is not
  • Just the act of making an entry in the calendar system helps you remember it later…there is a MUSCLE MEMORY to entering items into your calendar.
  • Consider a calendar type that you used effectively in the past, that involves minimal transfer/re-copying between calendars, and low stress – what did you use in the past?

Post-Traumatic Stress Tip:  Getting an organizational (calendar) system going is a trial and error process.  If one system doesn’t work, try and see it as a temporary setback and opportunity for self-discovery.  Many veterans and service members will enlist the help of another person in initially setting up the system, and then they can take it from there.  Some will ask their primary care doctor for a referral to see a Speech Pathologist, Occupational Therapist, or other rehabilitation professional who has expertise in helping people set up calendar systems (they’re not working on your speech in this case!).

Ideas for organizational calendar systems:

  • Electronic Calendar on your phone, or iPad
  • Pros: you can program repeatable events, you can set alarm reminders; easy to keep with you at all times; could potentially link with Google Calendar or other (like Outlook-based) calendar system.  Some will sync their phone calendar with a desktop computer calendar.  Google calendar could potentially be managed by another person you trust.  If you use an iPhone, there is an App you can download called Calendar with Alarm, which makes alarms go off “loud and long” until you extinguish them (sometimes it’s easy to miss the iPhone alarm).
  • Cons: can be hard to see everything you have going on for the week or month (“big picture view”) at once; easy to misplace; can be overly complex; expense (although sometimes this can be provided as part of your medical care if it is justifiable and occurs as a part of cognitive rehabilitation).
  • Paper pocket size calendar
  • Pros: can keep with you at all times
  • Cons: no alarm reminders; easy to misplace
  • 5 x 11 size paper calendar
  • Wall size hanging paper calendar
  • Pros: Easy to see how your day/week looks; others can help and modify (or is this a con?)
  • Cons: Hard to transport for reference or appointment entry
  • Dry erase board where you draw calendar days with marker
  • Pros: Easy to see how your day/week looks; others can help and modify (or is this a con?)
  • Cons: Hard to transport for reference or appointment entry
  • Desktop computer calendar: can use calendar in Microsoft Outlook
  • Pros: Could sync to phone; could print out appointments/reminders directly from calendar
  • Cons: can’t take it with you

Action Steps:   “ACDC”:  A Strategic Method of Keeping Yourself Organized

You can have the best calendar and it won’t work without at least some of the following user behaviors on your part.  Here is an acronym to help you remember these 4 routines.  Notice that the first letter of each makes the acronym “ACDC” – just think of the music group or batteries with AC DC current:

  1. Always have the calendar with you.
  1. Check the calendar frequently.

> Tip:  You are more likely to remember to check the calendar frequently if you “book-end” it to another routine you are doing, like checking after breakfast, lunch, and dinner.  Some people develop a motto like “Eat, check today, check tomorrow” referring to checking today’s calendar and tomorrow’s calendar.

Post-Traumatic Stress Tip:  Some say that it helps their stress level to say the following:  “Don’t think about what is next or tomorrow.  Just remember to check your calendar a lot.”

  1. DO IT, WRITE IT, OR FORGET IT: AS SOON AS you receive the information you need to remember for later (e.g., appointment) WRITE IT OR ENTER IT in your calendar.  Use the same calendar to record all appointments.
  1. CROSS OFF THE DAYS AS YOU GO when you have completed everything you need to do for that day. If the day is not crossed off by the end of the day or the next day that is a cue to your brain to look back and add missed tasks to an upcoming day.

Post-Traumatic Stress Tip:  Avoid checking your calendar RIGHT BEFORE bed as this has been known to create worry at night (about all the things you need to do or haven’t done), making it more difficult to sleep.

Post-Traumatic Stress Tip:  Using the 4 ACDC habits might seem taxing at first…it will get easier as you make it a routine.

What is ACDC?…Breaking it Down Barney-Style (Remember this from the military?)

  1. Always keep calendar with me
  2. Check calendar all the time
  3. Do it, Write it, or Forget it (applies to writing the info down asap or you’ll forget it)
  4. Cross off the days as you go

Actions/Tips:

  • You MUST have a CENTCOM (remember this from the military?) or HOME BASE or AUTOMATIC PLACE YOU AUTOMATICALLY CHECK every day for your calendar. Don’t put it down; put it away.  As you put it away, say out loud or to yourself, “I’m putting this ____ (say location, what it’s next to).”
  • Bookending: It works really well if you “bookend” any activities you need to do (including checking your calendar) to a routine you’re already doing.  So, you would check your calendar right after you walk the dog, eat breakfast, and/or brush your teeth in the morning.  You’re bookending your eating routine with checking your calendar.
  • Macgyver It: “Improvise, Adapt, and Overcome” (remember this from the military?):  Some who forget their medications will create a wall calendar using dry erase marker.  They will write times on the calendar.  They will then use one-sided adhesive and one-sided Velcro strip to Velcro medication bottles to the calendar and write a symbol (e.g., face with expression) indicating that they have taken that medication when they did so for that day and time.  The next day the bottle gets moved over to the next day on the wall calendar.  Of course they kept this out of reach of kids and vulnerable individuals.
  • Have a Strategic Planning Check-In or Meeting with Yourself: Once daily in the earlier part of your day briefly review the upcoming day’s events with a glance back at yesterday to carry undone items over to today if need be. Once a week you can do the same for the entire week.  This is like having the Plan of the Day in military terms.  During this planning check-in you make sure everything is entered for the next day.

Post-Traumatic Stress Tip:  People have found it works best to do the planning meeting once daily so things don’t pile up – piling up leads to feeling depressed.  Also cultivates the “one day at a time” mentality that prevents overload.  Sometimes glancing at a de-cluttered calendar can help you get started on a task.

Remembering Stuff You Need to Act On(Healthcare Appointments, Anniversaries, Chores, Taking Medications, Paying Bills)
Would definitely do this Would consider but haven’t done yet Would never do this  
Establish a base.  Choose a central or main calendar or planner (paper or electronic).  Write everything down and keep everything written mostly in one place.
Do It, Write It, Organize It, or Forget It!> Do the task right away> If you can’t do it right away, or it’s not appropriate, WRITE it down right away (key words on your hand works!)> If you can’t write it right away, organize it in your thoughts with some other idea (RELATE it to some other idea). It’s like mentally filing things that belong together in the same file folder.

 

Use your calendar as your to-do list
Carry your notebook or electronic organizer with you at all times or have in your vehicle at all times, and consider having a pad or sticky notes on hand in your vehicle at all times.
When you get incoming information that you need to later have in your calendar:Elevate the importance of the incoming information.  Tell yourself, “I have some information I need to manage in some way so it gets out of my head and on to paper so I can recall it later.”  Focus on the thing you need to remember over and over.  Say, “That’s my mission” until the appointment gets entered.  Sometimes you need to shift to “thinking about your memory” until you can get the item entered.Post-Traumatic Stress Tip:  Be careful not to elevate the importance of the mission of recording the information too high, so that it causes unnecessary anxiety.  Research shows some anxiety mobilizes us, but it’s a U-shaped curve (very low and very high anxiety will backfire!)

 

If you get an appointment slip for a future appointment reminder (good to always ask for one), make sure your appointment slip is in the same hand as your phone until you can input the appointment into your phone.
Link checking your calendar OR taking your medication OR some other item you need to remember to do to some routine or habit you’re already doing, like eating breakfast or brushing teeth.  This is called “bookending” or “linking tasks.”
Some say, “Don’t think about what is next or tomorrowJust remember to check your calendar frequently.”  This takes the burden off of your mind.
Have a planning meeting with yourself where you schedule your next day or the upcoming day or review to make sure you have completed all tasks from earlier in the day.
Use a Memory Notebook for things you need to remember as a temporary transfer center, where you don’t have your calendar, and then transfer the info to your calendar later (e.g., during a planning meeting).
Timers / Alarms:  Use alarms on cell phones/watches that can be set to remind you to take medication, attend appointments, perform errands and responsibilities.Post-Traumatic Stress Tip:  You can set an alarm to music so the “buzzing” or “vibrating” doesn’t trigger post traumatic stress
Make a “Modified To Do” List in the following situation:  I’ve got 50 projects going but I haven’t finished any of them.” One solution is to buy a small dry-erase board and put it up in the home (or office). On the board, you only list your top 5 priority items on the “To Do” list.You would not add another item to the board until you have completed one of the items already on the board.You can put this somewhere in your house where other people can see it. Other people can also use it to offer suggestions to help you to get projects organized. This board can also give those you live with a better understanding of all of the things that you are dealing with, and illustrates to them that you know these things need to be dealt with, so they don’t bug you.

 

Post-Traumatic Stress Tip:  You can keep a master list of many to-do items stashed away hidden from sight (for reassurance that you won’t forget), but only keep the 5-item list in sight….greater than that can trigger post traumatic stress!

 

Some people will create high, medium, and low priority lists to triage what they have to do so it doesn’t overwhelm them…others find that using the term “steps to completion” seems to help them manage the stress of completing a task.

 

Just the act of making and categorizing a to-do list helps you remember the items.
Create a template of things you typically have to do, that you can just print out or re-copy.  This serves as a cue (since cues are better than “free recall” from memory, in reminding us of what needs to be done).  Categorize your to-do list:  Consider separating your weekly schedule to-do list into categories, such as yard, house, work, and financial, and monthly and weekly repetitive activities such as taking out the trash.  Review at the end of the day to ensure you have done those things.  See example.
Medications:  Use a pill box or see if your primary care doctor can obtain one for you.
Medications:  Use environmental cues such as sunrise, sunset, meal times to remind yourself to complete certain tasks or to check your calendar
Medications:  Get in a routine about this…take at the same time every day
Ask another person to provide reminders for you (it can help you remember just by asking them) 
Paying bills:  Use “OHIO” to remember to pay bills – Only Handle It Once.  Deal with the bill as soon as you see it, the first time you get it.  Stop all other forward movement until you deal with it.  You can tell yourself, “I won’t have to worry about this later if I do it now.”  This could apply to other projects and chores as well.
For items to be remembered later….Leave yourself voicemail messages (call yourself); post yourself messages on Facebook; email or text yourself.  Just the act of leaving the message or emailing yourself helps you remember later without referencing the actual message.
Make signs to help you remember important things:  “Stop! Check Keys.”  Place on your door or steering wheel to avoid locking self out of home or car.

Post-Traumatic Stress Tip:  Keep any to-do lists folded in or attached to your calendar – the more loose sheets of paper you have lying around, the more stress.  Consider a folder, too, for to-do lists that you keep with your calendar.

Don’t leave the house without _____ !
Would definitely do Would consider but haven’t done yet Would never do
Have a bag of stuff that you never leave home or go anywhere without (“my surrogate brain”).  This can be a messenger bag, briefcase.Some people will put the bag in front of the door where they literally have to trip over it when they leave so they don’t forget.Other people will leave important items or the bag with items on the toilet seat – could be challenging with other people in the home, but they may work with you if it’s important!

 

Use an “automatic place” or “home” for your stuff that you automatically check for things before you leave the house that you need to take with you:  If your designated spot includes hanging the items on your front door in a clear plastic grocery bag, you can’t turn the door knob without seeing the bag.  This is like an automatic place that you check before you leave the house.
Make and use Appointment checklists (questions for doctors, etc.).  This can be entered as a note in your phone, too.
Veterans have used this effectively:  Use a designated medical folder that you bring to every appointment where you staple or tape every doctor’s business card in the inside.  This will help you remember details about the visit and the doctor’s name.
Cross check to ensure you have everything (some people will touch their pockets in a ritual routine to ensure they have keys, wallet).
If there is something  you need to do before you leave home every day, and you drive after that, adjust something in your car in an out of place way (like put the visor down) so that only after you have closed the garage door do you flip your visor up.  Seeing the visor out of place will remind you that something needed to be done (like close the garage door).
You can use automatic shut-off applications (coffee-maker, iron).  Buy these at any hardware store.
Touch all the knobs on the stove/range after every time you use it to ensure it’s turned off.

 

Where the bleep did I put my ________ ?
Would definitely do Would consider but haven’t done yet Would never do
Use the motto “Don’t put it down, put it away” – put your keys, glasses, wallet, etc. in a designated spot and keys in a certain place EVERY TIME.  When you come home every day, stash your stuff in the same place so you avoid the “scenic route” of looking for it.  As soon as you enter the house, put things away where they belong.
KEEP COMMON ITEMS IN THE SAME PLACE AT ALL TIMES (like “Cen Comm = Central Command”):  Have a special key hook and always leave your keys there, keep a spare set of keys in a strategic place.  Have one location for mail (bills).Have a specific location (refrigerator, bulletin board, or message board) for phone messages and reminders; choose a location easily seen as you enter or leave the housePost-Traumatic Stress Tip:  Having people move your stuff who live in your home can really cause rage if you’re trying to get organized!  Consider locating things in high places where others don’t go / can’t reach but where you safely can (on top of refrigerator) or a locked cabinet only you can access.  Or, work your system out with them in advance so they don’t mess with it.

 

Get a file box and file papers in it as soon as you get home.  This could be as simple as a three ring binder with folders.
Use Carabiner (hooks to pants) or lanyard (hooks around neck) to carry keys attached to you, or cords.
If you tend to forget items such as medication or keys in the morning, put them by your coffee maker – most people don’t forget the coffee!  Or, put items on your clothes for the next day, or in your car.
Keep your environment organized so that reminders are visible.Balance redundancy in reminders with excess reminders.Reminders in exit or entry points of vehicles and homes work well since people naturally pause to adjust clothing, use keys. While the safety of this will need to be evaluated by you, some people will put items they need to take with them every day inside in front of the door they leave through every day, so that they can’t leave without having to literally step over or bump into the items.

 No doctor-patient relationship is implied or established through the posting of these suggestions.

About the author.  Dr. Ana Messler is a board certified clinical neuropsychologist and licensed psychologist based in Charlotte, NC who has provided thousands of evaluations where the question of traumatic brain injury and symptom validity were raised.  She has also served as expert consultant and witness.  She believes it is critical to provide a scientifically defensible opinion, and to help the jury and court understand the implications of the neuropsychological aspects of cases before them.

 

 

 

By | 2017-05-25T13:35:32+00:00 July 6th, 2015|traumatic brain injury|0 Comments

About the Author:

Dr. Messler is a board certified clinical neuropsychologist and licensed psychologist who has provided thousands of evaluations where the question of traumatic brain injury was raised. She has also served as expert consultant and witness. She believes it is critical to provide an objective, scientifically defensible opinion, and to help the jury and court understand the implications of the neuropsychological aspects of cases before them. As a prior active duty neuropsychologist, she has extensive experience in the area of military forensic neuropsychology.