Rehabilitation of the central executive component of working memory: A re-organisation approach applied to a single case

Abstract

This paper describes and evaluates a programme of neuropsychological rehabilitation which aims to improve three sub-components of the working memory central executive: processing load, updating and dual-task monitoring, by the acquisition of three re-organisation strategies (double coding, serial processing and speed reduction). Our programme has two stages: cognitive rehabilitation (graduated exercises subdivided into three sub-programmes each corresponding to a sub-component) which enables the patient to acquire the three specific strategies; and an ecological rehabilitation, including analyses of scenarios and simulations of real-life situations, which aims to transfer the strategies learned to everyday life. The programme also includes information meetings. It was applied to a single case who had working memory deficits after a surgical operation for a cerebral tumour on his left internal temporal ganglioglioma. Multiple baseline tests were used to measure the effectiveness of the rehabilitation. The programme proved to be effective for all three working memory components; a generalisation of its effects to everyday life was observed, and the effects were undiminished three months later.

This project was supported by a grant to Julie Duval from the Communauté française de Belgique in association with the Ministère de l'Éducation du Québec (2004–2005), and from BCEI J-Armand Bombardier (2003). We are indebted to Victor for his participation. We would also like to thank Cécile Prairial and Auriane Speth for their collaboration.

Notes

1 The QAM contains 48 questions on the functioning of memory in daily-life situations: conversation, watching television, reading, personal information, people's names and faces, etc. this questionnaire has been standardised on 324 control subjects. For every question, the patient has to indicate the frequency of his or her difficulties along a 6-point Likert scale, ranging from “never” (score 1) to “always” present (score 6). The range of the total score is thus between 48 and 288.

2 The QAA is a questionnaire structured in the same way as the QAM but with the emphasis on attentional functioning in everyday situations. The norms have been derived from 426 control subjects. The questionnaire is composed of 55 questions, using the same 6-point likert scale as the QAM. The range of the total score is thus between 55 and 330.

3 The QAMT contains 14 questions related to the functioning of working memory. At present, there are no norms. Again, 6-point likert scales are used, and the range of the total score is thus 14 to 84.