Memory and Learning Tests
Memory involves cognitive mechanisms used to register, retain, and retrieve previous events, experience, or information (23). All aspects of this activity need to be assessed to provide sound diagnostic information in addition to developing remediation or compensatory strategies.
Questions of ecological validity are particularly cogent in memory evaluation, as necessary types of memory cannot be assessed in the testing situation. Adaptive behavior questionnaires and devices that attempt to incorporate real-life situations, like the Rivermead Behavioral Memory Tests, are useful to round out more traditional assessment tools, which are largely based on theoretical laboratory models. The nature of material to be remembered in everyday life is different, but so is a naturalistic setting, and the attendant natural distractions are part of many instances where memory is needed.A full examination of memory covers a number of distinctions, including declarative/explicit versus implicit/procedural memory, recognition versus recall, encoding versus retrieval issues, prospective and remote memory, short-term/working memory versus long-term memory. A prime distinction is verbal versus nonverbal memory, and it should be included as a referral question in most situations.
Findings need to be viewed in the context of the recognized developmental changes in memory functioning through childhood (60). Developmental changes that mark the progression toward mnemonic competence are attributable to the child's growing proficiency in the use of strategies to aid encoding and retrieval of information.
In situations of traumatic brain injury, there is a specific role for monitoring the time span where brain functioning was insufficient to record ongoing environmental input, referred to as post-traumatic amnesia (PTA). This is done through tracking orientation and return of continuous recall. The latter refers to the brain's resumption of the capacity to register everyday occurrences on an automatic basis. For pediatric rehabilitation, the Children's Orientation and Amnesia Test (COAT) was developed for this purpose by Ewing- Cobbs and colleagues (61), based on the Galveston Orientation and Amnesia Test for adults. The duration of PTA has been shown to more reliably predict recovery than the Glasgow Coma Score (GCS), the rubric used in general medicine to judge severity and, by implication, prognosis. Retrograde amnesia should also be assessed, representing the time span for which formation of long-term memory was disrupted, so that minutes, hours, and sometimes days prior to the injury are not recalled. This also requires serial monitoring, as restoration of retrieval processes results in more information being recalled as the brain recovers. For retrograde amnesia, the monitoring is essentially just patient responses to questioning of events leading up to the injury (Table 3.4).