THE EFFICACY OF IMAGERY MNEMONICS IN MEMORY REMEDIATION 2004

8/7/2019 THE EFFICACY OF IMAGERY MNEMONICS IN MEMORY REMEDIATION 2004

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~ PergamonNeuropsychologia,Vol. 33, No. 11, pp. 1345-1357, 1995Copyright 1995 ElsevierScienceLtdPrinted m G reat Britain. All rights reserved0028-3932/95 $9.50+ 0.00

0028-3932(95)00068-2T H E E F F I C A C Y O F I M A G E R Y M N E M O N I C S I N M E M O R Y

R E M E D I A T I O NJ O H N T. E. R I C H A R D S O N

Dep ar tme nt o f Human Sc iences , Brune l Unive rs i ty , Uxbr idge , Midd le sex UB8 3PH, U.K.(Received 10 May 1994; accepted 11 October 1994)

Al~ l ra e t - -Tr a in ing and ins t ruc t ions in the use o f menta l image ry can l ead to improv ed re t en t ion inpa t i en t s wi th memory impa i rment a s t he re su l t o f b ra in in ju ry o r d i sease . The amount o fimprov ement va r ie s inve rse ly wi th the seve ri ty o f memory impa i rment , bu t i s la rgely unre l a t ed toe i the r t he ae t io logy o r t he locus o f b ra in damage . I t a l so appea rs t o dep end on the pa t i en t s 'mot iva t ion ra the r t han the i r in t el l igence , educa tion o r image ry ab il it y . However , b ra in -damagedpa t i en t s may need exp l i ci t p romp t ing i f t hey a re to use image ry mnemonics successfu l ly and o f t enfai l to mainta in thei r use on similar learning mater ia ls or to general ise thei r use to new learningsi tuat ions. As a resul t , imagery mnemonics wi l l typical ly be of l i t t le pract ica l value in enabl ingmemo ry- impa i red ind iv idua l s t o r e spond to the cogni tive chal l enges o f eve ryday l i fe .Key Words : b ra in damage ; image ry ; l ea rn ing ; memory ; mnemonics ; r emedia t ion .

I N T R O D U C T I O NExperimental research has demonstrated that instructions and training in the use ofmental imagery lead to consistent, rel iable and substantial improvements in memoryperform ance [81]. This applies both to the use of simple interactive images in verbal-learning tasks and to mo re complicated mnem onic systems such as the pegw ord metho d o rthe me thod of loci (see Ref. [103]) . Defici ts in memo ry perform ance are a frequentconsequ ence of brain injury and disease [43]. The question therefore arises whetherinstructions and training in the use of mental imagery wil l al leviate the memoryimpairment encountered by patients with brain damage.This propo sal w as first put forward by Patten [68], who suggested that "such m nemo nictechniques ma y be the foundation of a new branch o f rehabil itation th erapy helpingpatients to recover their mem ories" (p. 26). He taught a variety of techniques to fo urpatients w ith verbal mem ory defici ts: tw o stroke patients, one case with an arterioveno usma lform ation and one case of herpes simplex encephalitis. T he procedures included a peg-word mnemonic in which concrete nouns (e.g. tea, shoe) were associated with the num bers1-10 and then used as mental "p egs" for remembering l ists or sequences of words, as wellas the use of more loosely structured interactive imagery.All four of these patients were able to use these techniques to improve theirperformance. Subsequent work confirmed that instructions and training in the use ofmental imagery could often lead to improved retention in brain-damaged individuals (seeRef. [87] for a review). These include patients with amnesia associated with K ors ako ff 'ssyn dro me or ence phalitis [5, 6, 26, 37, 39, 49, 50], patients wh o have un derg one unilateral

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1346 J. T. E. RICHARDSON

tem pora l lobe cto my [41], patients with closed hea d injuries [10, 11, 28, 33, 56, 86], patientswith cereb rova scula r disease [22, 53, 66, 94, 101,102] and patien ts with Pa rkinso n's disease[31].

Nevertheless, there are considerable individual differences in the benefits gained fromsuch training [29, 52]. At o ne extreme, Ric hards on and B arry [86] foun d tha t instruc tionsto use mental imagery raised the performance of patients with minor closed head injuriesto the level achieved by control patients. At the other extreme, a nu mbe r of studies havefailed to dem ons trate any significant imp rove me nt at all . Patten [68] himself me ntione d thelack of benefit from imagery training in three further cases: one patient with Alzheimer'sdisease, one with a tumo ur of the third ventricle and one wh o had undergon e surgicalrepair of an aneurysm of the anterior communicating artery. F our other studies also foundno en hancem ent of mem ory performance in cases of amnesia from various causes [2, 12,41, 94].

Clearly, i f training and instructions in the use of imagery mnemonics are to ha ve anypractical value in the remediation o f me mory disorders, i t is importa nt to understan d theorigins of this variability. In the first par t o f this paper, I shall discuss which characteristicsof brain-damaged individuals appear to be importan t determinants of the benefits whichthey gain from imagery mnemonics. I shall discuss in turn the lateralisation, aetiology andseverity of their lesions and the intelligence, education , m otiva tion and imag ery ability ofthe patients themselves. I shall go on to consider which properties of the learning taskswith w hich patients are con fronted influence the efficacy of imagery m nemo nicinstructions, and I shall conclu de by addressing the practical issue of whe ther brain-dam aged individuals who are given instructions and training in the use of imagerymnemonics will continue to use these techniques in their everyday lives.

L O C A L I S A T I O N , A E T I O L O G Y A N D S E V E R I T YLocalisation and lateralisation

Patten [68] considered that the three patients he had tested who had failed to benefitfrom m nem onic training had lesions in the midline structures of the brain. Elsewhere, heprop osed that such structures had a general ised function in the encoding of new memories,so that dam age to these regions wo uld give rise to a global m em ory deficit [67]. In con trast,structures within the two cerebral hemispheres had a specific role in encoding memories ineach modality; consequently, damage to these structures would give rise to selectivememory impairment which could be al leviated by encoding material instead using theintact modali ties.Mo re specifical ly, Patten [68] concluded that "each of the cases in which m em orytherapy was successful was able to overcome a verbal memory defect by the strategy ofencoding in the preserved, or relatively preserved visual modality" (p. 31). Clinicalinvestigations had confirmed that in these cases the brain damage was localised in the lefthemisphere (see Ref. [67]), and elsewhere he argued that these patients had been able tocom pensate for this damage by relying upon the intact capabili ties of the r ight hemispherefor creating mental images [69, 70]. This was indeed a natural conclusion to dra w fro m theconventional w isdom at the time that the r ight hemisphere contained the neural su bstrateof mental imagery [54].


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IMAGERY MNEMONICS IN MEMORY REMEDIATI ON 1347

Howe ver, Eh rlichm an and Barrett [16] showed that there was ac tually no reliableevidence to support this idea. Subsequent analyses based on case reports of the loss ofmen tal image ry following brain dam age [17], on research using medical imagingtechniques [32, 58] and on the f indings of experiments with patients who had unde rgon ecerebral com miss uroto my [19, 48] tended to emphasise the con tribution o f structureswithin the left hemisphe re to im aginal functioning. Nevertheless, mo re recently, Fara h [18]acknowledged that the available evidence was not wholly consistent, and Sergent [92]suggested that the mos t reasonable conclusion was that both of the cerebral hemispherescontrib uted simultaneously and conjointly to the process of image generation.

With specific regar d to the eff icacy of imagery mnemonics, a num ber of studies haveindeed confirme d Patten 's [68] original f inding that patients with left-hemisphere dama gemay benefit from mnemonic training or instructions [22, 31, 41, 93, 99]. Several of thesesame studies have however also shown that patients with lesions restricted to the righthemisphere do not differ from either normal control subjects or patients with left-hemisphere lesions in terms of the improvement which they derive from imagerymn em onic instructions. This indicates that the right hemisphere has no special role in thegeneration of mental images.More intriguingly, there have been several reports that instructions to use mentalimagery improve verbal me mor y in pat ients who have undergone cerebral commissur-oto my [24, 25, 75, 76, 78, 94]. Unfo rtunately , such reports were inadequately docu me ntedeither experimentally or clinically. However, the crucial f inding has now been formallydemonstra ted by Milner et al. [62] in the case o f eight com missu rotom y patients, of wh omsix were presumed to have undergone a complete section of the interhemisphericcommissures. As a group, these patients showed a significant improveme nt in the paired-associate learning of concrete words as a result of both experimenter-generated and self-generated images. This entails that the surgically isolated left hemisphere is capable ofimaginal encoding.Localisat ion and aet iology

The locus of brain da mag e in neurological patients typically depends up on the preciseaetiology of that damage. Relatively perman ent, stable and global impairme nts of recentmemory may result from damage either to the diencephalon (associated mainly withKorsakoff 's syndrome, thalamic infarction and tumours of the third ventricle) or to themedial temporal lobes (associated mainly with bilateral temporal lobectomy, herpessimplex encephalit is and anoxia). A number of case studies have also suggested thatsimilar (though often less severe) impairments m ay result from d amage to regions withinthe frontal lobes (associated mainly with intracranial aneurysms of the anteriorcom mun icating artery) (see Ref. [65], Chap ter 7).Lher mitte and Signoret [55] suggested that there were qualitative differences between thepatterns of impairm ent produc ed by diencephalic and temporal- lobe lesions, and there isnow substantial evidence for this point of view [64]. Weiskrantz [100] argued that in ma nycases apparen t differences between the two categories of patients co uld be attributed touncon trolled variation in the severity of their mem ory impairment, bu t i t is unlikely thatthis wou ld explain all of the differences tha t ha ve been o bserved (see Ref. [65], Ch apt er 8).Patients with anterior communicating artery aneurysms not surprisingly tend to showfrontal- lobe symptom s, but their me mo ry deficits may be the result of generalised arterialvasospasm rather than of localised frontal damage [84].


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1 3 48 J . T . E . R I C H A R D S O N

Patte n [70] asserted that imagery mnemonics "are of no value in the rehabil itation ofdeme ntia o r oth er general ised disorders of cerebral function, n or in patients w ith defectiveencoding of recent memory due to bi lateral midline lesions" (p. 352). However, mostresearch studies have not specifically tested whether the efficacy of imagery mnemonicsdepen ded up on the aetiology of the mem ory impairment to be al leviated. Leng and Pa rkin[51] found no significant difference between six patients with bilateral temporal-lobedamage (associated with encephali tis or posterior cerebral artery occlusion) and sevenpatients w ith diencephalic dam age (associated with Korsa kof f 's syndrom e) in the benefitsgained from imagery instructions, although the latter benefited less than the former fromthe provision of experimenter-generated images in the form of line drawings.

Mo re recently, Ga de [21] com pared the efficacy of imagery mnem onic instructions infour grou ps o f amnesic patients w ho were broad ly similar in the severi ty of their m em oryimpairment: 15 patients who had undergon e surgery for aneurysms o f the anteriorcommunicating artery; seven patients with diencephalic lesions associated with Korsak-off 's sy ndrom e or a tum our of the third ventricle; six patients with bi lateral tem poral-lobelesions associated with anoxia or with encephalitis; and seven patients with otheraetiologies. He found no significant difference among these four groups and concludedthat the aetiology and hence the local isation of the amnesic syndrom e was no t a significantfactor in the efficacy of mental imagery.Severity o f impairment

Nevertheless, a previous study repo rted by Wilson [102] had found systematic variationsin the effectiveness of imagery instructions that were related to the severi ty of memoryimpairm ent. She classified 36 brain-d ama ged patients with a variety of diagnoses intothree e qual gro ups on the basis of their scores in a delayed recall test for the passages in theLogical Mem ory c om pone nt o f the Wechsler Me mo ry Scale. On a test of paired-associatelearning, the patients who were classified as moderately or mildly impaired showed asignificant improvement in their performance as a result of instructions to use mentalimagery, but the patients who were classified as severely impaired did not. This suggeststhat patients with mild or moderate memory disorders can benefi t from imagerymnemonics whereas those with more severe disorders cannot [29].Acco rdingly, G ad e [21] reclassified his ow n amnesic patients into three group s in termsof the severity of their impairment as measured by their performance o n an independentpaired-associate learning task, and he similarly found differences in the benefits gainedfrom the adm inistration of imagery instructions. T he magnitude of their improve ment wasinversely related to the severity of their amnesia, a nd in particular the severely amne sicpatients typically showed little or no improvement at all as the result of self-generatedimagery. Hence, the primary cl inical determinant of the efficacy of mnem onic trainingwould seem to be the severity of the underlying memory deficit.

P A T I E N T V A R I A B L E SPatten [68] argued th at prem orbid characteristics of the patients themselves would alsoinfluence the efficacy of instructions or training in the use o f menta l imagery. He asserted:"Natural ly, low intel l igence, poor motivation, and poor imagination interfere with the

application o f the mnem onic system" (p. 31).


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IMAGERY MNEMONICS IN MEMORY REMEDIATION 1349

Intelligence an d educationThe role of intel ligence in this context is not clear. One study using norma l subjects foun d

that imagery instructions w ere of benefit only to those individuals who ha d obtained scores of110 or higher on the U .S. A rmy 's General-Technical Test [36]. There is nevertheless goodevidence that training in the use of mental imagery can b e beneficial even in the e ducablemental ly retarded [59, 63, 98]. Indeed, a study carried out w ith college students fou nd that theeffectiveness of imagery instructions was inversely related to their verbal ability; thisappare ntly reflected the sp ontane ous use of effective learning strategies on the pa rt ofsubjec ts of high verb al ability even in the ab sence o f specific instructions [60].

In neuropsyc hological research, educational attainm ent is sometimes used as a proxy forpre mo rbid intelligence, o r else it can be o f interest in its own right. G aspa rrini [23]suggested that training in the use of imagery mnemonics would be useful only to brain-damaged patients who were high-school graduates. I t is true that many studies have beenconce rned w ith patients w ho w ere educated to col lege standard [52]. Nevertheless, givenappro priate testing procedures, even children as young as 8 years can benefi t from trainingin the us e of ment al imag ery [15, 72, 74].Motivation and insight

Patt en [68] also stressed the importance of motiv ation and insight. Of the three patientswho fai led to benefi t significantly from training in imagery mnemonics, he stated that"none were aware of their memory defect or interested in improving i t" (p. 31). Theimporta nce of the patient 's m otivation is not surprising, given the effortful nature of mostmnemonic techniques. A patient 's motivation to engage in cognitive retraining maydepend upon the perceived relevance to the requirements of dai ly l iving of both thelearning task that is to be used for retraining and the cognitive strategies that arerecommended in order to achieve i t (see below).Unfor tunately , the f requency of mem ory complaints am ong pat ien ts wi th brain dam ageis sometime s uncorrelated with their level of impairme nt on objective psychom etric testing[44, 95]. This lack of insight compo unds the problem of poor m otivation w hen attem ptingto re med y me mo ry defici ts [89]. In deal ing with head-injured patients, Prigata no et al. [77]therefore incorporated psychotherapeutic interventions which were intended to develop"incre ased awa renes s and acce ptance o f the injury and residual deficits" (p. 507; see alsoRef. [78], Cha pte rs 5 and 6).Motivational factors may well explain two otherwise puzzling findings from my ownresearch on the effectiveness of imagery instructions in cases of closed head injury. First,middle-class patients benefi ted from these instructions but working-class patients did not,at least when tested by a middle-class psychologist [82]. Second, and independent of thiseffect, the benefi ts of imagery instructions decreased monotonical ly with age from theteens to the 60s, at least when the patients were tested by a you ng adu lt psycho logist [88].This pattern of results is unlike most effects of ageing on cognitive functioning, which arenormally not apparent unti l the 50s or 60s, and both findings are more plausibly to beinterpreted in terms o f variations in perceived dem and characteristics.Imagery ability

Obviously, any benefi t to be gained from the use of imagery mnemo nics depe nds on thepreservation of mental ima gery and the patient 's pre morb id abil ity to construc t and


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[83]. Seeking to improve m em ory function in neurological patients in a global manner bymeans of mental imagery and o ther mnem onic devices imposes fur ther dem ands upontheir already impaired m em ory for specific episodes and events. Glisky and Schacter [29,30, 91] have suggested instead that rehabilitation should exploit their residual learningcapacities and prior knowledge to facil i tate the acquisition and retention o f knowledgewithin partic ular dom ains of practical significance to patients themselves.

The co mplexity of the learning task is also important. Baddeley and W arrington [2]foun d no imp rovem ent in a heterogeneous group o f amnesic patients when they were giveninstructions to m ake u p mental images which l inked together groups of four i tems.However, Cermak [5] hypothesised that amnesic patients might be able to benefi t fromsomewhat less complex images, and he found indeed that imagery instructions enhancedthe recal l performance of Kors ako ff patients when learning simple paired associates. Ingeneral, the efficient use of mne mon ics de man ds vigilance and planning, and yet it isprecisely this sort of function that might be comprom ised in brain-damaged patients [91].Hence, the elaborated learning task should make only reasonable demands upon theirresidual information-processing capaci ty.

These issues have been illustrated by research on memory training in the elderly [71].Older subjects show less benefi t than younger subjects when asked to learn long l ists ofwords using a more complex mnemonic device such as the method of loci [3, 46, 47].How ever, they sh ow as much benefit when asked to learn short l ists of words by the sameme thod [80], and they tend to show more benefi t than younge r subjects when simply askedto co nstr uct linking images in the conte xt o f paired-a ssociate learning [4, 40, 90]. Thismight nevertheless require adapted procedures (e.g. longer acquisition and retrieval times)if older individuals are to benefit from imagery training [97].

Nevertheless, brain-damaged patients do seem to have problems in the spontaneous useof menta l imagery. Norm al individuals show an improvem ent in their me mo ryperform ance from the use o f ei ther experimenter-generated images in the form of linedrawings or self-generated mental images, and in older adults at least the amount ofimpro vem ent tend s to b e greater in the case of the latter than in the case of the forme r [40,96, 97]. In contrast, patients with memory impairment may benefi t more when images arepro vide d by the experim enter (e.g. Refs [11], [39], [41], [62] and [96], but cf. Ref. [51]).

Similarly, brain-damaged patients may need to be prompted or reminded at the time ofrecal l that they used mental imagery to learn the cri tical material i f they are to show anyimpro vem ent in their performance. Jon es [41] found that patients w ho had u ndergon ebilateral temporal lobectomy appeared to forget that they had previously formed animaginal association l inking the i tems to be remembered and so were unable to use theseimages at the time of recall . Cerm ak [7, 8] reported tha t the Ko rsak off patients wh o hadbenefited from imagery instructions in his earlier study [5] had nevertheless had to bereminded constantly of the specific image they were suppo sed to be using on eac h learningtrial and of the fact that they had used that mnemonic at the time of retr ieval .

In general , witho ut explici t structure at the time of learning an d explicit prompt ing atthe time o f retr ieval amnesic patients ma y show no im provem ent as a resul t of training o rinstructions in the use o f mental imagery. O f course, such explicit structure and prom ptingis not l ikely to be encountered outside the psychological laboratory or the cl inicalassessment room. For this reason alone, imagery mnemonics might well be expected to beof very l itt le value in enabling brain-dam aged individuals to resp ond to the cha!lenges ofeveryday l i fe unless they can also be trained to generate their own internal cues or


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1352 J.T.E. RICHARDSONreminders [87]. This demands a broader-ba sed appro ach to rehabil itation th at integratesthe cognitive and noncognitive modes of psychological processing [38].

M A I N T E N A N C E A N D G E N E R A L I S A T I O NPatten [68] made no systematic attemp t to fol low up his patients ' use of imagery

mnemonics in daily life, but in some cases their anecdotal reports indicated that theycontinued to use these techniques many m onths after their original training. Gianuts os [26]similarly found that one postencephali tic amnesic continued to use mental images orsimple stories as mediating devices to recall word lists for 2-3 weeks after his formaltraining had been discontinued. Malec and Questad [56] also found tha t a mildly impairedpatient with closed head injury learned to use imagery as a mediational device withoutprompting from his therapist. However, other researchers have not found convincingevidence that brain-damaged patients continue to use such devices in similar learning tasksbeyond a few days in the absence of explicit instructions to do so [7, 10, 22, 37, 53, 102].

Apa rt from the maintenance of imagery mnemonics b eyon d the period of formaltraining, one would also hope that patients could generalise their use to other tasks andparticula rly to learning situations in daily life. Crosson and Buenning [10] foun d th attraining a patient with closed head injury to use imagery and other devices to learn shortparagrap hs of text had mo dest benefi ts for his performance on other m em ory tasks.However, other researchers have found little evidence of generalisation of imagerymne mon ics to different tasks in brain-da ma ged patients, still less of any transfer tolearning in ev eryd ay situations [22]. This is not a specific limitation of imagery m nem onics,since similar problems are encountered in using methods based upon purely verbalelaboration or m ediation [34, 102]. In fact, brain-damaged individuals tend to reject bothverbal and imaginal techniques as being inappropriate or irrelevant to their needs inever yday life and instead prefer to use external me mo ry aids [10, 27, 28].

One aspect o f Patten 's [68] original study that has been generally neglected insubs equ ent research is the potential no ncognitive benefits of training a nd instruc tions inthe use of mental imagery. Patten com mente d that the patients for whom his memo ryremediation was successful were able to rely upo n their ow n m em ory skil ls rather thanthose of others, and that they experienced a marked increase in self-esteem as a result. Ofcourse, even those patients who d o show im proved retention m ay well not experience anyincrease in self-esteem if they attac h relatively li tt le importance to m emo ry im provem ent incomparison with other personal goals. Conversely, i t has been argued that having to relyon external mem ory aids might rob brain-damage d patients of any sense of ownershipover their own co gnitions and generate a pro fou nd existential anxiety [61]. This mightexplain why patients often fail to use external memory aids in an efficient way [29].

A S S E S S M E N T A N D C O N C L U S I O N SIt is quite clear that training a nd instructions in the use of menta l imag ery can lead toimproved retention in various groups of brain-damaged patients. These mnem onic

techniques do enable brain-damaged patients to impose some associative structure on anarbi trary a nd uns tructured dom ain o f information. H owever, the effective deploym ent ofthese techniques in daily life depends on the patients' "metacognitive" skills: that is, thepatien ts' aware ness o f how, w hen and w here such techniques shou ld be used [9, 45, 73].


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Research ers studying method s for improving me mo ry function in older adults have arguedthat, rather than teaching any particular mnemonic techniques, i t would be much morebeneficial to en courage the deve lopment of self-monitoring and other m etacognitive skil ls[13, 71], and this demands the use of somewhat different instructional methods [73].

Unti l the problem s of maintenance and general isation are adequately tackled, imagerymne monics are l ikely to be o f very limited value in the remediation of mem ory disorders.Indeed, in contrast to the enthusiastic tone that he had adopted in his earl ier wri tings,Pat ten [70] concluded more modest ly that " the ancient mem ory ar ts . . , may have a ro le inthe rehabil itation of brain-damaged patients" (p. 346). Howeve r, he remarked that theirusefulness would also be l imited by the substantial a mo unt of time neede d to trainindividual patients: "Th e current high cost of a neurologist 's t ime precludes theneurologist teaching the mem ory arts since a substantial am oun t o f time is involved andtrue mas tery of art of mem ory requires at least an hour 's work dai ly for 6 wee ks" (p. 352).

In a similar vein, Schacter a nd Glisky [91] noted that the average gain per patientresul ting from a cognitive retraining programme described by Prigatano et al . [77] was anaverage increase of one i tem on relevant subtests of the Wechsler M em ory Scale as a resul tof roughly 625 hr o f training del ivered by professional rehabil i tation specialists. H owe ver,Wils on [102] not ed tha t successful reme diation c ould ha ve very significant benefits in termsof both a reduced demand upon medical resources and the increased economicindependence of patients ' relatives ( if not of patients themselves). She also propo sedthat routine cognitive retraining c ould be del ivered by unpaid volunteers, bu t this ignoresthe fac t that in practice suc h duties are likely to fall up on the patien ts' female relatives whomay themselves have other domestic or occupational responsibi l i ties [79].

An equally serious proble m is that any benefits from im agery training tend to v ary withthe severi ty of mem ory impai rment . On the one hand, the performance of the mostprofoundly impaired patients may simply remain at a f loor throughout their training (e.g.Refs [12] and [41]). I t has been suggested that these patients may well benefi t mo re fromexternal aids and environm ental restructuring [102]. On the othe r hand, the performan ceof patients with minor closed head injuries can be raised to the level of normal controls[86], but in this population the memory impairment is quanti tatively sl ight and typical lyresolves within the first few weeks following the injury [85]. Parad oxically, then, anybenefi ts of imagery mnemonics wil l be inversely related to the need for memoryremediation.Acknowledgements--I am most g ra tefu l to Alan Baddeley, Michel Denis and a n an onymous r ev iewer fo r the i rcomments and suggestions.

R E F E R E N C E S1. Baddeley, A. D. Amnesia: A minimal model and an interpretat ion. In Human Memory and Amnesia, L. S.Cerm ak (Editor) , pp. 305-336. Lawrence Er lbaum , Hillsdale, New Jersey, 1982.2. Baddeley, A. D. and W arr ingto n, E. K. Me mory coding and amnesia. Neuropsychologia 11, 159-165, 1973.3. BaRes, P. B. and Kliegl , R. Fur ther test ing of l imits of cognit ive plast ici ty: Negative age dif ferences in amnemonic skil l are robust . Devl Psychol. 28, 121-125, 1992.4. Canes trar i , R. E. , Jr . Age differences in verbal learning and verbal behavior . Interdiscipl. Topics Gerontol. 1,2-14, 1968.5. Cerm ak, L. S. Imagery as an aid to retr ieval for Korsak off patients . Cortex 11, 163-169, 1975.6. Cermak, L. S. The encoding capacity of a patient with amnesia due to encephali t is . Neuropsychologia 14,

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