Download Memory and Concentration - Epsom and St Helier hospitals

St. Helier & Sutton CFS Service
Memory and Concentration:
Concentration
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People with CFS/ME have a tendency to lose concentration or be easily distracted from what they
are doing.
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This lack of concentration can have a direct impact on a persons’ ability to retain information.
This inevitably leads to memory problems. Attention can have an effect on encoding the
information.
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People with CFS/ME often complain of not being able to enjoy activities such as reading,
watching a television programme from start to finish, writing emails, etc.
Attention: is the cognitive process of being able to selectively concentrate on one aspect of the
environment you are in while being able to ignore other things.
Levels of Attention: (Sohlberg & Mateer, 1989)
FOCUSED ATTENTION: means the ability to respond discretely to a specific visual, auditory (sound/
hearing) and tactile (touch) stimuli. E.g. Listening to music
SUSTAINED ATTENTION: refers to one’s ability to maintain prolonged concentration on a continuous
activity or a repetitive activity e.g. Watching a movie.
SELECTIVE ATTENTION: this is a level of attention where one has the capacity to continue to participate in
a activity despite the distraction that maybe occurring near by – ‘freedom from distractibility’. A distraction
may include pain, fatigue, other people, the radio etc.
ALTERNATING ATTENTION: refers to the capacity for mental flexibility – it allows you to shift your focus
of attention between activities or tasks that often require different cognitive/ metal requirements.
DIVIDED ATTENTION: this is the highest level of attention and it refers to one’s ability to multi-task, either
engaging in multiple activities or task at once or engaging in multiple aspects of the one activity.
Helpful strategies
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Try to control the environment at home, work or in the therapy setting in order to minimalize
possible distractions. E.g. – excess noise, room temperature, bright light etc
Plan activities in short sessions allowing regular breaks. e.g. read for five minute intervals more
frequently.
Set realistic goals as far as reading is concerned. It may be easier to start with magazine articles,
short stories or poetry rather than novels or text books.
Try to engage in activities that require less concentration, i.e., physical activities, such as
walking or working in the garden.
To increase concentration, activities will need to be gradually upgraded in e.g., time, the
amount of distraction & the complexity of the activity. You can also apply pacing strategies.
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St. Helier & Sutton CFS Service
Memory
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It is worth noting that approximately 25% of the general population says their memory lets them
down.
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Memory is not like making a video – inaccuracies do arise.
Some of the most common problems with memory are…
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Losing things/ misplacing items.
Having to go back and check that you have done something.
A ‘tip of the tongue’ experience.
Forgetting people’s names.
Passing messages on e.g. from phone calls.
Remembering details read in a book or newspaper.
Remembering to take medication.
Not being able to recall information given in an appointment.
We all have these difficulties to some degree, but they are often more pronounced in people with CFS/ME.
Types of Memory:
It is important to be aware there are different types of memory, most people are aware of:
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Short-term memory – where information is temporarily stored for a small portion of time. Short-term
memory allows us to recall 7 to 9 items or chunks of information for example a telephone number
long enough to dial it.
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Long term memory – allows items to be stored for longer periods of time e.g. your childhood
memories or a friend who came to stay with you last year.
Memory is not just good or bad; there are more aspects to memory rather then just short or long term. These
include:
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EPISODIC – includes personal memories to you or events.
SEMANTIC – is memory or knowledge of facts (e.g. used in a pub quiz)
PROCEDURAL – remembering how to do things (e.g. riding a bike, touch typing, driving a car)
WORKING MEMORY AND PERMANENT MEMORY – an example of a working memory is
trying to hold a piece of information in your memory while manipulating it e.g. keeping a total in
your head of the cost of your groceries while adding another expense on to the total.
VERBAL & NON-VERBAL -. Some people tend to remember more from what they see e.g.
pictures, others find they remember more of what they have heard e.g. sounds & words, as well as
smell, taste or touch.
RECOGNITION & RECALL – as in seeing something that you recognize because you recall you
have seen it before e.g. seeing a face and remembering their name.
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Stages of Memory
1. ENCODING – getting the information into the memory area of the brain.
(If you have difficulty with your concentration this can influence the encoding stage)
2. STORAGE – keeping the information there.
3. RETRIEVAL – access the information at the time you need it.
Memory can be affected by:
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Medications.
Emotions – e.g. stress, anger, frustration etc.
Environment – e.g. are you being distracted while trying to recall something or trying to commit
something to memory?
Nature of what you want to remember – more likely to remember information that is of personal
interest.
Fatigue.
Useful strategies for Memory Difficulties
External Strategies/ Compensatory techniques:
1. Diary
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It keeps a record of what you have done in the past as well as what you need to do in the
future.
Everything goes in the diary and keep it in the same place so you can find it.
Set yourself a routine time of when you look at your diary.
2. Notebook
 Use to write things down, for example telephone numbers and messages.
 Create a list of things that need to be done.
 Make a checklist to ensure you don’t miss things out or complete in a certain order.
3. Notice board/ post-it-notes.
 Keep a reminder where you can see it. E.g. on the fridge, bathroom mirror or the front door.
 Make your reminder stand out e.g. brightly coloured post-it note or a coloured pen.
Strategies continued….
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4. Others can help you by:
 Simplifying the information or reducing the amount of information they give you at once.
 Reminding you.
 Keeping content simple and sentences short
 Repeating or paraphrasing information that is given.
5. Consistency
 Start to establish routines i.e. keep things in the same place (e.g. keys), have a filing system
(e.g. to keep track of paid and unpaid bills), or do things at the same time for example deep
relaxation or stretching exercises.
6. Alarms
 Mobile phones and clocks are helpful memory triggers, particularly if you need to do
something at a certain time.
 Kitchen timers can also be useful when you are trying to pace certain activities an example of
this maybe to limit time spent in a telephone call.
Internal strategies = doing things in your head (can help with the encoding process)
1. Summarize what has been said to you in your own words. If you’ve missed what has been said
it is perfectly ‘ok’ to ask them to repeat the information.
2. Personalize the information given so that it becomes more meaningful to you. You are more
likely to remember things that are meaningful.
3. Group information into ‘chunks’ for example if you are trying to remember a shopping list
section items into groups e.g. Fruit & vegetables, meat, dairy etc.
4. Using words and pictures can help in remembering as they elicit different parts of the brain.
Acknowledgements: Special thank you to Frenchay CFS/ME Service, LH 2008, Sited Source A.J. Champion (2006), Paula Doumanov, Sohlberg &
Mateer, 1989, Locum Occupational Therapist (Feb-June 2006), information handout put together by Margaret Rose – Sutton CFS/ME Locum
Occupational Therapist.
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