This is a guide to external memory aids for dementia and TBI.
Memory aids are a practical and effective way to support patients with memory deficits. They can orient, remind, and help patients gain independence.
In this article, you’ll learn evidence-based external memory aids for dementia and TBI, plus practical tips for how to use them.
For memory worksheets and treatment guides, check out our shop and online course for new SLPs!
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External Memory Aids For Dementia
External memory aids for dementia are often written reminders in the environment that are formatted for people with dementia.
They focus on their preserved abilities, like reading and following a routine, while taking the pressure off their memory deficits.
For instance, a reminder card posted by the bathroom door can help a patient find the toilet, even if they can’t remember where it is.
Use spaced retrieval and errorless learning to teach a patient with dementia how to use external memory aids.
Next, let’s explore 6 evidence-based external memory aids for dementia.
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1. Reminder Cards
Reminder cards have written information that reminds a patient of something important.
They’re functional and promote safety, orientation, and comfort. Post reminder cards in predictable places around the patient’s environment.
Example reminder cards:
- Bathroom sign
- Contact numbers by the phone
- Room number and name posted on the door
- Wheelchair safety steps attached to a wheelchair
- Walker safety sign attached to a walker
- Answer to a repetitive question on a wearable lanyard
- Personal identification card kept in wallet
- Daily schedule posted on walker tray
- Swallowing strategies taped on the dining table
- Labels in the closet
- Discussion cards during group discussions
- ‘Use Call Light’ sign posted on the wall
Tips for reminder cards for patients with dementia:
- Keep signs accessible and at eye level
- Use large fonts
- Use short and simple sentences
- Use high-contrast colors (black ink on white paper, white ink on red paper)
- Choose a brightly colored background to catch their attention
- Keep signs the same color throughout the environment. For example, all signs in the bathroom should be the same color
- Train patients on how to use them!
2. Memory Books
A memory book is a personalized, handmade book made up of photos with corresponding text. The pages are usually printed out and kept in a 3-ring binder or photo album.
The goal of a memory book is to help patients recall information and memories, orient, and feel more comfortable.
Include pages about family, favorite memories, daily schedule, orientation to places/dates, and answers to repetitive questions.
How to format a memory book:
- Use large font
- Black text on white paper
- Use short, simple sentences
- 1 sentence and 1 photo per page
- Laminate or place pages in plastic sleeves
- Choose simple images or photos with max 2 objects or people
3. Memory Wallets
A memory wallet is a pocket-sized memory book.
It can be a good option for patients who’d benefit from having a memory book handy at all times.
Make a memory wallet out of index cards on a metal ring or laminate pocket-sized photos. Another option is to use a small photo album. See the formatting tips above.
Consider your patient’s lifestyle, preferences, strengths, and weaknesses when deciding whether to recommend a memory book and/or wallet.
See the Memory Pack for Memory Wallet and Memory Book templates.
4. Calendars
Use calendars to help patients remember appointments, know their daily schedule, orient, jog their memories, and answer repetitive questions.
Helpful tips for calendars:
- Consider dry-erase calendars
- Post strategically (on the refrigerator or dining table)
- Use high contrast (dark ink on white background)
- Write legibly
- Use keywords (‘Eye doctor’ ‘Dinner at 6’)
Read Speech Therapy Exercises Using A Calendar for more ideas.
5. Checklists
Checklists are a type of reminder card that helps patients sequence tasks so they can be more independent. Consider asking an occupational therapist for help making these checklists.
Example checklists for dementia:
- Safe swallowing strategies taped on the dining table
- Steps to doing the laundry posted on the washing machine
- Spinal or hip precautions after surgery posted on the bed or wheelchair
- Medication management posted in the kitchen
- How to use the TV remote posted next to the TV
- Oral care posted next to the toothbrush
- Steps to washing your hands posted on the bathroom wall
6. Smartphones
A smartphone is a convenient external memory aid for some patients with mild cognitive impairment or mild dementia who are comfortable with the tech.
A randomized controlled trial found that patients in this population successfully used a digital voice recording app and automated reminder app to improve performance on prospective memory and IADLs (Scullen, 2022).
Ways to use a smartphone as an external memory aid:
- Orientation information
- Reminders
- Alarms
- Voice recorder (to record reminders)
- Calendar
- Lists
- Contacts
- Camera (to take a picture instead of writing a note)
- Siri or other virtual assistant (to get answers to questions or set reminders)
- Health information (medication list)
- Increase text size and contrast
- Have just a few apps on the screen
- Clean out clutter by erasing extra apps and organizing the rest
External Memory Aids For TBI
Evidence shows that some patients who’ve had traumatic brain injuries also benefit from external memory aids (Sohlberg et al, 2007; Cicerone et al, 2022).
The purpose of external memory aids for this population differs from dementia. For TBI, the goal is often to support memory rehabilitation and return to important roles, such as being a student, parent, or worker.
As always, interview the patients and their caregivers to choose meaningful goals together.
A student who wants to finish college may want help setting up external reminders to get to class and finish assignments on time.
While another patient may need external reminders to care for their pets.
Teach memory strategies to help your patients use their external memory aids.
For moderate to severe TBI, teach errorless learning and spaced retrieval. Read How To Do TEACH-M for a step-by-step guide.
For mild-moderate TBI, you can teach internal memory strategies like visualization and associations to help them remember upcoming events. See the Memory Pack for memory strategies and treatment guides.
Below are 5 external memory aids for TBI.
1. Smartphones
A systematic review and meta-analysis found that smartphones can improve prospective memory and task execution in people who’ve had a TBI (Jones et al, 2021).
In fact, a smartphone can house most of their external memory aids.
Memory aids in a smartphone:
- Calendar
- Checklists
- To-Do Lists
- Alarms and reminders
- Contacts
- Notes app for sequencing (steps to a recipe)
- Voice recorder
- Camera
- Health app (activity and medication reminders)
- Text, email, and other reminders (from loved ones, appointment reminders, from Google Calendar)
- Bill pay reminders from bank apps
- Siri and other virtual assistants
Read 10 Adult Speech Therapy Activities Using A SmartPhone for more ways to use a smartphone in therapy.
2. Calendars
A physical or digital calendar is a great way to improve prospective memory and keep track of upcoming events.
Physical calendars can be wall, desk, or pocket-sized. Teach patients to write events into their calendar. Then help them make a routine to check their calendar every day.
Digital calendars like Google Calendar can be synced between different devices and shared with other people, such as a spouse.
Teach patients to put all upcoming events into Google Calendar. Then train them to set up daily reminders to check their calendar and to set reminders for upcoming events.
A student, for example, could add their class schedule to their calendar at the beginning of the semester. Then set a recurring reminder for an hour before class to get there on time.
Read 15 Speech Therapy Exercises Using A Monthly Calendar for more treatment ideas.
3. Memory Notebooks
Teach your patients how to use a memory notebook.
For those with more severe TBIs, the memory notebook will help orient them and find the answers to their own questions.
Tips for formatting an Orientation page:
- Single page
- Simple and un-cluttered
- On the single page, add useful information such as name, age, location, date, phone number, date of injury, type of injury, answers to repetitive questions that the patient asks, etc.
- Laminate the page or place in a plastic sleeve
- Keep in a binder
Use errorless learning, spaced retrieval, and/or task analysis to teach your patient to check their notebook when they need help with orientation.
For mild-moderate TBI, add a Daily Schedule page and a To-Do List page.
Tips for formatting the Daily Schedule and To-Do List pages:
- Single page for each
- Simple and uncluttered
- Laminate each page or place in a plastic sleeve
- Keep the pages in a binder
- Start simple, then add pages as the patient’s cognition and ability to use their Memory Book improves. Examples of pages to add are contact information, medical information, sequences of how to do a task (a recipe, paying a bill, what to pack for school)
Have the patient add useful notes to their daily schedule. Examples are a change in location for class next week or the name of a new therapist.
Teach the patient to check their To-Do List every day. Create a routine of adding new items, checking off completed items, and setting reminders.
(Cicerone et al, 2022)
You’ll find worksheets and treatment ideas formatted for your patients in the Memory Pack.
4. Checklists
Create checklists to increase independence. Lists can be kept in a Memory Book or smartphone or posted in the environment.
Checklist ideas:
- Steps to doing laundry and other routines
- Steps to depositing a check
- Shopping lists
- Packing list for a trip
- Morning routine
5. Reminder Cards
Post reminders in the environment if they can’t be timed for an alarm.
An example is a laminated reminder on the front door to put on sunscreen. Or a sticky note on the fridge to soak the rice before cooking.
Reminder card ideas:
- Remember your keys and wallet/purse
- Turn off the stove
- What goes in the trash bin (versus compost or recycling bins)
- Attach your homework to Google Classroom
- Clean out the lint filter on the dryer
- Defrost a food item before leaving the house
More Memory Resources
Adult Speech Therapy Starter Pack
The Starter Pack is 900+ pages of print-and-go adult speech therapy worksheets, handouts, and templates.
Adult Speech Therapy Roadmap Course
The Adult Speech Therapy Roadmap is an online course that teaches you how to assess, treat, and document all major areas of adult speech therapy, from Day 1 to Discharge.
References
- Benigas, J.E. (n.d.) External Memory Aids and Memory Books for Memory Loss. Medbridge. https://www.medbridge.com/course-catalog/details/external-memory-aids-and-memory-books-for-memory-loss-jeanette-benigas/
- Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
- Brush, J. (2018, April). Tips for Creating Signs – Dementia Care Training & Education | Redesigning Dementia Care. Brush Development. Retrieved August 10, 2023, from https://brushdevelopment.com/tips-creating-signs/
- Brush, J., Fleder, H., & Calkins, M. (2012). Using the Environment to Support Communication and Foster Independence in People with Dementia: A review of case studies in long term care settings. Kirtland, Ohio: I.D.E.A.S., Inc.
- Cicerone, K. D., Dams-O’Connor, K., Eberle, R., Fraas, M., Ganci, K., Langenbahn, D., Shapiro-Rosenbaum, A., Tate, R. L., Trexler, L. E., & American Congress Of Rehabilitation Medicine. (2022). ACRM Cognitive Rehabilitation Manual & Textbook Second Edition: Translating evidence-based recommendations into practice.
- Jones, W. E., Benge, J. F., & Scullin, M. K. (2021). Preserving prospective memory in daily life: A systematic review and meta-analysis of mnemonic strategy, cognitive training, external memory aid, and combination interventions. Neuropsychology, 35(1), 123–140. https://doi.org/10.1037/neu0000704
- Scullin, M. K., Jones, W. E., Phenis, R., Beevers, S., Rosen, S., Dinh, K., Kiselica, A., Keefe, F. J., & Benge, J. F. (2022). Using Smartphone Technology to Improve Prospective Memory Functioning: A Randomized Controlled Trial. Journal of the American Geriatrics Society, 70(2), 459. https://doi.org/10.1111/jgs.17551
- Sohlberg, M. M., Kennedy, M., Avery, J., Coelho, C., Turkstra, L., Ylvisaker, M., & Yorkston, K. (2007). Evidence-based practice for the use of external aids as a memory compensation technique. Journal of Medical Speech-Language Pathology, 15(1), x–li.