Top-Down vs. Bottom-Up: A Case Series in Verbal Working Memory Treatments for Chronic Traumatic Brain Injury Deficits

Abstract

Purpose Individuals with traumatic brain injury may suffer chronic cognitive–linguistic deficits in areas such as verbal working memory, which impede attainment of long-term rehabilitation goals. The purpose of this study was to determine whether individual rehabilitation programs focusing on cognitive skill building of memory and attention in the verbal domain may provide comparable outcomes to traditional compensatory, mnemonics-based training approaches. Method Rhythmic language training is presented as a novel therapeutic tool for targeting discrete cognitive skills that may provide specific benefits for chronic traumatic brain injury symptoms that conventional therapy programs may not. Standardized testing with the California Verbal Learning Test–Second Edition ( Delis, Kramer, Kaplan, & Ober, 2000 ) was used for pre- and posttest comparisons in 2 cases presented as a series. Electroencephalography was employed concurrently with behavioral testing to examine changes in working memory for each case. Results Posttest measurements indicated positive changes in verbal working memory occurred, but to different degrees for each participant. Conclusion The preliminary positive effects observed in standardized testing for the experimental method of rhythmic language training warrant further investigation for potential clinical applications.