Active vs. Passive Memory Book – OT/SLP Collaboration

Memory books (not to be confused with Life Storybooks) can be useful tools to help patients with memory difficulties function in their environment. SLP often introduces memory books to patients when they can benefit from them. Memory books are often more successful when the interdisciplinary team is aware of its existence, purpose, location, and priorities leading up to discharge.

What is a Memory Book?

Although called a book, it is more like a journal of the patient’s notable daily activities such as BADLs, what they did with therapy, nursing, social activities, etc. They are more likely to be successful if daily entries are used, 7 days a week. They can be kept or integrated with the patient’s binder if they are provided one from the hospital, nursing home, or another program.

The format of a memory book can be freestyle, like a journal that you write in throughout the day, similar to how a busy meeting calendar looks with specific times. To make it more user-friendly, a template can be used that divides the day into say, morning/afternoon/evening. This can align with after-meal times.

Active vs. Passive

In an active memory book (AMB), the patient themselves writes the entries.

In a passive memory book (PMB), staff writes the entries for the patient.

When would active or passive be used? If a patient has physical or cognitive limitations for writing, they would benefit from a passive memory book. For example, if a patient has severe expressive aphasia, word-finding difficulty, or trouble forming sentences, they would benefit from a PMB. SLP often performs an evaluation and with their clinical reasoning, decides to use a PMB over AMB. An OT may, for example, write a summary of the session for a patient in a PMB. Remember to write in the patient’s easy-to-understand language! Do not use medical terminology, therapy-speak, etc. PMBs are also meant to be read and reviewed by patients with SLP or OT in future sessions.

One indicator of the use of a PMB is a low score on cognitive assessments or screens such as the MoCA.

With an AMB, the main goal is for the patient to recall events and to write them on paper. Staff often verifies the authenticity of the entires. Note that an AMB is intended for staff to read and is not private like a journal. For example, to promote memory, an OT in an afternoon session may begin with looking at the patient’s AMB and quizzing the patient about what they did in the morning with SLP or PT.

One goal is to have the patient remember to write in their AMB at a certain time or after certain events, such as the end of a therapy session. An OT may remind the patient (if they remember to do so themselves!) to write in their AMB after an OT session.

Example entry

1 PM – OT with Jeff. Sat at the edge of the bed and got dressed. Walked to the bathroom with a walker and used the commode. Stood at the sink and didn’t lose my balance! Worked on some upper arm coordination doing a laundry folding activity in the rehab gym. Returned to my room to relax and make a phone call to my daughter.

AMBs and PMBs can promote

  • Working memory
  • Short-term memory
  • Long-term memory
  • Habits and routines
  • Fine motor skills
  • Coordination
  • Visual/Perception
  • Attention (for inattention and neglect)
  • Communication
  • Language
  • Goal-setting (good for mental health – seeing achievements)
  • Psychosocial
  • Rx management
  • Something to look forward to, e.g. “discharging in 5 days!”.
  • and much more!

Intervention

If you think a patient may benefit from an AMB or PMB, implement one or collaborate with SLP about implementing one. Educate the patient about the memory book’s purpose, that it is personalized for the patient, is a useful compensatory tool, and the many advantages of its use. Patients often get a lot of satisfaction as well reading back on the progress they made in rehab. They can bring it home and reflect back on it too! The key to memory books is to use them frequently, encourage staff to as well, and follow-up with reviewing because if therapists and staff take it seriously, the patients will too.