Brain Injury, September 2005; 19(10): 853–859

CASE STUDY

Non-declarative memory in the rehabilitation of amnesia

S. CAVACO1,3, J. F. MALEC1,2 & T. BERGQUIST2

1
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA,
2
Department of Psychiatry, Mayo Clinic, Rochester, MN, USA, and 3Centro de Estudos Egas Moniz,
Brain Inj Downloaded from informahealthcare.com by Washington State University on 10/26/14

Faculdade de Medicina da Universidade de Lisboa, Portugal

(Received 2 December 2003; accepted 11 July 2004)

Abstract
The ability of amnesic patients to learn and retain non-declarative information has been consistently demonstrated in the
literature. This knowledge provided by basic cognitive neuroscience studies has been widely neglected in neuropsychological
rehabilitation of memory impaired patients. This study reports the case of a 43 year old man with severe amnesia following
an anterior communicating artery (ACoA) aneurysm rupture. The patient integrated a comprehensive (holistic) day
treatment programme for rehabilitation of brain injury. The programme explored the advantages of using preserved
For personal use only.

non-declarative memory capacities, in the context of commonly used rehabilitation approaches (i.e. compensation for lost
function and domain-specific learning). The patient’s ability to learn and retain new cognitive and perceptual-motor skills
was found to be critical for the patient’s improved independence and successful return to work.

Keywords: Basal forebrain, amnesia, non-declarative memory, rehabilitation

Introduction to develop a timetag for the separate stimuli that

The basal forebrain is a heterogeneous set of
telencephalic structures located immediately caudal
to the posterior extent of the ventral frontal lobes.
These structures contain large numbers of cho-
linergic neurons that innervate the cortical surface.
A critical function of the basal forebrain is to
provide neurotransmitters such as acetylcholine to
the hippocampus and dopamine, norepinephrine
and serotonin to various parts of the cerebral cortex.
Rupture of aneurysms located in the ACoA can
damage the basal forebrain. Focal damage to this
area is known to produce anterograde amnesia for
declarative information [1–4].
The ‘basal forebrain type’ of amnesia is known to
have a different pattern from the ‘hippocampus
type’ or the ‘diencephalic type’ [3, 5]. Patients with
basal forebrain amnesia are usually able to learn
separate modal stimuli, despite their inability to
learn the proper relationships and integrations of
those stimuli. These patients are also known to fail
they learned. In contrast to many ‘hippocampus
type’ amnesics, basal forebrain amnesics often
improve their memory performance when provided
with cueing. Both the basal forebrain (in the acute
phase) amnesics and the diencephalic amnesics
tend to confabulate. Unlike the diencephalic amne-
sics, the basal forebrain amnesics tend to confabulate
spontaneously. Despite the inability to learn new
declarative information, there are some forms of
non-declarative memory that are spared in these
types of amnesic syndromes [4, 6, 7].
Amnesic patients are usually disabled in their lives
to the point of needing constant supervisory care and
even mild memory deficits can impact on functional
independence. Unfortunately, there is currently
no clear way to restore lost memory functioning
in patients with amnesia once the period of acute
recovery is over. Specifically, memory retraining
strategies have shown reduced efficacy in the rehabil-
itation of patients with moderate-to-severe memory
defects [8].

Correspondence: Sara Cavaco, Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-035
Lisboa, Portugal. Tel: þ351217805217. Fax: þ351217942060. E-mail: sara.cavaco@mail.telepac.pt
ISSN 0269–9052 print/ISSN 1362–301X online # 2005 Taylor & Francis Group Ltd
DOI: 10.1080/01449290500109917
 854 S. Cavaco et al.
Preserved non-declarative memory capacity in
amnesiacs introduces new possibilities in the
rehabilitation of these patients, i.e. in the reduction
of the effects of their handicap on their everyday func-
tioning. There have been some limited attempts to use
skill learning methods and other non-declarative
methods in clinical settings [9–16]. However, such
resources still remain largely untapped.
This case report demonstrates the contribution of
the non-declarative memory capacity to the rehabili-
tation of a patient with severe amnesia for declarative
material due to probable basal forebrain damage.
As indicated in previous studies [11–14], the
patient’s non-declarative memory capacity played
a crucial role in his successful use of external aids
Brain Inj Downloaded from informahealthcare.com by Washington State University on 10/26/14
to compensate for declarative memory loss, in the
improvement of his functional independence and in
his return to work. This case report further demon-
strates the advantage of using the vanishing cues
technique to learn complex domain-specific knowle-
dge [9] and the importance of extensive practice and
errorless learning [16] in the amnesia syndrome.
Case description
For personal use only.
MH was a 43 years old right-handed man, with
13 years of education, who developed a severe
persistent headache. Ultimately he was diagnosed
with sub-arachnoid haemorrhage. He underwent
clipping of an anterior communicating artery
(ACoA) aneurysm. Subsequently, he underwent
multiple surgeries for hydrocephalus, including left
frontal ventriculostomy. Due to the clipping it was
not possible to obtain an MRI nor perform a detailed
anatomical analysis. However, ruptures of the ACoA
aneurysms are known to damage primarily the basal
forebrain.
Neuropsychological assessment
Patient MH was first evaluated by the Mayo Brain
Injury Outpatient Programme (MBIOP) 5 months
after the clipping. At that time, the patient’s
neuropsychological profile was most notable for the
presence of significant deficits in learning and
memory for both visual and verbal information, as
demonstrated by the patient’s performance on the
Wechsler Memory Scale III (WMS-III), the Visual
Spatial Learning Test and Rivermead Behavioural
Memory Test (Table I). During interviews and
spontaneously the patient showed confabulatory
tendencies.
The neuropsychological assessment reflected
verbal and non-verbal intellectual abilities within
the lower portion of the average range. In language
functioning, the patient showed normal performance
in visual naming and auditory comprehension.
Verbal fluency performance was slightly weaker, at
the low average level for both literal and semantic
fluency tasks. Screening of visual-spatial and con-
structional skills showed functioning to be within
normal range. His basic and higher order attention/
concentration abilities as well as higher level execu-
tive reasoning/problem-solving abilities were within
the average range. Mild residual weakness was
evident in cognitive processing speed/efficiency.
During the interview, the patient showed very limited
insight into the impact of his impairments on his
activities and daily life.
Patient’s neuropsychological profile is consistent
with damage to the posterior sector of the orbito-
frontal area, including the basal forebrain.
Intervention
MBIOP is a comprehensive (holistic) day treatment
programme, with a milieu-oriented approach to
post-acute brain injury rehabilitation [17–19]. This
individualized goal-setting programme aims to
optimize the physical, cognitive, psychosocial and
behavioural functioning of people with brain injury
in order to enable their community living, work and
adjustment to injury. Patient MH started the
MBIOP 5 months after the neurological event
and graduated the comprehensive day programme
8 months later. The MBIOP offers an integrated
and multi-modal rehabilitation. It emphasizes the
importance of community education, the importance
providing and receiving feedback from others and
the importance of self-evaluation based on indivi-
dualized goals to enhance the self-awareness and the
sense of involvement in the rehabilitation process.
The importance of using the patient’s preserved
non-declarative memory capacities was most notice-
able on the rehabilitation of memory impairment and
return to work. This report focuses on these two
major areas of intervention.
Memory impairment
The memory rehabilitation process of patient
MH focused primarily on compensation for lost
function and substitution of intact function. These
two approaches target disability (i.e. the lack of
ability to undertake an activity at a normal level)
rather than impairment (i.e. lack of a body part or
function) and attempt to achieve specific functional
outcomes (Table II).
Compensation for lost function
Use of external aids. The efficient use of a notebook
to compensate for MH’s memory impairment was
believed to be of major importance for his functional
independence. The training on the use of the
notebook was based on the method proposed
 Non-declarative memory in the rehabilitation of amnesia 855

Table I. Neuropsychological test results for patient MH.

Tests Scores

WAIS-III
Verbal IQ 97
Performance IQ 86
Full scale IQ 91
Verbal comprehension 93
Perceptual organization 91
Working memory 90
Processing speed 84
COWAT 30 (12–22%ile)
Category fluency 32
MAE naming 58
MAE token 44 (82%ile)
WRAT3 arithmetic SS ¼ 100
WMS-III
Brain Inj Downloaded from informahealthcare.com by Washington State University on 10/26/14

Word list—immediate 4/5/6/6

Delayed 0 (0% retention)
Logical memory—immediate 14
Delayed 2 (14% retention)
Visual reproduction—immediate 48
Delayed 17 (35% retention)
Visual spatial learning test
Designs 18 (SS ¼ 3 in reference to a 61 year old)
Errors 4 (SS ¼ 10 in reference to a 61 year old)
Design and position 2 (SS ¼ 2 in reference to a 61 year old)
Rivermead behavioural memory test 1/12
Wisconsin card sorting test
For personal use only.

Number of categories 6
Perseverative responses 12 (T score ¼ 51)
Perseverative errors 12
Category test (Russell’s short form) T score ¼ 42
Trail making test
A 2700 (T score ¼ 50)1
B 6700 (T score ¼ 47)1
Beta mazes SS ¼ 8
Beck depression inventory 7
1
According to the Mayo’s Older Americans Normative Studies (MOANS) standards.

by Sohlberg and Matter [20]. The training process
went through three major phases: acquisition,
application and adaptation. Based on the patient’s
accomplishments and consolidation of target behav-
iours, the level of demands from phase-to-phase
increased progressively. With the patient’s inability
to use declarative memory functions, it was believed
his training on the use of the memory notebook had
to rely heavily on non-declarative memory functions.
As a consequence, during the training, the number
of repetitions that MH needed to learn and the
amount of time the patient spent on each phase were
inevitably higher than other patients with less
declarative memory impairment that have partici-
pated in the programme. The training was based on
extensive practice, cueing and feedback.
The size and composition of the external aids
are important aspects for its adequate and efficient
use. Upon admission to the programme, the patient
used both a pocket-size month-at-a-glance planner
and a large notebook of personal information
and photographs to compensate for his memory
impairment. Rapidly it was clear that these external
aids were neither adequate nor efficient, because
the patient frequently failed to carry these aids.
After a small period of assessment of the patient’s
needs, he was recommended to use a pocket-size
notebook composed of a 2-page-per-day planner,
specific sections (e.g. medical section, vocational
section, telephone section, family section) and cue
cards (i.e. reminders of important information
designed to be quickly accessible).
A significant part of the rehabilitation team’s
efforts were focused on training detailed recording
of information in the notebook. People without
memory problems are often able to retrieve the
necessary information from minimally detailed
notes, because supported by their episodic memory
they can fill the missing parts and reconstruct the
message. When a patient has memory impairment
for episodic information, the quality of the notes
on the notebook becomes a central point.

Brain Inj Downloaded from informahealthcare.com by Washington State University on 10/26/14
Memory rehabilitation approaches
Restoration of damaged function—attempts to
restore damaged memory processes; targets
underlying impairment
For personal use only.
Optimization of residual function—attempts to
retrain normal memory processes; targets
underlying impairment
Compensation for lost function—compensates
for or bypasses memory deficits; targets
functional deficits
Substitution of intact function—uses intact
memory processes to substitute for damaged
ones; targets functional deficits
1
Based on Glisky and Glisky [22].
Table II. Rehabilitation of memory.
Rehabilitation methods
Practice and rehearsal
Mnemonic strategies
Environmental supports and
external aids
Domain-specific learning
Specific techniques
Meaningful or elaborative rehearsal,
distributed practice, over-learning,
spaced retrieval
Visual imagery, verbal organization
and association strategies, including
story mnemonics, first-letter cueing,
chaining and PQRST
Labels, instructions, notebooks,
diaries, calendars, alarm watches,
timers, electronic organizers, pagers
Vanishing cues, errorless learning
Goals
Achieve general mnemonic benefits
Achieve general mnemonic benefits
or learn specific information
Solve everyday memory problems
Learn specific knowledge relevant
in everyday life
856
S. Cavaco et al.
Applications
Learn specific pieces of
information
Learn arbitrary associations,
sequences of actions and text
Assist in independent living
and in prospective memory
Learn skills or tasks that can be
performed implicitly
 Non-declarative memory in the rehabilitation of amnesia
Patient MH had to learn important procedural
organizational skills. He was trained to record
daily information (e.g. appointments, assignments)
according to six major questions, i.e. what, when,
where, who, why, how. Besides the content, the
patient was also trained to record information
following a location outline (e.g. scheduled appoint-
ments should be recorded next to the appropriate
time, work assignments should be recorded on the
right side page). The consistency of these procedures
is believed to facilitate the efficient retrieval of
information.
The accurate recording for future reference also
depends on the adequate management of the avail-
able space. In addition to procedural organizational
Brain Inj Downloaded from informahealthcare.com by Washington State University on 10/26/14
skills, the patient had to acquire the perceptual-
motor skill of writing clearly all the necessary
information on a restricted space.
In addition to recording planned tasks and
activities, it was important for the patient to learn
the routine of checking off as soon as the tasks
were completed and to record a summary of what
he had just done for future reference. This type of
information is of critical importance for the patient’s
sense of accomplishment and continuity, as well as to
For personal use only.
document task completion for future reference.
MH was able to slowly transfer these learned skills
to the working setting. The routine of recording
information and referring to it on a regular basis
appeared to be a key factor in job performance.
Environmental supports. Acknowledging that the
environment where MH lived and worked could
potentiate or jeopardize his improvements, the staff
considered it critical to intervene thoroughly in the
environment. The family, other supportive people
involved in his life and the employers were educated
about his significant memory difficulties, his dimini-
shed awareness, on the use of cueing techniques and
the importance of structure and routine.
The patient underwent a complete change of
wardrobe in order to accommodate the consistent
transport of the notebook. New pants with pockets
of the size of the notebook facilitated the acquisition
of the behaviour of picking the notebook from the
pocket to record and/or retrieve information every
time it was necessary. It also facilitated the acquisi-
tion of the behaviours of reliably placing the note-
book in the pocket and carrying it everywhere
(including leisure situations). As an example, the
patient’s tendency to confabulate about the cause
of his brain injury was addressed with a ‘fact sheet’
placed on the first page of his notebook. The patient
was trained to refer to it every time he had to
introduce himself to a visitor. The automatization
of this behaviour was rapidly acquired through the
method of vanishing cues.
857
Domain-specific learning
Vanishing cues and errorless learning. The ability to
learn depends on the capacity to correct errors based
on prior experience. Patients with declarative
memory impairment are particularly vulnerable to
errors. Declarative memory has a crucial role in the
correction of performance based on the feedback of
prior learning episodes. Non-declarative memory
‘appears to be typically based on emitting the
strongest response, and if that response is an
erroneous response, then the error is likely to be
further strengthened’ [16 page 53].
To increase the potential for successful learning of
new skills, the programme promoted (especially in
the early phase of intervention) an errorless learning
environment (i.e. environment that prevents the
patient from making mistakes during learning)
based on the vanishing cues technique. So, patient
MH was provided with external cues to avoid
errors during learning. This goal was not always
achieved due to the outpatient characteristic of the
programme. The frequency and detail of cues were
progressively adjusted to the patient’s needs.
Based on the detailed evaluation of MH’s indivi-
dual needs, he and the staff within the first month
developed some specific long-term treatment goals
(e.g. I will use my planner and fact sheet throughout
the day to compensate for my memory so I can get
things done efficiently). These long-term goals were
then broken down in small behaviour anchors,
i.e. short-term goals (e.g. ‘with 0–1 direct cues,
I will write specific details to remember information
on the right page of my planner’). Attending to MH’s
achievements and/or difficulties, the amount and
quality of cueing aimed on the short-term goals
were periodically reviewed and gradually reduced
by the patient and the staff throughout the
programme.
Return to work
From the beginning, the patient identified as his
most important personal goal to return to work.
A comprehensive and individualized return-to-work
plan was developed for him. The programme’s
vocational service addressed patient’s functional
limitations, helped him to identify realistic goals
and bridged the gap between hospital and
community services.
Patient MH like any person with moderate-to-
severe memory impairment for declarative informa-
tion was hindered from performing certain types
of work that required continuous tracking of new
information. Some jobs may prove to be too
challenging or too hazardous for someone with
amnesia. This was the case for the job that MH
 858 S. Cavaco et al.
had before his injury. Prior to his injury, he had a
stable working history, operating his own business
as a landscaper and logger for
20 years.
Despite his defective acquisition, retention and
retrieval of new declarative information, he was able
to successfully learn to perform some jobs that relied
heavily on non-declarative information.
Six months after the beginning of the programme,
the patient started the vocational evaluation with a
5 week centre-based situational assessment, followed
by a community based situational assessment.
The rehabilitation process benefited from the
patient’s high motivation to work and his natural
interest on physical labour. He fully engaged on all
sheltered workshop-based and community-based
Brain Inj Downloaded from informahealthcare.com by Washington State University on 10/26/14
vocational evaluations (e.g. ‘sort, pack and prepare
forensic kits for shipping’; ‘operate a commercial
dryer’; ‘sort, fold and pack laundry’). All these job
trials relied heavily on cognitive and perceptual-
motor skill learning through extensive practice with
little demands on episodic learning. Two months
after discharge, the patient was still working in a
nursery garden department store. The patient was
adequately performing this job (i.e. unload, water,
For personal use only.
dispose of dead leaves and display plants in a nursery
garden department store) and expressed his wish
to pursue his vocational career in this area.
The work setting called the patient to transfer and
apply the skills (e.g. efficient use of cue cards to
perform tasks and to organize other aspects of the
work-site, such as locations and co-workers names)
and compensation techniques (e.g. stop and think,
double-check) learned in the programme. The joint
effort of hospital and community-based services
and employers helped the patient to transfer the
skills learned in the clinical setting to a job in the
community. As a result he was able to perform all
duties as assigned and his productivity was within
expectations of competitive employment.
Evaluation of the rehabilitation process
The Mayo-Portland Adaptability Inventory 3.0
(MPAI) is a measure of long-term (post-acute)
outcome of acquired brain injury. This inventory
was completed on the patient’s admission and
discharge of the programme by consensus of the
evaluation team. Upon admission, patient MH
received a total MPAI score of 44 points and at
discharge a score of 38 points. Both of these scores
indicated that the patient presented moderate overall
limitations related to his brain injury. The improve-
ments were on independence of self-cares, level of
initiation, frequency of social contacts beyond family
and professionals, involvement with leisure and
recreational activities and work situation.
When the patient entered the programme he was
not working, rating 1 on the five points’ Vocational
Independence Scale [21]. At discharge and at
2 months follow-up the patient was working part-
time in a community-based job with permanent
support, rating 3 on the same scale. Despite working
at a competitive level, he still needed a permanent
job coach support.
Upon admission to the programme the patient
lived with his relatives and required extensive super-
vision. At completion of the programme and at
2 months follow-up the patient was independent
with his self-cares and living in Adult Foster Care.
He still required moderate assistance with managing
responsibilities of independent living (e.g. meet
transportation needs, manage money and finances).
Discussion
The distinction between declarative and non-
declarative memory systems was clearly demon-
strated in this case. MH showed preserved capacity
to acquire and retain new procedures, while demon-
strating significant declarative memory impairment.
Patient MH’s severe memory dysfunction interfered
substantially with his ability to function adequately
in a broad range of day-to-day activities. However,
it was demonstrated that it is possible to improve
patient’s quality of life and independence by using
unaffected cognitive functions.
Vocational success and functional independence
are two of the most important measures of brain
injury rehabilitation. Vocational success was MH’s
most important personal goal. The patient’s
vocational reintegration plan was based on his
personal interests and preserved capacities. To
meet the demands of vocational functioning (e.g.
job performance, interacting in the working setting
and transportation needs) and functional indepen-
dence, patient MH had to learn and relearn new
skills.
The patient acquired most of the required cogni-
tive and perceptual-motor skills. These skills reached
the automated level after extensive repetition of
target behaviours. Most target behaviours were
associated with an adequate use of external aids.
The repetition of these behaviours was supported
by an errorless learning environment based on the
progressive reduction of cues (i.e. vanishing cues
technique).
The adequate use of external aids (e.g. planner,
cue cards) had a crucial role in MH’s return to
work. To optimize the rehabilitative power of this
training, the work settings were specifically prepared
to deal with a worker with memory impairment. As
a result, the patient learned to perform some jobs
and maintain an adequate working situation, which
 Non-declarative memory in the rehabilitation of amnesia
had a significant positive impact on his sense of
self-esteem and functional independence.
This case report shows the need to reduce the
declarative memory demands from an amnesiac’s
day-to-day life and shows the usefulness of exploring
the patient’s non-declarative memory capacities to
reach functional independence and vocational reinte-
gration. As expected, the vanishing cues technique
and the errorless learning environment facilitated
the acquisition and retention of target behaviours.
It was demonstrated that a combination of
different memory rehabilitation methods (i.e. use
of external aids, environmental supports and
domain-specific learning) and an individualized
vocational reintegration plan were efficacious in the
Brain Inj Downloaded from informahealthcare.com by Washington State University on 10/26/14
rehabilitation of a severe memory impaired patient.
References
1. Abe K, Inokawa M, Kashiwagi A, Yanagihara T. Amnesia after
a discrete basal forebrain lesion. Journal of Neurology,
Neurosurgery, and Psychiatry 1998;65:126–130.
2. Alexander MP, Freedman M. Amnesia after anterior
communicating artery aneurysm rupture. Neurology
For personal use only.
1984;34:752–757.
3. Damasio AR, Graff-Radford NR, Eslinger PJ, Damasio H,
Kassel N. Amnesia following basal forebrain lesions. Archives
of Neurology 1985;42:263–271.
4. Tranel D, Damasio AR, Damasio H, Brandt J. Sensorimotor
skill learning in amnesia: Additional evidence for the neural
basis of nondeclarative memory. Learning & Memory
1994;1:165–179.
5. Tranel D, Damasio H, Damasio AR. Amnesia caused by
herpes simplex encephalitis, infarctions in basal forebrain,
anoxia/ischemia. In: Boller F, Grafman J, editors. Handbook
of neuropsychology, 2nd ed. New York: Elsevier Science B.V.;
2000. pp 85–110.
6. Milner B. Les troubles de la mémoire accompagnant des
lésions hippocampiques bilatérales. Colloques Internationaux
du Centre National de la Recherche Scientifique. No 107.
Physiologie de L’Hippocampe. Paris: Centre National de la
Recherche Scientifique; 1962.
7. Nissen MJ, Willingham D, Hartman M. Explicit and implicit
remembering: When is learning preserved in amnesia?
Neuropsychologia 1989;27:341–352.
859
8. Sohlberg MM, Mateer CA. Cognitive rehabilitation: An
integrative neuropsychological approach. New York: The
Guilford Press; 2001.
9. Glisky EL, Schacter DL, Tulving E. Computer learning
by memory-impaired patients: Acquisition and retention of
complex knowledge. Neuropsychologia 1986;24:313–328.
10. Suhr J, Anderson S, Tranel D. Progressive muscle relaxation
in the management of behavioural disturbance in Alzheimer’s
disease. Neuropsychological Rehabilitation 1999;9:31–44.
11. Donaghy S, Williams W. A new protocol for training severely
impaired patients in the usage of memory journals. Brain
Injury 1998;12:1061–1076.
12. Kime SK, Lamb DG, Wilson BA. Use of a comprehensive
programme of external cueing to enhance procedural
memory in a patient with dense amnesia. Brain Injury
1996;10:17–25.
13. Andrewes D, Gielewski E. The work rehabilitation of a herpes
simplex encephalitis patient with anterograde amnesia.
Neuropsychological Rehabilitation 1999;9:77–99.
14. Godstein G, Beers SR, Shemansky WJ, Longmore S. An
assistive device for persons with severe amnesia. Journal of
Rehabilitation Research & Development 1998;35:238.
15. Wilson B, Baddeley AD, Cockburn JM. How do old dogs
learn new tricks: Teaching a technological skill to brain
injured people. Cortex 1989;25:115–119.
16. Baddeley A, Wilson B. When implicit learning fails: Amnesia
and the problem of error elimination. Neuropsychologia
1994;32:53–68.
17. Malec JF. Impact of comprehensive day treatment on societal
participation for persons with acquired brain injury. Archives
of Physical Medicine and Rehabilitation 2001;82:885–894.
18. Malec JF, Basford JS. Postacute brain injury rehabilitation.
Archives of Physical Medicine and Rehabilitation
1996;77:198–207.
19. Malec J, Schafer D, Jacket M. Comprehensive-integrated
postacute outpatient brain injury rehabilitation.
NeuroRehabilitation 1992;2:1–11.
20. Sohlberg MM, Mateer C. Training use of compensatory
memory books: A three stage behavioral approach. Journal
of Clinical and Experimental Neuropsychology 1989;
11:871–891.
21. Malec JF, Buffington ALH, Moessner AM, Degiorgio L.
A medical/vocational case coordination system for persons
with brain injury: An evaluation of employment outcomes.
Archives of Physical Medicine and Rehabilitation
2000;81:1007–1015.
22. Glisky EL, Glisky ML. Learning and memory impairments.
In: Eslinger PJ, editor. Neuropsychological interventions:
Clinical research and practice. New York: The Guilford
Press; 2002. pp 137–162.