External Memory Aids and Cognitive Offloading

Incorporating external memory aids into patient care can effectively alleviate the memory challenges and increased cognitive demands that accompany a brain injury.72 A systematic review by Gillespie et al72 on assistive technology for cognition showed offloading the cognitive work of remembering appointments and routine daily activities to a digital tool releases cognitive resources to be used for rehabilitation. There is a clear cognitive difference between a calendar and tasks since Shum et al73, demonstrated that the executive function requirements placed on a traumatic brain injury differ between time-based prospective memory, like a calendar, and event-based prospective memory, such as tasks. Calendar items include set appointments for dates or times, while tasks include prioritization that may or may not be associated with a due date. Helping patients separate the two allows the prioritization of tasks more straightforwardly while minimizing the cognitive workloads.73,74 Kliegel et al74 also concluded that separating the executive function demands of the time-based calendar plans from tasks lessens cognitive burden on the brain.

Wearable tech can also support the organizational structure that patients will require post-injury. Jamieson et al74 discovered that a smartwatch can be an invaluable reminder device after a brain injury. A smartwatch serves as a useful tool, gently reminding patients when to take their medications, when to get to appointments, and when to take a break. Jamieson et al76 also found in a systematic review that having digital mobile aids available to patients helps maintain structure through the day and did not add cognitive burden. Clinicians can even help patients use voice commands through smartwatches, smart glasses and apps to set timers, schedule calendar events, and add items to lists. Scullin et al77 conducted a randomized controlled trial showing that teaching patients to use voice activation is a simple and accessible way to manage memory tasks without causing cognitive overload.

In conjunction with the use of wearable tech, a smart phone or tablet acts as a central hub for coordinating everyday activities. When all appointments and daily tasks are logged to a digital calendar, to-do app, or planner app, the smartphone/tablet becomes an accessible memory aid and a living document that can be easily seen and shared between digital devices.78 Writing by hand on a tablet or phone can support neurological recovery since handwriting for notes, appointments, or tasks offers a unique neuronal advantage compared to digital typing.79-80 Mueller and Oppenheimer79 showed that handwriting leads to deeper information processing and memory formation compared to typing on a digital keyboard. Ose Askvik et al79 used a high-density electroencephalography (EEG) to confirm that writing with a digital pen exercises motor control over brain regions across the whole brain. Helping patients create notes, appointments, or tasks that can be shared with other smart devices creates a searchable digital record that is never lost and reduces further cognitive load and anxiety.78 Tablet writing is a valuable tool for both efficient task decomposition and cognition support.

Using digital organization technology in combination creates what can be referred to as an “external brain” which takes the heavy cognitive load of remembering and organizing information off of patients who are neurocompromised. Risko and Gilbert81 developed a framework for cognitive offloading, illustrating that patients that use external aids can be more efficient at cognitive tasks. Using gentle and constant reminders, this system can create a predictable environment to overcome cognitive fatigue. Research by Grinschgl et al82 shows that the cognitive offloading of daily tasks and routines frees up working memory to allow a greater capacity of rest for the injured brain. Ponsford et al83 observed that cognitive fatigue after traumatic brain injury can be a severe neurological side effect in recovery. Helping patients free daily executive memory functions to support the cognitive work of rehabilitation can improve quality of life significantly.

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