Visual Memory Improvement Techniques
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To 35 years, very poor attention skills were documented on continuous performance testing. Verbal learning was also deficient. There was moderate impairment on formal measures of executive functioning and visual memory. Auditory processing, language and reading skills were preserved. Motor impairments were variable 68, 76 .
The differential diagnosis of BD and borderline personality disorder (BPD) is an issue faced by many clinicians, including neuropsychologists, who frequently encounter patients with complex psychiatric presentations which may be additionally complicated by some form of neurological insult. Whereas much attention has been given to a BD-BPD spectrum, the preponderance of the evidence supports a robust distinction between the clinical features of these conditions. Neuropsychological testing may additionally aid in the differential diagnosis of BD and BPD. Although their cognitive profiles share a generalized cognitive deficit, BPD is characterized by more marked impairments in visual memory and executive planning
Of interest, cognitive and behavioral impairments have also been demonstrated close to the time of recurrent seizure onset. Children with newly diagnosed epilepsy examined prior to the administration of antiseizure medications showed significantly poorer performance in the areas of attention, reaction time, academic achievement, and visual memory 8 . Comparable results were reported in children with new-onset localization-related and idiopathic generalized epilepsy when compared to controls 9 . In both studies, a pattern of mild generalized cognitive impairment was evident across measures of intelligence, language, attention, executive function, and psychomotor speed.
Perhaps the most comprehensive quantitative review of the neuropsychological literature for schizophrenia patients in the 18 to 56 year age range (mean age of illness onset 21.9 years) revealed significant deficits (Cohen's d 0.60) across several cognitive domains to include general intelligence, verbal and visual memory, auditory and visual attention, executive function, spatial abilities, language, and motor functions 8 . Indices of verbal memory demonstrated the greatest magnitude of difference between schizophrenia patients and healthy controls, followed by
In a follow-up study, Aharon-Peretz et al. 45 observed a similar pattern of cognitive deficits up to 6 weeks post-injury in 18 patients 60 years old with mild, moderate, and severe TBI. The investigators excluded patients with subdural and intracerebral hematomas in order to examine the effects of diffuse as opposed to focal brain injury. Compared to a healthy control group, the patients exhibited impairments in verbal and visual memory, word fluency, and verbal similarities. However, there were no significant differences in cognitive functioning between the patients with TBI and an orthopedic control group. The authors attributed this latter result to the possibility that the orthopedic controls had pre-existing cognitive impairments that predisposed them to having accidents.
Research is limited regarding assessment and intervention of written expression. Unlike reading and mathematics (which have definite input and output characteristics), written expression is predominantly an output task. As a result, approaches taken with intervention are often focused on how a child reaches the final product. For example, the ability to accurately spell words is an integral component ofwritten expression. Research indicates that children who have spelling deficits often present with predominant deficits in phonological awareness and difficulties with executive functioning 8 . As a result, interventions for children who demonstrate a primary deficit with spelling focus not only on developing the phoneme (sound) - grapheme (symbol) relationship but also on improving the child's visual memory retrieval 8 . Although supportive technology devices such as keyboarding, voice dictation, and word prediction software are quite often prescribed to children with writing...
Pediatric patients with epilepsy exhibit low average range 15 to average range 14, 37, 39 simple nonverbal recall. Patients with higher intellectual functioning exhibited better visual memory performance 37 . Across patients with temporal lobe epilepsy, right-sided focus was associated with significantly decreased visual retention 20, 37 . On the other hand, patients with frontal lobe 37 and partial epilepsy 29 do not exhibit the same effect of lateraliza-tion. Complex etiological variables (e.g. congenital hemiparesis) were negatively correlated with visual retention 29 . Age of onset was not associated with nonverbal learning 14, 37 . Parental adaptation to diagnosis correlated positively and long-standing behavioral problems correlated negatively with nonverbal recall 39 .
Visual memory The strong findings for deficits in verbal memory have not been found in the visual domain. More complex tasks, such as the Rey-Osterrieth Complex Figure Test, appear to better differentiate control and ADHD groups than do simpler tasks such as the WMS Visual Reproduction test, which presents one relatively simple figure at a time 43 . Anxiety and depression may also affect performance on visual memory tasks. The WMS Spatial Span has not been useful in distinguishing ADHD from control groups 44 . In Hervey's meta-analysis, adults with ADHD did not appear to have a specific difficulty with visual-spatial memory rather a general problem with encoding, retrieval, and organization of material was evident 37 .