Our memory is limited, so we write things down to remember later: appointment times, phone numbers, what the pharmacist said.

Unfortunately, for someone with an acquired brain injury, this simple strategy asks a lot.

🤔 Why note-taking is harder than it looks

To be successful, your patient has to:

• Follow what the speaker is saying (sustained attention)
• Tune out distractions (selective attention)
• Switch between listening and writing (alternating attention)
• Hold what they heard in working memory
• Pick out the main points from the details
• Check for understanding in real time
• Condense it into writing that makes sense later

Every one of those steps relies on a skill that can be affected by a stroke or brain injury! That's why note-taking should be explicitly taught and practiced, rather than assumed.

👥 Teach writing notes as a memory strategy

The INCOG 2.0 guidelines recommend notebooks, smartphones, and whiteboards for memory impairments after TBI. They also state that it's important for clients and caregivers to be trained in how to use them (Velikonja et al., 2023).

A classic way to do this follows 3 steps:

1) Acquisition: Learn what the notes are for and how the system works.

2) Application: Practice in structured tasks during therapy.

3) Adaptation: Use it in real life (appointments, phone calls, work).

📝 4 ways to make note-taking practice count

Keep it short. Copying word-for-word is linked to poorer learning. Coach the main idea first, then keywords.

Test the note. Afterward, ask a few questions your client has to answer using only their note.

Compare and reflect. Compare their note to a model and ask what they might do differently next time. Learning from errors this way led to better generalization in adults with severe TBI (Ownsworth et al., 2017).

Use real-life material. Practice with voicemails, medical instructions, work meetings, or conversations that match your client's goals.

🙌 Make it easy with ready-to-go materials

​Taking Notes, the newest treatment in the Virtual Rehab Center, does all the prep for you!

In this treatment, patients:

1) Listen to recordings across four categories: Daily Living, Work, Medical, and/or Learning.

2) Type notes that focus on the main idea and key points of the message.

3) Answer questions using their typed notes as an external aid.

4) Compare their note to an example and reflect on what they might do differently next time.

Plus, 3 difficulty levels adjust automatically based on patient performance.

If you're not signed up for the Virtual Rehab Center yet, try it free for 21 days using the link below. You can use this treatment, and all 60+ others, for a full 3 weeks!

Warmly,
​-Megan

P.S. We're publishing a new guide in our What SLPs Need to Know series about memory next week. Catch up on the topics you've missed before then!