Predictions of recall and study strategy decisions after diffuse brain injury

Objective: To investigate relationships between self-monitoring operationalized by predicting recall and study strategy decisions made by adults with diffuse, acquired brain injury (ABI) and adults without ABI. Research design and methods: Eighteen adults with ABI and 16 without ABI studied two lists of unrelated noun-pairs, made item-by-item immediate and delayed recall predictions and selected items (after predictions) to restudy again. The computer selected items for restudy based on the lowest prediction rating (i.e. unlikely to recall). A mixed list design was used to balance item selection (self or computer, within-lists) by type of prediction (immediate or delayed, between-lists). Recall was tested prior to and after restudying. Hypotheses: Delayed recall predictions would be more accurate than immediate recall predictions; participants would select items for restudy that corresponded with 'lower' delayed predictions (i.e. less likely to recall) and 'higher' immediate predictions (i.e. more likely to recall); for adults with ABI, recall would improve the most from restudying items selected after delayed predictions; and that recall predictive accuracy and study selection decisions are independent processes. Results: Delayed recall predictions were more accurate than immediate recall predictions, though adults with ABI tended to be less accurate than controls. Both groups selected items for restudy that had relatively low prediction ratings irrespective of prediction timing. Of adults with ABI, those with low recall prior to restudy selected items that had 'high' immediate predictions (i.e. likely to recall). However, there was no greater benefit to recall using this strategy. For adults with ABI, recall improved the most from restudying items that were self-selected after delayed predictions, whereas controls' recall improved, irrespective of prediction and selection timing. Between-person correlations revealed no relationship between recall predictive accuracy and study selection strategies. Conclusions: These findings imply that adults with ABI should base strategy decisions on delayed predictions rather than on 'in the moment' immediate ones, selecting items that they have predicted will be difficult to recall. Continued efforts to disambiguate self-monitoring from strategy decisions are required before direct clinical applications can be made.