FAQ

The web-based Contextual Memory Test v2, (CMT-2) was designed to assess self-awareness of memory performance, strategy use, and recall in both children and adults with memory difficulties. It involves immediate (IR) and delayed recall (DR) of 20 pictures of objects related to a scene (eg. restaurant, school, or morning). Questions before and after recall examine the ability to predict memory abilities and estimate actual recall performance. In addition, strategy use such as the use of association or the overall context is investigated and rated during the after-task interview. Results are presented as a quick summary and a narrative report is automatically generated.

The CMT-2 is not diagnostic and is not intended to replace other standard measures of memory. It provides additional information that can be helpful to the healthcare team. Information obtained on awareness, strategy use, and recall are interpreted together and are used, along with other data and tests, for the purposes of choosing and planning rehabilitation interventions.

The original CMT was developed for use with adults with memory disorders and published in 1993 by Therapy Skills Builders and later by Pearson Inc. The online CMT-2 is similar to the original paper version of the CMT (Toglia, 1993), however, colored photos are used instead of black and white drawings; some items have been replaced, and 2 scenes (school and morning) have been added for use with children. A similar modified children's version of the CMT was investigated in Israel by Kizony et al, 2014.

The CMT-2 is in a pilot phase.  Users should be familiar with the original CMT or have access to the original CMT manual for optimal use.  The extent to which performance on the web-based version of the CMT (CMT-2)  is similar to the original paper version of the CMT is unknown. Care was taken to keep the themes consistent and items similar. Preliminary observations suggest there is general consistency between average recall scores in both versions however, research has not yet been completed.

 Users are encouraged to read all the FAQs and consult the original CMT manual for background information and interpretation, including analysis of patterns (awareness, strategy use, and recall performance) and implications for treatment.

The CMT-2 is temporarily free of charge during this pilot phase and supported by MC CogRehab Resources.   

Toglia, J.P. (1993) The Contextual Memory Test. Tuscon, Arizona: Therapy Skills Builders.

Please cite this website as

Toglia, J.(2019). Contextual Memory Test 2 (CMT-2). https://cmt.multicontext.net

The CMT-2 can be used with children ages 7 and above through adulthood.

The CMT-2 is appropriate for adults with traumatic brain injury (TBI), stroke, brain tumor, multiple sclerosis, Parkinson’s Disease, mild cognitive impairment (MCI), mild-mod dementia, depression, bipolar disease, schizophrenia, substance abuse disorders and other neurological or mental health conditions that can affect memory. Similarly, the CMT-2 can be used for children with neurological, developmental or mental health conditions such as intellectual developmental disability (IDD), autism, fetal alcohol syndrome, childhood brain tumor, childhood depression.

The CMT-2 may not be sensitive to subtle memory deficits; and is not appropriate for individuals with moderate/severe aphasia, neglect or object recognition deficits.

The CMT-2 was designed to be used by or under the supervision of a licensed occupational therapist or other licensed health professional such as a speech and language pathologist and psychologist with a minimum of a Master’s degree, good interviewing skills, and knowledge or expertise in the areas of cognition and memory.

No. The CMT-2 is currently in a pilot/ research phase.  Normative data is in the process of being collected and analyzed. The normative data for the initial CMT is included in the original published manual (1993) and has also been reported in some of the studies on the CMT (see FAQ references).

The extent to which performance on the web-based version of the CMT (CMT-2)  is similar to the initial paper version of the CMT is unknown.  Care was taken to keep the themes consistent and items similar between versions.  Preliminary observations suggest there is general consistency between average recall scores in both versions,  however, research has not yet been completed.

The CMT-2 is in the research phase and is available free of charge at this time. We welcome feedback and suggestions.

The Quick Score Summary and the Report can be printed or saved to your computer as a pdf using your browser’s Print function. For example when using Google Chrome or Microsoft Edge, press on the 3 dots in the upper right corner, and go to print. If you want to save it on your computer as a pdf, change the destination printer to "save as pdf" or Press "change" and select "save as pdf".

The saved document is in PDF format so it cannot be edited, however once it is downloaded ont the therapists computer, it can be shared with others.

The Client ID is an arbitrary number and/or letters that the user creates to identify their client. This ID is not identifiable by others. The link between the patient ID and the actual patient is only known by the user.

Retesting: For repeated tests of the same client, entering the same client ID, results in pre-filling the general client profile (gender, age, diagnosis) with the most recent profile data so that this information does not need to be re-entered.

The new test is dated and saved individually. Previous test results for the client can be accessed by clicking on the “Previous Reports” link in the top navigation.

Previous Quick Score Summary and Reports of your clients can be accessed at any time by clicking on the “Previous Reports” link in the top navigation bar. Client reports are coded by the client number that you assigned on testing.

Use of the CMT-2 does not require, collect or store any personally identifiable information (e.g. client’s name, e-mail, dates or address). The user assigns a patient ID or an arbitrary number and/or letters to identify their client. The patient ID is not identifiable by others. The link between the patient ID and the actual client is only known by the user.

Absolutely. Your registration information is stored securely and will never be shared without your permission. Passwords are encrypted with a one-way hash and cannot be decrypted. The CMT-2 Website can only be accessed securely via SSL.

Journal Articles that include studies using the CMT

Chang, L. H., Chen, P. Y., Wang, J., Shih, B. H., Tseng, Y. H., & Mao, H. F. (2021). High-ecological cognitive intervention to improve cognitive skills and cognitive–functional performance for older adults with mild cognitive impairment. The American Journal of Occupational Therapy, 75(5).

Engel-Yeger, B, Durr, D.H. & Josman, N. (2010). Comparison of memory and meta-memory abilities of children with cochlear implant and normal hearing peers. Disability and Rehabilitation, (Aug) 1-8

Josman, N., & Hartman-Maeir, A. (2000). Cross-cultural assessment of the Contextual Memory Test (CMT). Occupational Therapy International, 7, 246-258.

Josman, N., Berney, T., & Jarus, T. (2000). Performance of children with and without traumatic brain injury on the Contextual Memory Test (CMT). Physical and Occupational Therapy in Pediatrics, 19 (3/4), 39-51.

Gil, N., & Josman, N. (2001). Memory and metamemory performance in Alzheimer’s disease and healthy elderly: The Contextual Memory Test (CMT). Aging Clin Exp Res, 13, 309-315.

Goverover, Y., Rosenfeld, M., DeLuca, J., & Toglia, J. (2025). Enhancing everyday memory and participation in multiple sclerosis: A pilot study of a metacognitive strategy-based intervention. Multiple Sclerosis Journal–Experimental, Translational and Clinical, 11(2), 20552173251333383.

Kizony, R., & Katz, N. (2002). Relationships between cognitive abilities and the Process Scale and skills of the Assessment of Motor and Process Skills (AMPS) in patients with stroke. OTJR:Occupation, Participation,and Health, 22 (2), 82- 92.

Kizony R, Tau S, Bar O, Engel Yeger B. (2014) Comparing memory and meta-memory abilities between children with acquired brain injury and healthy peers. Res Dev Disabil. 2014 Jul;35(7):1666-73. doi: 10.1016/j.ridd.2014.03.041. Epub 2014 Apr 13.

Liao, W. W., Wu, C. Y., Liu, C. H., Lin, S. H., Chiau, H. Y., & Chen, C. L. (2020). Test-retest reliability and minimal detectable change of the Contextual Memory Test in older adults with and without mild cognitive impairment. PloS one, 15(7), e0236654.

So, Yin Ping; Toglia, J.P. & Donohue, M. (1997). A study of memory functioning in chronic schizophrenic patients. Occupational Therapy in Mental Health. 13 (2), 1-23.

Book Chapter that includes a full description of CMT

Toglia, J. P. (2011). A dynamic interactional model of cognition in cognitive rehabilitation. In N. Katz, (ed.) Cognition, occupation, and participation across the life span: Neuroscience, neurorehabilitation, and models of intervention in occupational therapy (3rd ed., pp. 161 - 202). Bethesda, MD: AOTA.

Raphael-Greenfield, E., Toglia, J., Hartman, A. (2020). The Contextual Memory Test.  In B. J. Hemphill-Pearson and C. K. Urish (Eds.) Assessments in Occupational Therapy Mental Health: An Integrative Approach (4th Ed.) (pp. 223-237). Slack Inc: Thorofare, NJ.

At this time, the CMT-2 is not available in different languages.

Yes. Please contact info@multicontext.net with a description of your research project.

At this time, there is no direct assistance for technical problems. The online CMT-2 works best with Google Chrome or Microsoft Edge (do not use internet explorer). Please report technical issues to
info@multicontext.net.

The school scene is appropriate for children ages 7 and up as well as adolescents.

The restaurant version is generic and can be used across any age. Although some items (coffee) are more likely to be used by adults, children are very aware of items used by their parents.

The morning scene includes items one would use as they get ready in the morning to leave the house. The Children versions uses items that are more relevant for a child getting ready in the morning or for a parent getting a child ready for school whereas the adult version includes items that are more relevant to adults (eg. newspaper, razor, coffee).

• Recall items are listed in alphabetical order for ease.

If the client states the recall items quickly, it might be easier for the therapist to temporarily write or use the comment box to type the first 2-3 letters of each item reported by the client and then go back and check off the boxes on the recall list.
Note: In standard procedures, the client is not permitted to write the names of the items recalled. Writing a list will help the client keep track of what items were recalled and may serve as a cue.

• Probe vague responses during recall: If the client provides a vague answer. e.g. “utensils” probe the response by asking the client to ‘Describe it more” or “Tell me more about what it looked like”

During recall, there is an option for the therapist to view the pictures again. This is helpful if a person describes an object (rather than naming it). You will need to press the Esc key to return to the recall screen.

• If the person is able to accurately describe the picture or object but cannot state the name accurately, they are still given full credit. The person should not be penalized for a naming problem
• The order in which items are checked are recorded – This allows analysis of order of recall. Order of recall can reflect strategy use.
• If the client repeats the same item more than once, or names extraneous items that are not present, include this information under observations.
• If you are not sure if the person has finished, say to the person “tell me when you are finished”.

Yes, press the square on the right lower corner of the image page.

A self-administer version is included for use with adults, under therapist supervision, if appropriate. In this version, the client takes the test themselves. This involves self-typing items that were recalled. Some names may not be recognized by the computer, particularly if they are mispelled or are less typically used. Therefore, the therapist will need to double check and manually score.

The self-administer version also does not include automatic rating or scoring of strategies used. Strategy rating is only included in the therapist version.

The report can be accessed by using the “previous report tab”.

No. The person is not informed that they will be asked to recall the pictures later.

There is a 15 minute timer on the computer that makes a sound when time is up. During this time, the therapist is free to minimize the browser and use the computer for other tasks.

The person should be engaged in other activities such as conversation, interview, reading or writing, paper and pencil tasks, computer or functional activities. Other memory tests or activities that involve pictures of objects should be avoided during this period.

If the person has significant difficulties with recall, performance can be cued in the following ways to determine the methods that facilitate performance. This provides additional information relevant to rehabilitation treatment.

Cued recall - following the “after task interview” of the first scene, the examiner can provide "cued recall" by telling the person the context of the scene such as morning or restaurant scene to determine if helps the person to recall additional objects. For example, “ Think of a restaurant. It might help you to remember more items” . Recall may be increased if the person encoded the information but is experiencing difficulty with retrieval. However, if the person did not encode the scene to begin with, it is unlikely that this will influence recall.

Induced encoding - If the person has poor immediate recall with the first scene, a second scene can be administered with slightly different instructions. The therapist can choose to add the "context" to the directions by stating "As you study these pictures think of ...... (a restaurant, or what you do as you get up to get ready to leave the house in the morning ...etc). This may “induce encoding” or encourage the person to study the items in a different way.

Dynamic Test-Teach-Retest version – If the person has poor immediate recall with the first scene, immediately following the after task interview, the therapist goes back to the recall scene (presses “show pictures” on the quick score summary page) and mediates performance. The person is asked a series of questions to encourage them to explain how they went about studying the items and to identify different strategies or ways to go about studying the information. Sample mediation questions are listed below. This is also considered “induced encoding”, however instead of providing the strategy, the person is encouraged to think of it on their own.

Sample Mediation Questions
Let’s think about the best way to go about remembering. What could you do to help yourself remember? Do you see any ways that the items can be grouped together or associated ? If you studied these items again, would you do anything differently ? Do the pictures belong to a theme ? The person is encouraged to use a different strategy and is given the message that “there are methods that you can use to increase your ability to remember”
Retest after mediation: A different scene is then used to determine if the strategies discussed during mediation are utilized with a different set of pictures and if they effect performance.

These questions are optional after delayed recall and can be skipped. However, they can provide additional insights into awareness and strategy use, particularly. if there is a difference between the number of items recalled between part 1 and 2 by > 3 items.

The CMT has 3 main recall scores; (1) Immediate Recall (IR)  (2) Delayed Recall (DR) (3) Total Recall

Should both Immediate Recall (IR) and Delayed Recall (DR) be administered ?

Yes.  Immediate Recall (IR) and Delayed Recall (DR) each provide information on different aspects of memory.

IR = Immediate Recall or recall immediately after viewing the objects reflects the input of information or the person's encoding. Encoding is initial learning. It involves the input of information or "encoding" information into something manageable and accessible for later use. 20 individual items exceeds the normal working memory capacity of 7 +/- 2, pieces or chunks of information. Successful performance requires actively re-organizing the 20 items by using the theme/ context or grouping related items together to effectively manage the amount of information. If the person does not fully or effectively encode the information, it will not be stored or accessible for later use. Decreased immediate recall often reflects decreased attention, concentration, or poor working memory capacity (such as inability to simultaneously hold more than a couple of items in mind at once within a task), a lack of active studying (may be related to decreased initiation, motivation or apathy) or decreased use of effective strategies such as use of meaningful associations, context (theme) or categorization. The order of recall can reflect how the items were encoded (eg. grouped together in categories, in order of location etc)

DR = Delayed Recall or recall of objects after a 15 minute delay reflects the ability to hold onto information over time or retrieve information after it has been stored in short term memory storage.

Interpretation of Recall Scores

It is important to examine the similarities and differences between IR and DR and analyze patterns of performance. This is explained in the original CMT manual. A couple of examples are included below.

IR is = or nearly = to DR.   Interpretation: If both are low, it indicates that the amount of information that could be processed or encoded was very limited, but the information that went "into memory" was held over time.

IR > DR.   Interpretation: If IR is significantly greater that DR (eg IR = 10 and DR = 3), it suggests rapid forgetting or that memory decreases quickly over short periods. This may be related to weak encoding as reflected by poor strategy use; difficulty retrieving information that was encoded into memory; or difficulty holding onto new information. If the items were stored in memory but the person is having difficulty with retrieval or getting the information out of short term memory storage, cues often increase recall (cued recall) and/or the person is able to identify the correct item from a multiple choice (recognition). A recognition option is not yet available in this version. For cued recall, see the separate "cued recall question.  If delayed recall is not enhanced with cues or multiple choice (in the presence of good IR) , it suggests problems in holding onto or storing information over time.

The Total Recall score is the sum of the Immediate and Delayed Recall scores. While this provides a general or overall baseline of memory abilities, examination of similarities and differences between Immediate and Delayed Recall, as described above, is more informative and more important for treatment planning.

The CMT was designed so that recall results are examined in combination with awareness (estimation of memory performance before and after the task) and with strategy use (reported and observed by order of recall). The combination of all 3 together has implications for rehabilitation as detailed in the original test manual.

How is Self Awareness examined in the CMT-2

Self awareness is examined by comparing the person’s perception of their memory ability as reflected through pre-immediate recall task general questions, optional ratings of everyday memory problems, and predicted (before) and estimated (after) scores in comparison to actual recall performance. The predicted and estimated scores are the same the original CMT.

Prediction and Estimation Question:   What if my client states they have “no idea” how many they will be able to remember? or just recalled?

The client should be encouraged to guess. For example, “ I know it may be difficult to estimate, but tell me your best guess”. If the person still has difficulty, you may ask more specific questions. For e.g. Would you remember 5 out of 20?; 10 out of 20? etc.

How are the predicted and estimated scores used?

The predicted score is the person’s response to question 3 before immediate recall - "If you studied 20 objects for 1 1/2 minutes, how many do you think you would be able to remember whereas the estimated score is the person’s estimation of their score after recall.   The predicted or estimated score is compared to the actual immediate and delayed recall score by subtracting the number of items actually recalled from the predicted or estimated score.

Prediction or Estimated discrepancy scores are characterized by both direction and magnitude.

0 = good awareness or 100% accurate prediction or estimation,  Discrepancies of 1 or 2 are typically not significant

Positive numbers indicate overestimation of abilities and negative numbers indicate underestimation of abilities

For example +5 indicates the person overestimated their actual score by 5 items, or recalled 5 items less than they had predicted or estimated, whereas -5 indicates the person underestimated their actual score by 5 items.  Underestimation scores >3 can suggest decreased self-confidence in memory abilities.

Overestimation greater than +2 was not commonly observed in the healthy population in the original CMT.  Most healthy controls underestimated performance by - 1-3.  In general overestimation > 2 was associated with lower recall performance.

 

 

 

The methods or type of strategies the person uses to help them remember are probed and rated.

• Probe responses to strategy questions after the task with questions such as “tell me more about that” or “give me an example”. Do not accept vague responses without asking for a specific example, For e.g. if the client states “I used association”, then ask: “Tell me how you associated items” or if the client says “I thought of a restaurant” then ask, “Tell me more about that ? or how did the items relate to a restaurant?
• Record the strategies the person identifies verbatim in the text box. Code responses by referring to the strategy definitions on the screen and selecting the highest strategy level using the drop-down menu (under strategies reported). Although the person may identify multiple strategies, the highest level strategy is selected and is assigned a score.
• Note -If the person does not mention the theme or context, they are asked an additional question related to the context.  If the person has spontaneously mentioned use of a context or theme, the context question is skipped.

Strategy Rating:  Strategy responses to the after recall strategy questions are rated on a hierarchy from 0-4 according to their effectiveness, with higher ratings reflecting greater effectiveness.  For example, strategies that include use of the context or theme, meaningful associations (mentions groups with ≥ 3 items), or elaboration (linking items in a story) are assigned higher ratings, compared to those who only identify partial context, used limited associations (using pairs or 1 small group), repeat items, study location or order of pictures, or picture the item without meaningful associations or groupings.   Although most people use a combination of different strategies, only the highest level strategy reported is rated or entered into the "strategies reported" box using the drop-down menu.

The strategy score is automatically calculated by adding the "strategy reported (o-4)" and response to the "context question"(0-3) .  If the context question was not asked, because the person spontaneously mentioned use of context, they are automatically assigned a score of 3.    Immediate or Delayed strategy ratings range from 0 to 7 with higher scores reflecting greater use of meaningful associations or context.   Immediate and delayed recall strategy ratings are added together for the total strategy scores (0-14).

Original studies on the CMT demonstrated that those with lower recall, used less efficient strategies.

After completing the test, a quick summary of scores is presented. This Includes

DEMOGRAPHICS:    Age, gender, grade in school or years of education

RECALL

• Immediate Recall (IR)  0-20
• Delayed Recall (DR)     0-20
• Total Recall (IR + DR) 0-40
• A  list of the items in the order the items were recalled immediately or after a delay is included so that the order of recall can be analyzed
• The pictures can be viewed and reviewed with the client if desired (press view pictures). You can return to the score summary page by pressing Esc.

Awareness

BEFORE TASK: General Self-Perception on Memory Abilities and Prediction

1. General Perception of Memory (below average, average, above average)
2. Predicted score compared to actual recall (see awareness)
3. Self-report of Memory Functioning Difficulties (optional questions) - If the subjective memory questions were administered, responses can be viewed by pressing the Plus sign+

AFTER TASK: Estimation of Memory Task Performance

1. General Ratings (compare to responses before task)
2. Estimated Score compared to actual recall

 Strategy Use

-Overall Strategy effectiveness or efficiency

-Strategy type reported

-Use of Context

-IR strategy score (0-7, DR Strategy Score (0-7) and Total Strategy Score (0-14)

At the bottom of the quick score screen, the therapist can press "view report" and the same results are presented in a narrative report.

The summary score and narrative report can be printed or saved as a pdf by following the instructions in the FAQ in the above section. The narrative report is also saved and can be accessed at any time by going to "previous reports" on the top menu bar.