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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Errorless Learning for Memory Impairment

Published August 27, 2014 12:19 PM by Brian Ferrie

Post written by ADVANCE guest blogger Rachel Wynn, MS, CCC-SLP

Let's start with a story that takes place in a SNF where I worked. The tight quarters of a small therapy gym and rehab wing allowed for easy co-treating and observation of my fellow therapists' treatment, which I found incredibly valuable as a new graduate. I noticed when a very gentle occupational therapist worked with a patient (with memory and cognitive impairment) on training safe ADLs, she often corrected with "no," "don't do that," or "uh uh."

Despite the constant correction, this patient was continuing to make the same "mistakes" (or not complete targeted behavior). I had a hunch about what was holding this patient back from making progress; after all she was physically able to complete the task. I went home and did a little research (since then I have read a lot of research). Sure enough, I found evidence to support my hunch. Because the patient was doing the wrong thing, she was making the undesired pattern stronger.

What is Errorless Learning?

Errorless learning is a strategy or philosophy with the goal of reducing errors. We aren't trying to reduce errors for the sake of improved accuracy during therapeutic trials. We are trying to reduce errors so patients are practicing the desired information or process correctly (even if that means they need more assistance during trials). This in turn results in improved accuracy of task completion.

When you are working with a patient with dementia, it is easy to set a goal for improved accuracy (e.g. transfers, ambulation with walker etc.); however, it is much more challenging to obtain improved accuracy. Errorless learning is a well-researched dementia communication strategy.

Errorless vs. Errorful Learning

If focusing on correction of tasks isn't ideal (due to creating an errorful learning situation), then how do we get patients to complete therapy tasks in an errorless environment? The first thing we need to do is separate task-training accuracy and independence goals for patients with dementia or cognitive impairment.

An errorless learning environment relies on the patient receiving all the cues (verbal, visual, and tactile) required in order to complete tasks without error. If the goal is learning a task accurately, then we need to remove the independence aspect, until the task has been mastered.

Evidence-based dementia communication strategies, such as spaced-retrieval therapy and vanishing cues, pair nicely in facilitating an errorless learning environment. As tasks are being mastered, these strategies support our goals for patient independence.

Using dementia communication strategies may be the missing component to helping your patients achieve their goals. Co-treatment requires scheduling and extra effort, but disciplines working together have more tools to use. Collaborate with the SLP on your team to design individualized plans using dementia communication strategies, so you and your patients can meet goals even when dementia or other cognitive impairment is a factor.

Rachel Wynn, MS, CCC-SLP, is a speech-language pathologist specializing in elder care. As the owner of Gray Matter Therapy, she provides education to therapists, healthcare professionals, and families regarding dementia and elder care. She is an advocate for ethical elder care and improving workplace environments, including clinical autonomy for therapists. She is presenting at an upcoming webinar "Dementia Communication Strategies to Improve Therapy Outcomes" with Gawenda Seminars.

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Webinar: Communication Approaches for People with Dementia

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