Instructional Techniques in Cognitive Rehabilitation: A Preliminary Report

ABSTRACT

Instruction is an essential component of effective cognitive rehabilitation, which requires teaching or reteaching a variety of skills and concepts to people with compromised learning. Currently, the field lacks a cohesive set of principles to guide clinicians’ instructional behaviors. A review of the literature in related fields, in conjunction with findings in neuropsychology, reveals evidence-based principles that lead to effective instructional design and implementation. This article summarizes this work and attempts to provide clinicians with principles to guide their treatment planning when training or teaching clients with cognitive-communication disorders.

Acquired brain injury - memory rehabilitation - direct instruction - strategy training - errorless learning - distributed practice - spaced retrieval

REFERENCES

1 Meta-analysis is a process by which quantitative research findings on a prescribed topic are aggregated and statistically analyzed to determine the magnitude of difference or “effect size” between experimental and control groups (Gall, Borg, and Gall, 1996 [26b]).

2 The memory systems (e.g., nondeclarative versus declarative) associated with improvements under errorless learning conditions are a subject of some debate. Experimental evidence and reviews centered on this topic may be found in several sources (e.g., Evans et al, 2000 [37a]; Hunkin, Squires, Parkin, and Tidy, 1998 [37b] Riley et al, 2004 [40]; Tailby and Halsam, 2003 [44]; Wilson et al, 1994 [11]) but are not specifically addressed in this review.

• 1 Madigan K, Hall T, Glang A. Effective assessment and instructional practices for students with ABI. In: Glang A, Singer GH, Todis B Students with Acquired Brain Injury. Baltimore, MD; Paul H Brookes 1997: 123-160
• 2 Sohlberg M M, Mateer C. Cognitive Rehabilitation: An Integrative Neuropsychological Approach New York; Guilford 2001
• 3 Ylvisaker M, Hanks R, Johnson-Green D. Rehabilitation of children and adults with cognitive-communication disorders after brain injury.  ASHA. 2003;  23(suppl) 59-72
• 4 Ducharme J M, Spencer T F. Training brain injury rehabilitation therapists to use generalized teaching skills.  Brain Inj. 2001;  15 333-347
• 5 Mozzoni M P, Bailey J S. Improving training methods in brain injury rehabilitation.  J Head Trauma Rehabil. 1996;  11 1-17
• 6 Ylvisaker M, DeBonis D. Executive function impairment in adolescence: TBI and ADHD.  Topics Lang Dis. 2000;  20 29-57
• 7 Clare L, Wilson B A, Carter G, Breen K, Gosses A, Hodges J R. Intervening with everyday memory problems in dementia of the Alzheimer type: an errorless learning approach.  J Clin Exp Neuropsychol. 2000;  22 132-146
• 8 Clare L, Roth I, Wilson B, Carter G, Hodges J. Relearning face-name associations in early Alzheimer's disease.  Neuropsychology. 2002;  16 538-547
• 9 Kern R S, Liberman R P, Kopelowicz A, Mintz J, Green M F. Applications of errorless learning for improving work performance in persons with schizophrenia.  Am J Psychiatry. 2002;  159 1921-1926
• 10 O’Carroll R E, Russell H H, Lawrie S M, Johnstone E C. Errorless learning and the cognitive rehabilitation of memory-impaired schizophrenic patients.  Psychol Med. 1999;  29 105-112
• 11 Wilson B A, Baddeley A, Evans J, Shiel A. Errorless learning in the rehabilitation of memory impaired people.  Neuropsychol Rehabil. 1994;  4 307-326
• 12 Engelmann S E, Carnine D W. Theory of Instruction. Eugene, OR; Association for Direct Instruction 1991
• 13 Stein M S, Carnine D, Dixon R. Direct instruction: integrating curriculum design and effective teaching practice.  Intervent Sch Clin. 1998;  33 227-234
• 14 Becker W C. The national evaluation of follow through: behavioral-theory-based programs come out on top.  Educ Urban Soc. 1978;  10 431-458
• 15 Marchand-Martella N E, Slocum T A, Martella R C. Introduction to Direct Instruction. Mahwah, NJ; Pearson Education 2004
• 16 Stebbins L B, St. Pierre R G, Proper E C, Anderson R B, Cerva T R. Education as Experimentation: A Planned Variation Model (Volume IV-A: An Evaluation of Follow Through). Cambridge, MA; ABT Associates 1977
• 17 Glang A, Singer G, Cooley E, Tish N. Tailoring direct instruction techniques for use with elementary students with brain injury.  J Head Trauma Rehabil. 1992;  7 93-108
• 18 Englert C S, Raphael T E, Anderson L M, Anthony H M, Stevens D D. Making writing strategies and self-talk visible: cognitive strategy instruction in regular and special education classrooms.  Am Educ Res J. 1991;  28 337-372
• 19 Graham S, MacArthur C, Schwartz S. Effects of goal setting and procedural facilitation on the revising behavior and writing performance of students with writing and learning problems.  J Educ Psychol. 1995;  87 230-240
• 20 Idol L. Group story mapping: a comprehension strategy for both skilled and unskilled readers.  J Learn Disabil. 1987;  20 196-205
• 21 Baker S, Gersten R, Scanlon D. Procedural facilitators and cognitive strategies: tools for unraveling the mysteries of comprehension and the writing process, and for providing meaningful access to the general curriculum.  Learn Disabil Pract. 2002;  17 65-77
• 22 Harris K, Pressley M. The nature of cognitive strategy instruction: interactive strategy instruction.  Except Child. 1991;  57 392-404
• 23 Palinscar A S, Brown A L. Reciprocal teaching of comprehension-fostering and comprehension-monitoring activities.  Cogn Instr. 1984;  1 117-175
• 24 Swanson H L. Searching for the best model for instructing students with learning disabilities.  Focus Except Child. 2001;  34 2-15
• 25 Hughes C, Ruhl K, Schumaker J, Deshler D. Effects of instruction in an assignment completion strategy on the homework performance of students with learning disabilities in general education classes.  Learn Disabil Res Practice. 2002;  17 1-18
• 26a Kavale K A, Forness S R. Policy decisions in special education: the role of meta-analysis. In: Gersten R, Schiller EP, Vaughn S Contemporary Special Education Research Mahwah, NJ; Erlbaum 2000: 281-326
• 26b Gall M D, Borg W R, Gall J P. Educational Research: An Introduction. White Plains, NY; Longman Publishers 1998
• 27 Mastropieri M A, Scruggs T E, Bakken J P, Whedon C. Reading comprehension: a synthesis of research in learning disabilities. In: Scruggs TE, Mastropieri MA Advances in Learning and Behavioral Disabilities. Greenwich, CT; JAI 1996: 277-303
• 28 Swanson H L. Instructional components that predict treatment outcomes for students with learning disabilities: support for the combined strategy and direct instruction model.  Learn Disabil Res Practice. 1999;  14 129-140
• 29 Swanson H L, Carson C, Sachse-Lee C M. A selective synthesis of intervention research for students with learning disabilities.  Sch Psychol Rev. 1996;  25 370-391
• 30 Swanson H L, Hoskyn M. A synthesis of experimental intervention literature for students with learning disabilities: a meta-analysis of treatment outcomes.  Rev Educ Res. 1998;  68 277-322
• 31 Melton A K, Bourgeois M S. Training compensatory memory strategies via the telephone for persons with TBI.  Aphasiology. 2005;  19 353-364
• 32 Brush J, Camp C. Using spaced retrieval as an intervention during speech-language therapy.  Clin Gerontol. 1998;  19 51-64
• 33 Cherry K E, Simmons S S, Camp C J. Spaced retrieval enhances memory in older adults with probable Alzheimer's disease.  J Clin Geropsychol. 1999;  5 159-175
• 34 Hillary F G, Schultheis M T, Challis B H et al.. Spacing of repetitions improves learning and memory after moderate and severe TBI.  J Clin Exp Neuropsychol. 2003;  25 49-58
• 35 Turkstra L S, Bourgeois M S. Intervention for a modern day HM: errorless learning of practical goals.  J Med Speech Lang Pathol. 2005;  , (in press)
• 36 Baddeley A, Wilson B. When implicit learning fails: amnesia and the problem of error elimination.  Neuropsychologia. 1994;  32 53-68
• 37a Evans J J, Wilson B A, Schuri U et al.. A comparison of “errorless” and “trial and error” learning methods for teaching individuals with acquired memory deficits.  Neuropsychol Rehabil. 2000;  10 67-101
• 37b Hunkin N M, Squires E J, Parkin A J, Tidy J A. Are the benefits of errorless learning dependent upon implicit memory?.  Neuropsychologia. 1998;  36 25-26
• 38 Baddeley A, Wilson B, Watts F. Handbook of Memory Disorders. West Sussex, UK; John Wiley & Sons 1995
• 39 Landauer T K, Bjork R A. Optimum rehearsal patterns and names learning. In: Grunenberg KM, Morris PE, Sykes RN Practical Aspects of Memory New York; Academic Press 1978: 625-632
• 40 Riley G A, Sotiriou D, Jaspal S. Which is more effective in promoting implicit and explicit memory: the method of vanishing cues or errorless learning without fading?.  Neuropsychol Rehabil. 2004;  14 257-283
• 41 Thoene A IT, Glisky E. Learning name-face associations in memory impaired patients: a comparison of procedures.  J Int Neuropsychol Soc. 1995;  1 29-38
• 42 Hunkin N M, Squires E J, Aldrich F K, Parkin A J. Errorless learning and the acquisition of word processing skills.  Neuropsychol Rehabil. 1998;  8 433-449
• 43 Kalla T, Downes J J, van den Broek M. The pre-exposure technique: enhancing the effects of errorless learning in the acquisition of face-name associations.  Neuropsychol Rehabil. 2001;  11 1-16
• 44 Tailby R, Haslam C. An investigation of errorless learning in memory-impaired patients: improve the technique and clarifying the theory.  Neuropsychologia. 2003;  41 1230-1240
• 45 Challis B H. Spacing effect on cued-memory tests depend upon level of processing.  J Exp Psychol Learn Mem Cog. 1993;  19 389-396
• 46 Krug D, Davis T B, Glover J. Massed versus distributed repeated reading: a case of forgetting helping recall?.  J Educ Psychol. 1990;  82 366-371
• 47 Spooner F, Spooner D. A review of chaining techniques: implications for future research and practice.  Educ Train Ment Retard. 1984;  19 114-124
• 48 Glisky E. Acquisition and transfer of word processing skills by an amnesic patient.  Neuropsychol Rehabil. 1995;  5 299-318
• 49 Glisky E L, Delaney E L. Implicit memory and new semantic learning in posttraumatic amnesia.  J Head Trauma Rehabil. 1996;  11 31-42
• 50 Hunkin N A, Parkin A J. The method of vanishing cues: an evaluation of its effectiveness in teaching memory impaired individuals.  Neuropsychologia. 1995;  33 1255-1279
• 51 Komatsu S, Mimura M, Kato M, Wakamatsu N, Kashima H. Errorless and effortful processes involved in the learning of face-name associations by patients with alcoholic Korsakoff's syndrome.  Neuropsychol Rehabil. 2000;  10 113-132
• 52 Ehlhardt L, Sohlberg M M, Glang A, Albin R. TEACH-M: a pilot study evaluating an instructional sequence for persons with impaired memory and executive functions.  Brain Inj. 2005;  19 569-583