Comparing the Efficacy of using Spaced Retrieval and Cueing Hierarchy in enhancing the use of External aids by Persons with Dementia

Memory training in demented individuals presents unique challenges since most of the functions that enhance such training in non-demented older individuals are impaired in demented individuals.  Although variability exists in the type of memory loss that occurs in different forms of dementia (Hornberger & Piguet, 2012; Adlam, Patterson & Hodges, 2009), people with Alzheimer’s disease, the most common form of dementia, exhibit impairment in episodic, semantic and prospective memory functions (Hodges & Patterson, 1995; Kasl-Godley & Gatz, 2000). Episodic memory helps one to remember events or material that one experiences, semantic memory helps one in recounting general information and prospective memory helps one in remembering an action supposed to be done and performing such an action at the appropriate time (Kasl-Godley & Gatz, 2000).

Unlike the episodic, semantic and prescriptive memory functions, implicit and procedural memory functions are argued to be relatively preserved in dementia (Harrison, Son, Kim & Whall, 2007; Baid & Samson, 2009). Implicit memory enables experience-based cognitive processing that does not involve conscious information retrieval whereas procedural memory refers to memory for performance of skills such as playing a musical instrument (Kasl-Godley & Gatz, 2000). Accordingly, memory-training interventions for demented individuals seek to utilize such preserved memory functions to enhance their effect. Other features that enhance memory-training interventions include restructuring tasks to use recognition instead of recall, emphasis on external rather than internal aids and use of a cooperative approach in task performance (Kasl-Godley & Gatz, 2000). This proposal seeks to compare the efficacy of two methods, spaced retrieval (SR) and modified Cueing Hierarchy (CH), in enhancing the use of external aids by demented individuals.

SR seeks to build participants’ learning and information retention capabilities by engaging participants in recalling exercises carried out over increasingly longer periods (Bourgeois et al., 2003). Whenever the participant is able to recall the information of interest, the interval before the next recall exercise is increased (Bourgeois et al., 2003). Alternatively, when the participant fails to recall the information of interest, the trainer tells the participant the correct response and asks him or her to repeat it. The interval length for the next recall exercise following such recall failure is then adjusted to the last interval at which the retrieval was successful (Bourgeois et al., 2003).

SR is founded on the principle of “errorless learning”, a neuropsychological principle that seeks to eliminate errors during the learning process (Bourgeois et al., 2003; Clare & Jones, 2008). In memory rehabilitation, such elimination of errors is targeted by approaches such as immediate correction of errors, breakdown of tasks into small, discrete steps, and provision of sufficient models before task performance (Sohblerg et al. 2005 as cited in Clare & Jones, 2008, p. 1). Such practise is used for demented individuals since their declarative (also referred to as explicit) memory, which entails conscious learning and retrieval of information, is impaired (Kasl-Godley & Gatz, 2000; Bourgeois et al., 2003). Accordingly, such individuals cannot accurately use past information to correct themselves thus ensure appropriate task performance (Kasl-Godley & Gatz, 2000; Bourgeois et al., 2003). On the other hand, errorless learning does not allow such individuals to make errors during training, hence preventing instances of inaccurate learning (Bourgeois et al., 2003; Clare & Jones, 2008). Such a perspective thus explains the emphasis in SR of the participant having a successful recall during each trial. The errorless learning approach is advanced to use nondeclarative (implicit or procedural) memory where learning is achieved via unconscious, and relatively effortless processes Bourgeois et al., 2003; Clare & Jones, 2008).

Cueing Hierarchies (CHs) is a common approach used to develop speech and language capabilities in persons with memory and language impairments arising from neurological damage (Bourgeois et al., 2003; Bourgeois & Hickey, 2009, p. 163). The strategy involves evaluation of an individual’s response to every cue to create a hierarchy of cues based on each cue’s power to elicit the desired response in that particular individual (Linebaugh & Lehner, 1977; Bourgeois et al., 2003; Bourgeois & Hickey, 2009, p. 163). Cues at the highest hierarchy present the participant with the highest form of information with which the participant is likely to provide the desired response (Linebaugh & Lehner, 1977). Traditionally, CHs used cues in both ascending and descending order but modified CHs use cues only in descending order i.e. the cue with the highest likelihood of eliciting the correct response from the participant is used first (Bourgeois et al., 2003; Bourgeois & Hickey, 2009, p. 163).

Although use of CHs in dementia settings is limited, Bourgeois et al. (2003) found out that demented individuals trained using CH learned targeted goals in almost equal timeframe as when SR was used. However, the study found out that goals learned via SR were significantly retained compared to goals learned via CH in a follow up evaluation. In their CH evaluations, Bourgeois and colleagues (2003) used such cues as semantic (‘something to look at’), phonemic (‘providing first syllable of the activity list’), visual (‘pointing to the list’) and tactile (‘touching/holding the list). The proposed study seeks to use a similar approach to evaluate the efficacy of using CH in achieving training goals in dementia settings.

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