Errorless learning of everyday tasks in people with dementia

Abstract

Errorless learning (EL) is a principle used to teach new information or skills to people with cognitive impairment. In people with dementia, EL principles have mostly been studied in laboratory tasks that have little practical relevance for the participants concerned, yet show positive effects. This is the first paper to exclusively review the literature concerning the effects of EL on the performance of useful everyday tasks in people with dementia. The role of factors such as type of dementia, type of task, training intensity, EL elements, outcome measures, quality of experimental design, and follow-up are discussed. The results indicate that, compared with errorful learning (EF) or no treatment, EL is more effective in teaching adults with dementia a variety of meaningful daily tasks or skills, with gains being generally maintained at follow-up. The effectiveness of EL is highly relevant for clinical practice because it shows that individuals with dementia are still able to acquire meaningful skills and engage in worthwhile activities, which may potentially increase their autonomy and independence, and ultimately their quality of life, as well as reduce caregiver burden and professional dependency. Suggestions for future research are given, along with recommendations for effective EL-based training programs, with the aim of developing a clinical manual for professionals working in dementia care.

Outcomes of a community-based treatment programme for people with acquired brain injury in the chronic phase: a pilot study

“…In another review, which discussed the effectiveness of remediation of language and communication deficits in people with TBI and stroke, Cicerone et al (2005) suggest that interventions provided in the home or community by trained volunteers or caretakers may be valuable adjuncts to traditional treatments, particularly for chronic aphasia. Finally, in a review that evaluated the effectiveness of errorless learning of everyday tasks in people with minimal to moderate dementia, four studies were mentioned that promoted additional practice in the home environment, and all four were found to be effective in the short and long term (De Werd, Boelen, Olde Rikkert, & Kessels, 2013).…”

Structured relearning of activities of daily living in dementia: the randomized controlled REDALI-DEM trial on errorless learning

“…Evidence from systematic reviews of small-scale clinical trials suggests that structured teaching techniques may optimize or even stabilize daily functioning in AD [3–5]. Errorless learning (EL) is a prominent method for optimizing learning, which uses feed-forward instructions in order to prevent people from making mistakes during the learning process.…”

“…In people with AD who have profound deficits in explicit memory, these errors may not be recognized as such and are therefore not corrected, but instead are implicitly consolidated into long-term memory. EL may include different techniques such as graded tasks broken down into small steps, modeling, encouragement not to guess, anticipating errors and immediate correction, prompts when steps are performed successfully, vanishing cues and spaced retrieval (rehearsal of the retrieval of information using increasing time intervals) [4, 5]. …”

“…A qualitative review [5] included 26 studies on teaching persons with dementia daily tasks or skills. Five controlled group studies and 12 single-case studies obtained significantly superior effects of EL immediately after training compared with TEL or a no-treatment condition.…”

“…Therefore we conducted the REDALI-DEM trial (RElearning methods on DAily LIving task performance of persons with DEMentia), a multisite randomized controlled trial (RCT) with the aim of comparing the effects of EL vs TEL on the performance of activities of daily living in persons with mild to moderate dementia living at home. Based on earlier studies [4, 5] we hypothesized that EL is superior compared with TEL.…”