Errorless Learning: Motivating Strategy for Patients with Memory Impairment

No. Thats not a good idea. I dont think that will work. Thats dangerous. Dont do that. Wait! Think again. Thats not quite right. Uh oh! You might want to double-check that.

Feeling defeated? Me too. Yet, I have heard these phrases uttered during many therapy sessions.

I love to learn and have a list a mile long of things I want to learn, but I dread failing over and over when Im learning something new. Its exhausting. Especially if those negative corrections are not just a voice in my head, but they are the voice of a teacher.

We are in the position to teach patients and clients a variety of things, including exercises and compensatory strategies. I can see how patients might dread sessions with me if I provide negative correction constantly. I want my patients to be successful, but the last thing I want is for them to dread therapy. Errorless learning is one solution to increase patient success and morale.

What is Errorless Learning?

Errorless learning is a strategy to help clients reduce errors, which allows patients to accurately practice recalling information or completing tasks. The targeted outcome isnt documentation of 100% accuracy during therapeutic trials, although you might achieve that. Instead, the desired outcome is for the patient to learn. Errorless learning is a learning tool.

Errorless learning is successful at reducing the use of negative corrections leading to a more pleasant experience. Luckily for people with memory impairment due to TBI, CVA, dementia, amnesia, and schizophrenia, errorless learning can help them learn new things.

In a review by Clare and Jones (2008), errorless learning was proven effective for some people with memory impairment to learn specific tasks.¹ Its not a foolproof strategy that will work in every circumstance with every patient by any means, but its an excellent tool to try.

How to Use Errorless Learning

Make your targets specific. Errorless learning isnt used to help learning in general. It is successful with helping people learn specific tasks. For example, if a patient demonstrates unsafe behaviors, I would determine which specific behaviors need improvement to achieve the greatest gain for the patient. I might target locking brakes on a 4-wheel walker before sitting down rather than improving safety in general.

Personalize the targets. If someone has minimal motivation to accomplish the task or recall the information successfully, errorless learning isnt likely to help. However, if a resident is frequently lost and looking for their room, errorless learning may help them learn their room number and recognize their room.

Use "just right" level of cues. There isnt a prescribed sequence of cues to provide someone when using errorless learning. The goal is to reach the Goldilocks just right level of cues. Aim to provide as many cues as necessary to help the client recall information or complete the task accurately every time. Using too few cues leaves room for errors or moving into trial-and-error learning (which isnt as helpful for people who have memory impairment).

Visual, verbal, written, and tactile cues may all be helpful in creating an errorless learning environment. Consider visual and hearing impairments when selecting cues.

Tips for Improving Errorless Learning Success

I find errorless learning is most successful when I do the following things:

• Have your patient recall information or complete the task (correctly) many times to increase proper encoding of the correct answer.

• Pair this tool with other memory interventions, such spaced retrieval or vanishing cues.

• Break up complex tasks into smaller tasks or units.

• Model desired task prior to patient completing task.

• Discourage guessing.

• Choose targets that were at one time familiar to the client.

• Train only one or two targets at a time until mastery is achieved.

Give errorless learning a try. It might help you achieve better outcomes for people who have memory impairment and also have a little more fun during sessions!