Errorless learning in dementia

Contains fulltext : 173273.pdf (publisher's version ) (Open Access)Radboud University, 1 juni 2017Promotores : Kessels, R.P.C., Olderikkert, M.G.M. Co-promotor : Boelen, D.H.E

Subjective Memory Ability and Long-Term Forgetting in Patients Referred for Neuropsychological Assessment

Contains fulltext : 168160.pdf (publisher's version ) (Open Access)It has been suggested that the memory complaints of patients who are not impaired on formal memory tests may reflect accelerated forgetting. We examined this hypothesis by comparing the 1-week delayed recall and recognition test performance of outpatients who were referred for neuropsychological assessment and who had normal memory performance during standard memory assessment with that of a non-patient control group. Both groups performed equally in verbal learning and delayed recall. However, after 1 week, the patients performed worse than controls on both recall and recognition tests. Although subjective memory ability predicted short-term memory function in patients, it did not predict long-term delayed forgetting rates in either the patients or controls. Thus, long-term delayed recall and recognition intervals provided no additional value to explain poor subjective memory ability in the absence of objective memory deficits.8 p

Errorless learning of everyday tasks in people with dementia

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

Foutloos leren bij dementie in de praktijk

Foutloos leren (FL) is een leerprincipe dat wordt toegepast om mensen met dementie alledaagse taken (op)nieuw aan te leren. In deze literatuurstudie werd de effectiviteit van FL onderzocht, waarbij ook de rol van de soort en de ernst van de dementie, de soort taak, de trainingsintensiteit, toegepaste foutreducerende technieken, en follow-up effecten werden besproken. Resultaten laten zien dat FL in vergelijking met trial and error-leren (TEL), of geen training, effectiever is in het aanleren van verschillende soorten alledaagse taken. Bovendien bleken de geleerde taken en vaardigheden ook na langere tijd te beklijven. De FL-effecten werden met name gevonden bij het aanleren van gezicht-naamassociaties, namen van alledaagse voorwerpen en het gebruik van apparaten aan mensen met een minimale tot matige ernst van dementie. Uit dit literatuuroverzicht komt een aantal aanbevelingen over de toepassing van FL in de zorgpraktijk naar voren

Physiological and metabolic responses of wheelchair athletes in different racing classes to prolonged exercise

Various studies have shown the efficacy of errorless learning (EL) in teaching patients with dementia a wide variety of skills and everyday tasks, with some studies showing beneficial effects and others reporting limited or no advantage. However, EL procedures vary greatly and, to date, no clinical guidelines or manuals are available. Here, we present a nationwide survey exploring the interest in, and feasibility of, EL in dementia care in The Netherlands. Based on the survey results and available evidence in the literature, we subsequently drafted an EL manual and had this concept manual evaluated in a Delphi round using the AGREE instrument. Forty-five health professionals associated with 22 dementia care facilities in The Netherlands, including those survey respondents who had piloted an EL intervention in accordance with the concept manual and an eight-strong expert panel representing various disciplines, deemed EL to be meaningful and feasible for use in dementia care and their residential facilities. Although our manual was favourably received, future studies are required to examine how EL can best be implemented in clinical practice and to determine the optimal outcome measures and quality indicators to reliably evaluate intervention outcomes and to consider the cost-effectiveness of the approach

Interrater reliability and concurrent validity of a new rating scale to assess the performance of everyday life tasks in dementia: The core elements method

Errorless learning (EL) is an instructional procedure involving error reduction during learning. Errorless learning is mostly examined by counting correctly executed task steps or by rating them using a Task Performance Scale (TPS). Here, we explore the validity and reliability of a new assessment procedure, the core elements method (CEM), which rates essential building blocks of activities rather than individual steps. Task performance was assessed in 35 patients with Alzheimer's dementia recruited from the Relearning methods on Daily Living task performance of persons with Dementia (REDALI-DEM) study using TPS and CEM independently. Results showed excellent interrater reliabilities for both measure methods (CEM: intraclass coefficient [ICC] = .85; TPS: ICC = .97). Also, both methods showed a high agreement (CEM: mean of measurement difference [MD] = -3.44, standard deviation [SD] = 14.72; TPS: MD = -0.41, SD = 7.89) and correlated highly (>.75). Based on these results, TPS and CEM are both valid for assessing task performance. However, since TPS is more complicated and time consuming, CEM may be the preferred method for future research projects

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

Contains fulltext : 168906.pdf (publisher's version ) (Open Access)Background: Errorless learning (EL) is a method for optimizing learning, which uses feed-forward instructions in order to prevent people from making mistakes during the learning process. The majority of previous studies on EL taught patients with dementia artificial tasks of little or no relevance for their daily lives. Furthermore, only a few controlled studies on EL have so far been performed and just a handful of studies have examined the long-term effects of EL. Tasks were not always trained in the patients' natural or home environment, limiting the external validity of these studies. This multicenter parallel randomized controlled trial examines the effects of EL compared with trial and error learning (TEL) on the performance of activities of daily living in persons with Alzheimer's or mixed-type dementia living at home. Methods: Patients received nine 1-hour task training sessions over eight weeks using EL or TEL. Task performance was measured using video observations at week 16. Secondary outcome measures were task performance measured at week 26, satisfaction with treatment, need for assistance, challenging behavior, adverse events, resource utilization and treatment costs. Results: A total of 161 participants were randomized, of whom 71 completed the EL and 74 the TEL arm at week 11. Sixty-nine EL patients and 71 TEL patients were assessed at the 16-week follow-up (the primary measurement endpoint). Intention-to-treat analysis showed a significantly improved task performance in both groups. No significant differences between the treatment groups were found for primary or secondary outcomes. Conclusions: Structured relearning improved the performance of activities of daily living. Improvements were maintained for 6 months. EL had no additional effect over TEL.11 p