Thursday, June 23, 2022

A Therapy Technique For Improving Memory Spaced Retrieval

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How Much Sr Training Does A Client Usually Need

Spaced Retrieval Therapy app from Tactus Therapy for memory training in dementia & brain disorders

How much training needed is really determined by the client. Therefore, it’s going to vary.

The number of sessions needed can depend on the individuals level of cognitive impairment. Its also dependent on the number of sessions the client has. If you’re seeing them three times a week or five times a week, they’re likely to get the answer much quicker. Whereas if you’re just seeing them once a week, it might take more time. The number of sessions is also dependent on the number of goals you’re addressing using spaced retrieval. You could address a number of different things. You could work on the patient tucking their chin before they swallow, as well as work on the names of family members. You can have some different things in play. I always recommend making sure that the goals are pretty different from one another so that people aren’t getting confused by all the questions. Again, the more frequently you see patients, the more likely they are to retain the information faster or attain the goal faster.

What If Our Learner Is Struggling

If our learner is struggling, we should try to figure out why.

  • Does the prompt question or verbal response use unfamiliar language?
  • Is the expected physical response too complicated?
  • Is it too much to remember the words and the actions together?

Does the prompt question or verbal response use unfamiliar language?

If our learner were struggling with the verbal response, we would stop training and talk about the goal. Wed see if the wording we selected for the prompt question and verbal response makes sense to our learner. We could ask our learner how they would explain it to someone else. Then we could use their wording.

Now is the best time to try out different wording, although its still better to keep changes to a minimum. The more variability there is in training, the more confusion and errors we may see during the entire process.

Is the physical response too complicated?

If our learner struggles to imitate the task, consider breaking the expected response down into more manageable chunks.

For instance, the goal may be to have our learner correctly stand up, release the brakes on a walker, walk, return to the correct position in front of the chair, lock the brakes, and sit down.

If this is too much all at once, our initial target for training may be locking the brakes before sitting down. Once our learner has mastered that, add in the rest of the sequence .

Is it too much to remember the words and the actions together?

  • Use a visual aid.
  • Train the verbal response first.
  • A Therapy Technique For Improving Memory: Spaced Retrieval

    Spiral-bound. Condition: Good. Item is in good condition. Some moderate creases and wear. This item may not come with CDs or additional parts including access codes for textbooks. Might be an ex-library copy and contain writing/highlighting. Photos are stock pictures and not of the actual item.

  • Stock Image
  • Condition: new.

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    If Our Learner Makes Any Mistake At All

    If our learner makes any type of error, we dont shake our head no or provide any sort of feedback.

    Instead, we immediately interrupt with the correct verbal response and perform the action.

    • Trainer: Look down How should you swallow liquids?

    If our learner responds correctly, then we drop down to the last waiting period. For instance, if they hesitated when we presented the prompt question after a four-minute delay, then we would drop down to a two-minute delay for the next waiting period.

    If our learner makes a mistake, interrupt again with the expected response. If our learner makes three mistakes in a row, take a break.

    Establish The Prompt Question

    Spaced Retrieval Therapy and Errorless Learning Program for ...

    Now that weve identified a need for our learner and theyve passed the screening, its time to establish the prompt question to achieve our learners need.

    The key is to ask a question that will prompt the anticipated response in a way that makes sense to our learner. Some possibilities:

    • What should you do when you drink?
    • What should you do when you swallow liquids?
    • How should you swallow liquids?
    • What should you do when you use a cup?

    The planned outcome of the training is for the learner to automatically perform a chin tuck whenever they swallow thin liquids.

    Lets start off with How should you swallow liquids? as this would include soup and cold cereal from a spoon.

    Since our learner has a moderate to severe memory impairment, I would train only with a cup until the habit is established, and then train with the spoon if necessary.

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    Spaced Retrieval: Enabling People With Memory Loss To Lead More Independent Lives

    Twenty years ago while working at a long-term care community, I learned about a memory-training strategy called Spaced Retrieval, which is used to teach people with memory loss new or previously known information. I began using this strategy with people who had Alzheimers disease, Parkinsons disease, traumatic brain injury, aphasia and other conditions that cause memory loss. The results amazed me by practicing verbalizing information, my clients were able to remember important facts, names and tasks that were part of their daily lives over increasing amounts of time. I began to teach Spaced Retrieval to occupational therapists, physical therapists and other speech-language pathologists, and we began to teach the residents of the long-term care community to remember essential information such as how use their walkers, lock their wheelchair brakes, find their rooms and swallowing strategies.

    Since then, I have used Spaced Retrieval to help countless individuals living with memory loss lead more independent lives.

    What is Spaced Retrieval?

    The success of Spaced Retrieval is based on the exposure to and the practice of specific information. These aspects combined are what increase the probability of remembering.

    And it can be used by any care partner.

    Family members, speech-language pathologists, physical therapists, occupational therapists, nurses, social workers and home health aides can all employ Spaced Retrieval.

    Dr. Lyn Turkstra, CCC-SLP, BC-NCD

    Japan

    Teach The Prompt Question And Expect Response

    Now that weve established the question and response, its time to teach it.

    • Trainer: Im going to ask you, How should you swallow liquids? and youre going to say, Look down and then take a drink like this. How should you swallow liquids?
    • Learner: Look down and demonstrates correct procedure.

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    Remembering Therapy Teams Names

    A functional place to start remembering names is with the patients therapy team!

    Create a worksheet like the one below. Ask your patients to use their memory strategies to remember their therapy teams names. First, they will write down the name. Then they will write down an association for each name .

    NURSE:

    OTHER TEAM MEMBERS:

    A Word About Motivation

    A Step by Step Guide to Spaced Retrieval

    In my practice, Ive found that people who have a moderate or severe memory impairment may not be willing to admit that theyre having trouble with their memory. In these cases, Ive sometimes had success by asking open-ended questions that allows the person to talk about their concerns in a way that allows them to admit to an issue while saving face.

    Others may not immediately understand why its necessary to learn or re-learn the information or skill. In these cases, once Ive explained why were working on a particular goal, the person is often agreeable to participating. If theyre forgetful enough, Ill start each training session by explaining the goal and how were practicing. As long as they participate, they can potentially achieve the goal.

    If someone refuses to participate, then youll have to reduce the risk of a bad outcome some other way. For instance, by modifying the environment or relying on the caregiver for supervision.

    The tricky situation is when someone agrees to work with you, perhaps to be polite, but they really dont want to achieve the goal. I once had this come up with a lovely lady who knew she had to use the walker and did well during the sessions, but rarely used the walker when I wasnt there. She finally told me that she wasnt ready to accept that she needed it and deliberately chose NOT to use it.

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    When Is Sr Goal Considered Mastered

    • If a client is able to correctly respond to the prompt question and/or perform the targeted strategy at the beginning of 3 consecutive therapy sessions, the goal is considered mastered.
    • It is important to make sure that the client is consistently performing the targeted strategy or response before discharging the goal.

    When is a space retrieval goal considered mastered? Typically, the rule of thumb is if a client can recall information to a prompt question or perform a targeted strategy at the beginning of three consecutive sessions, then the goal can be considered mastered. If they are consistently recalling that information or the action that you want them to remember, then you are probably seeing some good retention happening. It is important to make sure that the client is consistently performing a targeted strategy before you discontinue it. Sometimes, people can answer a question correctly, but they do not follow through with the desired action. We also want to make sure that that is in place.

    Memory Strategies: More Advanced

    For patients with mild memory deficits, introduce these more advanced memory strategies.

    Ask them which strategies they already use. And which they are interested in trying. Practice the strategies during other memory tasks.

    Patient Instructions:

    PAY ATTENTION. Listen to, look at, and focus on what you want to remember.

    USE MENTAL PICTURES. Take a mental picture and store it in your brain. For example, visualize where you left your keys and take a mental picture of the scene.

    REPEAT & REHEARSE. Repeat over and over what you have just learned, such as a new name.

    CHUNK & ORGANIZE INFORMATION. Sort information into categories. For example, organize your grocery list into groups.

    CREATE ASSOCIATIONS. Make connections between what you want to remember and what you already know. For example, remember a new name by connecting it to someone with the same name.

    USE EXTERNAL AIDS. Wear a watch, use a planner or calendar to help keep a schedule, or write a checklist to remember grocery items.

    ADAPT YOUR ENVIRONMENT. Remove background noise and clutter.

    KEEP ITEMS IN THE SAME PLACE Have containers of places where items belong, such as a key rack by the door.

    HAVE A ROUTINE. Have a set schedule for waking up, meals, naps, bedtime, etc. to get your body into a routine. This helps with memory.

    IMPROVE YOUR OVERALL HEALTH. Go for walks, eat a healthy diet with plenty of fruits and vegetables, and drink plenty of water. This improves brain function.

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    Learning & Memory In Dementia: Model Of Memory

    • Priming
    • Squire, 1994

      Figure 1 shows a nice visual to help you to understand a little bit more about how long term memory works. Dr. Larry Squire was an innovator and researcher in the area of different types of memory. I would definitely recommend looking into his work.

      Figure 1. Squire’s work on memory.

      What Happens After The First Sr Session

      Spaced Retrieval Training for Memory: A

      After the first session of SR training, we write down the longest time interval that the person demonstrated success. Then, at their next session, the very first thing I’m going to do is ask the person the prompt question. I want to see if any retention has occurred from our training from the prior day. I’m going to say, “It’s great to see you. I’m so glad we’re going to be working together. What is my name?” If the person looks at me and is able to remember that Megan is my name, then that shows me that they’ve retained the information for longer than four minutes or eight minutes. They’ve shown 24 hours or 48 hours of retention, which is amazing.

      That means I don’t have to backtrack and do these smaller intervals for the rest of this next session. I might say, “Yep, absolutely. That’s great, you did remember my name. We’re going to keep working together today.” Then I might go ahead and proceed to the other goals I might be working on with them. Maybe intermittently throughout the session, I might ask what my name is, just to see if it’s been retained. I am spot-checking to see if any retention has happened. Again, this is what happens after that first session when you started training a new piece of information.

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      Sr Goals: Prompt Question/answer Examples

      If a patient passes the screen and they’ve shown to be a viable candidate for using this technique, we can work on many different goals with them. Some examples of prompt questions and answers are listed below, but in no way are you limited to this list. You’re only limited by your imagination of what you can do with this. It’s actually pretty fun to do.

      • Disorientation
      • Question: Where do you live now?
      • Answer: Name of Facility
      • Question: What is your room number?
      • Answer: Room #
      • Question: What is your address?
      • Answer: Clients address

      Repetitive questioning is another issue that we might get referrals for. We might have challenging behaviors that our patients are exhibiting, and speech can often be the discipline that can intervene. For example, maybe the patient’s always asking what time meals are served or did they have their pills yet or when is their daughter coming? There can be many things that cause the patient quite a bit of distress because they’re asking that question over and over again. Maybe they’re nervous about it.

      Examples of prompt questions and answers for swallowing include:

      • Question: What should you do before you swallow?
      • Answer: Tuck my chin
      • Question: After you take a bite
      • Answer: Take a drink

      An example for voice is, What should you do before you speak? The answer might be, Take a deep breath. If you’re using a different kind of voice program, there might be some things that you want the patient to recall to be able to use.

      Sr Using The Spaced Retrieval Therapy App

      While anyone can do SR with a clock and a pad of paper, it can be a test of your own memory to recall which interval youre on, which one to do next, and then remember to ask the question at that exact moment.

      The Spaced Retrieval Therapy app lets you enter up to three targets at a time. It runs in the background while you use other apps, alerting you when its time to ask the question again. The app tracks your intervals and data automatically, putting it in a professional report you can email to yourself at the end of the session.

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      Use Our Learners Vocabulary

      Well spend a little time to figure out what the verbal response should be. Well demonstrate what we want our learner to do and ask them to describe the action in their own words.

      • Trainer: Im going to show you a way of drinking that protects your lungs. Ill take a small mouthful of liquid and hold it in my mouth. Then Ill look all the way down. When Im ready, Ill swallow fast and hard. Now watch me.
      • Trainer demonstrates the chin tuck.
      • Trainer: Now how would you describe that?
      • Learner: You took a drink, looked down, and swallowed.

      The key part of our learners response was look down. We wouldnt want to use their entire answer, as its probably too long for them to remember. It doesnt matter how accurate or complete the verbal response is, as long as it makes sense to them.

      In this case, our verbal response will be look down.

      Speech Therapy Memory Activities For Adults: A Practical Guide

      Spaced Retrieval Method

      This post is a guide to treating memory deficits in the adult population.

      The treatments are broken down by severity: mild, moderate, and severe memory deficits. For each of these groups, youll find step-by-step speech therapy memory activities for adults.

      Bookmark and open this post while treating. Or feel free to copy and print the activities.

      For print-and-go handouts & worksheets that are expertly formatted for patients, check out our shop!

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      Tips To Maximize Success

    • Work in a quiet, well-lit room.
    • Use familiar vocabulary.
    • Make sure the learner can easily imitate you.
    • Do not talk during the waiting periods until youve passed the two-minute mark.
    • Ask the prompt question as soon as the waiting period is up, even if you interrupt.
    • Make sure you have the learners attention before you ask the prompt question.
    • Do not allow the slightest hesitation or variation in the response.
    • Be patient. It can take a few sessions to get past the two-minute mark.
    • Modify the waiting period schedule as needed to ensure success without annoying your learner.
    • How To Do Spaced Retrieval Training

      Choose one or more functional targets or goals .

      Ask a question to elicit the target response. If the person answers/performs correctly the first time, choose another target for the session. If the answer is unknown or incorrect, tell or show them the right answer and have them repeat it back.

      Ask again 15 seconds later. If they cant recall, give the answer and have them repeat it back. Try again in 15 seconds. If its still not right, spaced retrieval may not be appropriate.

      When the answer is given correctly, double the time interval and ask the question again. Repeat this step each time the answer is correctly given.

      If the answer is incorrect, give the right answer immediately and ask the question again at the last correct time interval.

      In between asking the questions, fill the intervals with other therapy activities or conversation though its best to choose activities or topics that have little to do with the memory target.

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