EBP Compendium: Summary of Systematic Review
Academy of Neurologic Communication Disorders and Sciences
Evidence-Based Practice Guidelines for Instructing Individuals with Neurogenic Memory Impairments: What Have We Learned in the Past 20 Years?
Ehlhardt, L., Sohlberg, M. M., et al.
Neuropsychological Rehabilitation, 18, 300-342.
Indicators of Review Quality:
The review addresses a clearly focused question
Criteria for inclusion of studies are provided
Search strategy is described in sufficient detail for replication
Included studies are assessed for study quality
Quality assessments are reproducible
Description: This is a review of experimental and non-experimental studies evaluating instructional practices in cognitive rehabilitation for individuals with neurogenic memory disorders, including traumatic brain injuries and related conditions. Instructional interventions used systematic approaches (e.g. vanishing cues, errorless learning and spaced retrieval) and conventional approaches (e.g., errorful learning/trial and error learning). The review is part of an Academy of Neurologic Communication Disorders and Sciences Practice Guideline for the management of traumatic brain injury.
Question not specifically stated.
Population: Individuals with memory impairments as a result of traumatic brain injury or other related conditions.
Intervention/Assessment: Instructional interventions (i.e. vanishing cues, errorless learning and spaced retrieval, errorful learning trials).
Number of Studies Included: 51
Years Included: 1986 - 2006
- Cognitive-Communication (Adults)
- Instructional Memory Treatments - "Globally, the research evidence provides strong support for the effectiveness of systematic instruction” (p. 23). The heterogeneity of the participants, lack of treatment descriptions/instruction and methodological weaknesses of studies should be considered.
- Cognitive-Communication (Children)
- Instructional Treatments
- Across instructional methods (i.e., errorless learning, method of vanishing cues, spaced retrieval, systematic instructional packages), the majority of studies reported favorable outcomes for individuals with acquired brain injury (ABI).
- For the majority of studies that included generalization measures, generalization of treatment targets occurred partially or in full from laboratory to naturalistic environments or naturalistic environments to other settings for individuals with ABI.
- Maintenance of treatment targets occurred partially or in full for up to nine months post-intervention in all of the studies that measured maintenance of skill acquisition in individuals with ABI.
- Key instructional practices that can promote learning for individuals with ABI:
- Provide a “clear delineation of intervention targets and/or use of task analyses when training multi-step procedures” (p. 27).
- Employ techniques which constrain errors and control “client output while acquiring new skills or relearning information and procedures” (p. 27).
- Provide sufficient practice.
- Distribute practice.
- Use stimulus variation (e.g., multiple exemplars).
- Use strategies to promote more effortful processing (e.g., verbal elaboration; imagery).
- Select and train ecologically valid targets.
Keywords: Brain Injury, Memory
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Added to Compendium: December 2011