Evidence-based practice guidelines for instructing individuals with neurogenic memory impairments: What have we learned in the past 20 years?

Abstract

This article examines the instructional research literature pertinent to teaching procedures or information to individuals with acquired memory impairments due to brain injury or related conditions. The purpose is to evaluate the available evidence in order to generate practice guidelines for clinicians working in the field of cognitive rehabilitation. A systematic review of the instructional literature from 1986 to 2006 revealed 51 studies meeting search criteria. Studies were analysed and coded within the following four key domains: Population Sample, Intervention, Study Design, and Treatment Outcomes. Coding included 17 characteristics of the population sample; seven intervention parameters; five study design features; and five treatment outcome parameters. Interventions that were evaluated included systematic instructional techniques such as method of vanishing cues and errorless learning. The majority of the studies reported positive outcomes in favour of systematic instruction. However, issues related to the design and execution of effective instruction lack clarity and require further study. The interaction between the target learning objective and the individual learner profile is not well understood. The evidence review concludes with clinical recommendations based on the instructional literature and a call to clinicians to incorporate these methods into their practice to maximise patient outcomes.

Keywords:

• Evidence based practice guidelines
• Memory impairment
• Cognitive rehabilitation
• Instruction
• Errorless learning

Acknowledgments

The authors gratefully acknowledge colleagues who participated in the ANCDS guidelines peer review process. They also wish to express sincere appreciation to all the first authors who so generously gave their time to provide edits and ensure that the review accurately reflected their work. Finally, the authors thank Cathy Thomas and Laura Beck of the Teaching Research Institute-Eugene and Rik Lemoncello of the University of Oregon for their assistance in the preparation of this manuscript.

Notes

¹To limit manuscript space devoted to citations in the results section, the first two authors selected and cited the two most representative studies to illustrate certain evidence parameters. For objective evidence parameters (e.g., demographics) with more than three studies, percentages were reported without citations.

²Outcome decisions were based on statistically-analysed group data, individual participant data, or both depending on each study's research design and primary mode of analysis. The authors acknowledge that for studies with group data only, individual variations in performance masked by statistical analysis might have resulted in a different outcome assessment had individual data also been available.

³Other authors would argue such procedural tasks rely on implicit rather than explicit memory (e.g., Baddeley & Wilson, 1994; Page et al., 2006).