Errorless learning in cognitive rehabilitation: A critical review

Abstract

Cognitive rehabilitation research is increasingly exploring errorless learning interventions, which prioritise the avoidance of errors during treatment. The errorless learning approach was originally developed for patients with severe anterograde amnesia, who were deemed to be at particular risk for error learning. Errorless learning has since been investigated in other memory-impaired populations (e.g., Alzheimer's disease) and acquired aphasia. In typical errorless training, target information is presented to the participant for study or immediate reproduction, a method that prevents participants from attempting to retrieve target information from long-term memory (i.e., retrieval practice). However, assuring error elimination by preventing difficult (and error-permitting) retrieval practice is a potential major drawback of the errorless approach. This review begins with discussion of research in the psychology of learning and memory that demonstrates the importance of difficult (and potentially errorful) retrieval practice for robust learning and prolonged performance gains. We then review treatment research comparing errorless and errorful methods in amnesia and aphasia, where only the latter provides (difficult) retrieval practice opportunities. In each clinical domain we find the advantage of the errorless approach is limited and may be offset by the therapeutic potential of retrieval practice. Gaps in current knowledge are identified that preclude strong conclusions regarding a preference for errorless treatments over methods that prioritise difficult retrieval practice. We offer recommendations for future research aimed at a strong test of errorless learning treatments, which involves direct comparison with methods where retrieval practice effects are maximised for long-term gains.

Keywords:

• Errorless
• Errorful
• Retrieval practice
• Testing
• Spacing
• Aphasia
• Amnesia

Acknowledgments

This work was supported by the National Institutes of Health (RO1 DC000191-30 to MFS and 5-T32-HD-007425 to the University of Pennsylvania).

Notes

¹Drawing from Roediger and Karpicke (2006a), information loss is calculated as the difference between performance on immediate and delayed tests divided by performance on the immediate test.

²In Riley et al.'s (2004) interpretation, their results reflected the operation of transfer-appropriate processing. In this view, both standard EL treatment and vanishing cues are effective for implicit learning, but the match between study and test format is an important predictor of which type of training will emerge as superior for a specific test format.

³Note that although the cognitive representations that arise to mediate stimulus–response pairings may be predominantly formed through Hebbian learning, there can be a role for feedback that ameliorates such learning (see Vallabha & McClelland, 2007 for a computational approach; McCandliss, Fiez, Protopapas, Conway, & McClelland, 2002 for a discussion).

⁴This work is not without interpretive difficulty. Their key result involved performance at session 2 for items in two groups: (1) items that were assigned to the short condition and that were not resolved within 10 seconds at session 1; (2) items that were assigned to the long condition and that were not resolved within 30 seconds at session 1. Such an analysis may have introduced a selection bias in that items in the latter group may tend to be more difficult (i.e., they are by definition hard enough to require at least 30 seconds to resolve).

⁵The Pashler et al. (2003) training paradigm manipulated the lag between two test events, which followed an initial study event. In terms of word retrieval, we draw the parallel that trying to retrieve a name from lexical memory (i.e., naming) is a form of “test”, whereas producing the name immediately after hearing or reading it in repetition training is akin to engaging in “study”.