is errorless learning a useful concept in the treatment of word retrieval disorders? lyndsey...
TRANSCRIPT
Is errorless learning a useful concept in the treatment of word retrieval disorders?
Lyndsey Nickels, Kate Makin, Belinda McDonaldMelanie Moses & Christine Taylor
Speech Pathology Service, Royal Rehabilitation Centre Sydney
& Macquarie Centre for Cognitive Science
Treatment of word retrieval disorders (anomia) in aphasia
• Word retrieval disorders can be successfully treated.
• But no single treatment is successful for every individual.
• Do not yet understand the circumstances under which treatments work (who, what, when, why and how)
• Our research aims to investigate these issues
Errorless learning
Hypothesis• Remediation is more effective if errors are prevented
- the act of producing an error may strengthen the incorrect association, and make the correct response less likely to occur.
• Technique widely & successfully used with people with acquired memory impairments (amnesia)
• E.g. Baddeley & Wilson, 1994
Errorless learning and anomia treatment
• Fillingham et al (2003)
“error reducing techniques do have positive effects for patients with word finding difficulties. As yet there is limited information on which to judge whether this technique is significantly advantageous over errorful approaches” (p358).
This study:
compares an errorful and errorless approach directly using facilitation
Facilitation?
• The effects of performing a task once on subsequent performance (usually of another task).
• Compare effects of two different tasks on word retrieval in individuals with impaired word retrieval
- Errorless / error reducing (repetition)
vs
- Errorful (phonemic cueing)
Tasks
“kangaroo”
Errorless
Repetition
“k”
Errorful
Phonemic cueing
Method
Name 300 pictures until 95 failed (10 second limit)
Sort the failed items into 3 (frequency & length)matched sets
Errorless Errorful Control
Facilitation
Name all 3 sets of pictures+ 30 easy fillers
1 week later
10 mins later
Participants
15 individuals with aphasia & word production impairments.
Age 31-74
9 women, 6 men.
11 Left CVA, 3 TBI, 1 HSE.
Time p.o. 6 months – 20years
8 fluent aphasia; 7 non-fluent
Majority show comprehension impairments
(word-picture matching)
All have impaired picture naming
-0.10
0.00
0.10
0.20
0.30
0.40
0.50
FM
E
JNI
KC
C
PS
J
DR
S
JUE
SJS
JMM
DIP
MC
B
WV
K
FA
B
JOW
MF
T
SM
G
Mea
n
Phon Cues
Repetition
Facilitation effect compared to control pictures:Errorless (Repetition) & Errorful (Phonemic cues)
*
*
*
*
*
**
*
-0.10
0.00
0.10
0.20
0.30
0.40
0.50
FM
E
JNI
KC
C
PS
J
DR
S
JUE
SJS
JMM
DIP
MC
B
WV
K
FA
B
JOW
MF
T
SM
G
Mea
n
Phon Cues
Repetition
Facilitation effect compared to control pictures:Errorless (Repetition) & Errorful (Phonemic cues)
*
*
*
*
*
**
*
-0.15
-0.10
-0.05
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40
FM
E
JNI
KC
C
PS
J
DR
S
JUE
SJS
JMM
DIP
MC
B
WV
K
FA
B
JOW
MF
T
SM
G
Mea
n
ben
efit
rep
etit
ion
- c
ue
Relative benefitErrorless (repetition) vs Errorful (phonemic cueing)
Ph
on
cue b
enefit
Rep
etition
ben
efit
*
*
**
-0.15
-0.10
-0.05
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40
FM
E
JNI
KC
C
PS
J
DR
S
JUE
SJS
JMM
DIP
MC
B
WV
K
FA
B
JOW
MF
T
SM
G
Mea
n
ben
efit
rep
etit
ion
- c
ue
Relative benefitErrorless (repetition) vs Errorful (phonemic cueing)
Ph
on
cue b
enefit
Rep
etition
ben
efit
*
*
**
Summary
• Errorless (repetition) & Errorful (phonemic cueing) tasks significantly facilitate subsequent naming over 10 minutes later.
• Errorless (repetition) significantly more beneficial than errorful (phonemic cueing).
cf Best et al – no significant difference between repetition & cueing.
Conclusion: Errorless tasks are more beneficial than errorful tasks in the treatment of aphasia
Conclusion
Errorless tasks are more beneficial than errorful tasks in the treatment of aphasia
Why might we doubt this simple conclusion?
1) Can we be sure the errorless task was more accurate?
How errorless is errorless? Accuracy of the facilitation task.
Repetition is more errorless than cueing.
(except for JNI)
0.00
0.20
0.40
0.60
0.80
1.00
FME
JNI
KCCPSJ
DRSJU
ESJS JM
MDIP
MCB
WVK
FABJO
WM
FTSM
GM
ean
repetition
phoncue
Conclusion
Errorless tasks are more beneficial than errorful tasks in the treatment of aphasia
Why might we doubt this simple conclusion?
1) Can we be sure the errorless task was more accurate?
2) If it is the errorless nature of the task that is important then within a task the more accurate that task the greater the benefit for naming.
Is this the case …
across people?
YES
The more errorless, the more benefit?
Examine at the correspondence between accuracy of the task (repetition/cueing) and the amount of benefit for naming
-0.20
0.00
0.20
0.40
0.60
0.80
1.00
Repetition - Facilitationaccuracy
Repetition naming benefitOrder the individuals by facilitation task
accuracy and look at whether the naming accuracy shows a parallel
increase
The more errorless, the more benefit?
Examine at the correspondence between accuracy of the task (repetition/cueing) and the amount of benefit for naming
-0.2
-0.1
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
MFT
DRSFAB
FME
KCCSJS DIP JN
IJM
MM
CBPSJ
JUE
WVK
SMG
JOW
Phon Cue - Facilitationaccuracy
Phon Cue naming benefit
The more errorless, the more benefit?
Examine at the correspondence between accuracy of the task (repetition/cueing) and the amount of benefit for naming
In other words: it is not the case that the more accurate the facilitation task the more naming benefits.
i.e. errorless is not better than errorful WITHIN a task across individuals
Pearson’s Correlation (r=)
Significance (p=)
Repetition 0.17 0.539
Phon cue 0.03 0.906
No significant correlation between success of the cue
during facilitation and benefit of cueing for subsequent naming
Conclusion
Errorless tasks are more beneficial than errorful tasks in the treatment of aphasia
Why might we doubt this simple conclusion?
1) Can we be sure the errorless task was more accurate?
2) If it is the errorless nature of the task that is important then within a task the more accurate that task the greater the benefit for naming.
Is this the case …
across people?
within people across items?
YES
NO
Accuracy within task & within individual across items.
• Compared accuracy of items that were accurate in facilitation and those that were not.
• Are the items that are accurate repeated/named with a cue more accurately named 10 minutes later?
• Repetition: Correctly repeated: 47% correctly named
Incorrectly repeated: 23% correctly named
• Phonemic Cueing:
Correctly named with cue: 62% correctly named
Incorrectly named with cue: 18% correctly named
Conclusion
Errorless tasks are more beneficial than errorful tasks in the treatment of aphasia
Why might we doubt this simple conclusion?
1) Can we be sure the errorless task was more accurate?
2) If it is the errorless nature of the task that is important then within a task the more accurate that task the greater the benefit for naming.
Is this the case …
across people?
within people across items?
YES
NO
Yes …but
Summary of present thinking
Errorless learning • An overly simplistic notion……• CANNOT evaluate using two tasks • More sensible to evaluate within a task.
It MAY be the case that items which are more accurate in some therapy tasks that involve output are better named at a later point.
….this is counter to the traditional notion that tasks which are harder and more effortful are more productive.
Maybe not!
Is errorless learning a useful concept in the treatment of word retrieval disorders?