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.

Figure 1

The abscissa corresponds to lag between Test 1 (squares) and Test 2 (triangles) at Day 1; the ordinate corresponds to test performance. Day 1 Test 2 shows increased errors during training as a function of lag, whereas the final test at Day 2 (circles) shows improved retention of learning with increasing lag between Test 1 and Test 2 during Day 1. See text for description. From “Is Temporal Spacing of Tests Helpful Even When It Inflates Error Rates,” by H. Pashler, G. Zarow, & B. Triplett, (2003). Journal of Experimental Psychology: Learning, Memory & Cognition, 29, p. 1053. Copyright 2003 by American Psychological Association, Inc.