Some recent studies suggest that errorless learning principles may be beneficial in memory rehabilitation for people with dementia, while others indicate that effortful processing may be more important. The present study compared the effects of four different learning techniques, varying in level of effort required and number of errors elicited, on free recall, cued recall and recognition of novel and previously known associations among people with early-stage dementia. Ten participants with a diagnosis of early-stage Alzheimer's, vascular or mixed dementia learned novel and previously familiar face–name associations with each of four techniques – vanishing cues, forward cues, target selection, and paired associate learning – in a within-subjects design. All conditions produced significant learning for both novel and familiar associations. There were no significant differences between conditions, although mean scores were slightly higher for errorful conditions. Reducing errors did not produce any benefits. Enhancing level of effort had no significant effects for familiar associations, but high-effort conditions were significantly more effective than low-effort conditions in facilitating cued recall of novel associations. The results confirm that memory rehabilitation techniques can produce significant benefits, but do not support the view that error reduction during learning facilitates greater improvement in early-stage dementia. Effort enhancement may be more important, especially when learning novel associations. We are indebted to a number of people for their assistance. Sue Okell and Julia Brownlie provided valuable support in setting up the research, and Margaret Mooney was instrumental in helping to recruit participants. Professor Robert Logie and Dr Hazel Emslie provided methodological assistance, and Dr Rik Henson generously provided access to stimulus items. Dr Robert Jones offered helpful comments on an earlier draft of this paper. Finally, we would like to thank the staff of the Day Hospital for supporting the research, and most importantly the participants themselves for their enthusiastic and valued contribution. The work reported here formed part of Josephine Dunn's thesis for the doctorate in clinical psychology at University College London, awarded in 2003, which was supervised by Linda Clare.

Learning Face-name Associations in Early-stage Dementia: Comparing the Effects of Errorless Learning and Effortful Processing

INTRODUCTION Following traumatic brain injury (TBI), children experience a variety of physical, motor, speech, and cognitive deficits that can have a long-term detrimental impact The emergence and popularity of new technologies has led to research into the development of various apps, gaming systems, websites, and robotics that might be applied to rehabilitation The objective of this narrative review was to describe the current literature regarding technologically-assisted interventions for the rehabilitation of motor, neurocognitive, behavioral, and family impairments following pediatric TBI EVIDENCE ACQUISITION We conducted a series of searches for peer-reviewed manuscripts published between 2000 and 2017 that included a technology-assisted component in the domains of motor, language/communication, cognition, behavior, social competence/functioning, family, and academic/school-based functioning EVIDENCE SYNTHESIS Findings suggested several benefits of utilizing technology in TBI rehabilitation including facilitating engagement/adherence, increasing access to therapies, and improving generalizability across settings There is fairly robust evidence regarding the efficacy of online family problem-solving therapy in improving behavior problems, executive functioning, and family functioning There was less compelling, but still promising, evidence regarding the efficacy other technology for motor deficits, apps for social skills, and computerized programs for cognitive skills Overall, many studies were limited in the rigor of their methodology due to small heterogeneous samples and lack of control groups CONCLUSIONS Technology-assisted interventions have the potential to enhance pediatric rehabilitation after TBI Future research is needed to further support their efficacy with larger controlled trials and to identify characteristics of children who are most likely to benefit

Technology-assisted rehabilitation interventions following pediatric brain injury.

PURPOSE/OBJECTIVE Anosognosia for spatial neglect (ASN) can be offline or online. Offline ASN is general unawareness of having experienced spatial deficits. Online ASN is an awareness deficit of underestimating spatial difficulties that likely to occur in an upcoming task (anticipatory ASN) or have just occurred during the task (emergent ASN). We explored the relationships among spatial neglect, offline ASN, anticipatory ASN, and emergent ASN. Research Method/Design: Forty-four survivors of stroke answered questionnaires assessing offline and online self-awareness of spatial problems. The online questionnaire was asked immediately before and after each of 4 tests for spatial neglect, including shape cancellation, address and sentence copying, telephone dialing, and indented paragraph reading. RESULTS Participants were certain they had difficulties in daily spatial tasks (offline awareness), in the task they were about to perform (anticipatory awareness) and had just performed (emergent awareness). Nonetheless, they consistently overestimated their spatial abilities, indicating ASN. Offline and online ASN appeared independent. Online ASN improved after task execution. Neglect severity was not positively correlated with offline ASN. Greater neglect severity correlated with both greater anticipatory and emergent ASN. Regardless of neglect severity, we found task-specific differences in emergent ASN but not in anticipatory ASN. CONCLUSIONS/IMPLICATIONS Individuals with spatial neglect acknowledge their spatial difficulty (certainty of error occurrence) but may not necessarily recognize the extent of their difficulty (accuracy of error estimation). Our findings suggest that offline and online ASN are independent. A potential implication from the study is that familiar and challenging tasks may facilitate emergence of self-awareness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Online and offline awareness deficits: Anosognosia for spatial neglect.

Background: Self-awareness and insight are critical functions required to maintain safe and optimal participation in all daily life activities in a variety of environmental contexts. In the past two decades, occupational therapists have developed several psychometrically sound assessments designed to identify self-awareness and insight deficits in patients with neurological disorders. This scoping review identifies and evaluates key properties of such assessments to inform clinical practice. Method: Multiple electronic databases were searched using the key search terms of “self-awareness” and “self-awareness assessment,” and “insight” and “insight assessment.” Included studies were original primary sources from the peer-reviewed journals. Results: Nine assessments met the inclusion criteria: Assessment of Awareness of Disability, Awareness Interview, Awareness Questionnaire, Insight Interview, Patient Competency Rating Scale, Patient Competency Rating Scale for Neuro-Rehabilitation, Patient Distress Scale, Self-Awareness of Deficits Interview, and Self-Regulation Skills Interview. Each assessment is reviewed in detail regarding its purpose, administration time, format, type of awareness assessed, psychometric properties, and advantages and disadvantages. Conclusions: Although all nine assessments are psychometrically sound, some may hold more usefulness for occupational therapists depending on a variety of factors, including patient cognitive level and activity tolerance and clinical setting and time constraints. Comments The authors report that they have no conflicts of interest to disclose.

/pdf/a-scoping-review-of-self-awareness-instruments-for-acquired-4mavr13p12.pdf

A Scoping Review of Self-Awareness Instruments for Acquired Brain Injury

Previous research with typically developing children and adults shows that active control of the learning experience leads to enhanced episodic memory, as compared with conditions lacking this cont

Memory enhancements from active control of learning in children with autism spectrum disorder

Objective: Awareness deficits are common after traumatic brain injury (TBI); however, relatively little is known of awareness deficits in the early stages post-injury. This study outlines the development of a new tool, ‘The Insight Interview’, designed to measure awareness across different domains (awareness of change, severity of deficits, current and future functional consequences) from 3 months post-TBI.Methods: Forty-three patients with at least a severe TBI, their nominated family member and treating clinician were all administered different versions of the Insight Interview during the patient’s inpatient stay. Awareness was measured; (1) by calculating a discrepancy score between the patient’s and their family informant’s and/or clinician’s ratings of the patient’s abilities and (2) using interviewer-based ratings of the patients’ responses to interview questions.Results: Awareness differed depending upon the domain being assessed, with patients demonstrating greatest awareness in the curren...

The Insight Interview: A new tool for measuring deficits in awareness after traumatic brain injury

Errorless learning has demonstrated efficacy in the treatment of memory impairment in adults and older adults with acquired brain injury. In the same population, use of elaborative encoding through supported self-generation in errorless paradigms has been shown to further enhance memory performance. However, the evidence base relevant to application of both standard and self-generation forms of errorless learning in children is far weaker. We address this limitation in the present study to examine recall performance in children with brain injury (n = 16) who were taught novel age-appropriate science and social science facts through the medium of Skype. All participants were taught these facts under conditions of standard errorless learning, errorless learning with self-generation, and trial-and-error learning after which memory was tested at 5-minute, 30-minute, 1-hour and 24-hour delays. Analysis revealed no main effect of time, with participants retaining most information acquired over the 24-hour testing period, but a significant effect of condition. Notably, self-generation proved more effective than both standard errorless and trial-and-error learning. Further analysis of the data revealed that severity of attentional impairment was less detrimental to recall performance under errorless conditions. This study extends the literature to provide further evidence of the value of errorless learning methods in children with ABI and the first demonstration of the effectiveness of self-generation when delivered via the Internet.

Elaborative encoding through self-generation enhances outcomes with errorless learning: Findings from the Skypekids memory study

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The Insight Interview: A new tool for measuring deficits in awareness after traumatic brain injury

Elaborative encoding through self-generation enhances outcomes with errorless learning: Findings from the Skypekids memory study