Validated Practices for Teaching Clients with Cognitive Impairments ADDENDUM

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Validated Practices for Teaching Clients with
Cognitive ImpairmentsADDENDUM

• McKay Moore Sohlberg, Ph.D., University of
  Oregon, Eugene
• Cameron J. Camp, PhD, Myers Research Institute,
  Beachwood, Ohio
• Michelle Bourgeois, PhD, Florida State
  University, Tallahassee, Florida
• Laurie A. Ehlhardt, PhD, The Teaching Research
  Institute-Eugene, Western Oregon University

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TEACH-M Pulling All the Pieces Together

• Laurie Ehlhardt, PhD

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TEACH-M

• Task analysis/Content analysis Know your
  content. What is the target skill/information?
  Break it into small steps/chunks, as appropriate.
  Chain steps together.
• -Develop multiple training and probe examples
• -Determine the natural contexts in which the
  skill/information will be used.
• -Training-to-functional use clinic to natural
  natural to natural
• --------------------------------------------------
  --------------------------------------------
• Errorless learning Keep errors to a minimum
  during the acquisition phase. Model target
  step(s) BEFORE client attempts a new skill/step.
  Carefully fade support
• Assess performance Probe performance at the
  beginning of a teaching session and/or before
  introducing a new step/piece of information.
• Cumulative review/Correct mistakes/Chain steps
  Regularly review previously learned skills. Dont
  let an error sneak by! Demonstrate the correct
  skill/step right away and ask client to do it
  again.
• High rates of correct, distributed practice
  trials 5 trials is not enough-- 50 plus, is more
  like it!
• Meta-cognitive component--how can you increase
  effort or engagement?

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Examples of Different Types of Instructional
Targets

• Informationwould use spaced retrieval
• Names/Addresses/Phone
• Location
• Important dates
• Vocabulary (names of functional objects)
• Multi-Step Tasks
• Chin tuck before swallow
• Activities of daily living (tooth brushing, hair
  combing, dressing)
• Driving
• Email steps
• Entering appointments external memory aid
  (APPLIED EXERCISE)
• Self-Instructional Routines (Meta-cognitive
  Strategies)
• Reading Comprehension (PQRST)
• Goal Management Training (Stop, Plan, Try, Check)

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Examples of the TTask Analysis- multi-step
procedure(examples-contexts different cars,
different settings)

• Driving Lesson/Task 1
• Ready procedure
• Seatbelt
• mirrors X3
• key in
• check
• turn key

• Driving Task 2
• Breaking
• Ready procedures
• Foot on brake, car in park
• Check around before moving
• Release gently
• Brake
• Release gently
• Brake
• Put car in park

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Example of the TTasks analysis of multi-step
procedures(examples-contexts different
msgs/users different computers/settings)

• Email Task 1
• Ready Procedures
• Turn on computer
• Turn on monitor
• Click on OutLook email icon on desktop

• Email Task 2
• Read-Reply (short msg)
• Ready procedures
• Click on Inbox
• Click on new message Read message
• Click on reply
• Type message
• Click on send

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Example of the TExternal memory
aid(examples-contexts different
appointments/settings)

• Appointments Task 1
• Recording Appointments
• 1. Read appt. card (use several examples)
• 2. Open book to month
• 3. Find date
• 4. Record appt.

• Appointments Task 2
• Reviewing Appointments
• 1.(before bed) Open memory aid to month.
• 2. Locate day/date for the next day.
• 3. Review appointments.
• 4. Place memory aid next to bed.
• 5. (after waking up) Review appointments for the
  day.

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Examples of the TTask Analysis- metacognitive
strategy(examples-contexts different reading
material different settings)

• PQRST
• Preview
• Question
• Read
• Say
• Test

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Examples of the EMinimize Errors

• Show first guided-carefully faded prompting
  scaffolded instruction.
• Preview Heres what well work on today.
• Clinician Tells Models then Client Tells
  Models
• Show examples non-examples/ then client picks
  out examples and non-examples
• Develop key words/symbols (e.g., stop sign)

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Some Examples of AAssessment

• (information)
• What is your phone number?
• (multi-step task)
• Show me what you do to get ready to drive.
• (meta-cognitive strategy)
• PQRST You are reading this chapter for
  homework. Show me how youll remember whats in
  the chapt.

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Some Examples of HHow to Facilitate High Rates
of Practice/Distributed

• Model (s), then
• May need massed practice initially
• You do it, Good! Try it again, Try it
  again
• Now, Im going to distract you (fill with chat
  or another simple task) Now, try it again.
• Not quite Ill show you. Isolate any step that
  is difficult and do it several times space the
  rehearsal/distribute practice chain step with
  previously trained steps

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Some Examples of HHow to Facilitate High Rates
of Practice/Distributed

• Avoid
• That was great! You got it! You had a difficult
  time with that before but not now. Way to go!
  Now, try it again.
• Problems with this? Alternative wording?
• Well, that wasnt quite it.Almost, though. You
  got the first step, but not the second step. Can
  you tell me what the second step is?
• Problems with this? Alternative wording?

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Some Examples of CCumulative Review,
Correction, Chaining

• Review-refresher
• Youve been using PQRST for awhile, but it might
  be useful to review each step just to be sure
  these are solid.
• Immediate correction
• Immediately correct errors by modeling step
  (isolating, if necessary) 2-3x, followed by
  several practice trials
• Chaining via Task Analysis
• If you isolate a step, go back and chain it to
  the one before it. You are trying to establish
  patterns.

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Examples of MThe meta-cognitive
component(NOTE Dont confuse with
meta-cognitive strategy as its own instructional
target.)

• Prediction-Reflection
• Are there any driving steps you tend to forget?
  (model-practice) How many steps did you
  remember?
• Youve learned five steps for your reading
  strategyhow many do you think youll remember
  without cues? (model-practice) How many steps
  did you remember?
• Level of Effort
• Whats the hardest part of writing a
  paragraph/Whats the easiest?
• Data Collection
• You check off the steps that you have
  mastered.

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Evidence in support of TEACH-M(finishing where
we started)

• TEACH-M applied to an adapted email interface
• Ehlhardt, L.A., Sohlberg, M.M., Glang, A.,
  Albin, R. (2005) TEACH-M A pilot study
  evaluating an instructional sequence for persons
  with impaired memory and executive functions.
  Brain Injury, 19 (8), 569-584.
• TEACH-M applied to learning selected tasks on a
  commercial PDA NIH National Center on Medical
  and Rehabilitation Research R03 2007-2009
• Sohlberg, M.M., Ehlhardt, L., Kennedy, M (2005)
  Instructional Techniques in Cognitive
  Rehabilitation A Preliminary Report, Seminars in
  Speech and Language, 26, 268-279.

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YOUR TURN!Test your skills at identifying
TEACH-M components

• Task Analysis for Recording Appointment
• 1. Read appt. card
• 2. Open book to month
• 3. Find date
• 4. Record appt.

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Errorless learning ( other direct instruction
principles)

• Video clip What do look for
• explaining the task vs. doing the task
• transition from assessment to training
• model first, THEN practice
• chaining steps
• of correct practice trials distribution