How does spaced retrieval therapy work?

By January 14, 2014 Apps, Dementia, Research, SLP 20 Comments

spaced retrieval therapy

For Research Tuesday this month, Gray Matter Therapy brings you information on spaced retrieval therapy. I recently read the “papers in press” version of a systematic review looking at the effectiveness of spaced retrieval therapy on semantic memory in Alzheimer’s Disease.

What is spaced retrieval therapy?

According to a systematic review by Oren, Willerton, and Small, “Spaced Retrieval Training (SRT) is one such intervention that has been used for a variety of memory deficits, including

  • semantic memory (i.e., remembering facts such as names of people and objects, current year, city and facility of residence, room number);
  • procedural memory (i.e., remembering to perform some action, such as how to get out of a chair, swallowing techniques);
  • prospective memory (i.e., remembering future appointments, activities or tasks, such as looking at a calendar, taking medication); and
  • recent episodic memory (i.e., remembering recent personal events such as one’s birthday, a dinner party).” [formatting my emphasis]

To perform spaced retrieval therapy several functional targets (such as the examples above) are selected. Then one target is focused on at a time until maintenance level is achieved. The SLP asks a question to elicit the target. If the client answers correctly, increase the time interval and ask the question again. If the answer is incorrect, provide immediate correction and ask the question again at the last correct time interval.

Selecting spaced retrieval therapy targets

I first learned about spaced retrieval therapy during my clinical fellowship. It was presented to me as a way to help people remember things better. An exercise for their memory. The SLP who told me about spaced retrieval therapy frequently used picture cards of common objects (e.g. shoes, ball, tree, banana) as the targets.

Spaced retrieval therapy is best reserved for functional information that will make clients more independent. Examples may include: where to look for meal times, checking the guest book to find out when family last visited, safe ambulation strategies, etc. With each of these the goal is to generalize into everyday practice to improve independence and quality of life.

An example of spaced retrieval therapy

I love this assignment idea for those of you that teach graduate students. These students demonstrate the use of spaced retrieval therapy.

According to Cameron Camp, if Mildred (the client) recalled the target information (her husband’s name) on the first attempt of the session then the SLP would address something else in therapy. After 2-3 consecutive therapy sessions of correct answers at the beginning of the session (before any training has occurred) then the SLP would move to maintenance mode for that target.

Now if Mildred could not recall her husband’s name then the SLP would continue with spaced retrieval therapy. The SLP would end the initial trial with the correct target, wait increasing intervals, and ask a question to elicit the target.

What to expect from spaced retrieval therapy

I read a pre-print version of Oren, Willerton, and Small’s systematic review looking at the effects of spaced retrieval therapy using semantic memory targets in 12 studies. A prior review was completed by separate authors in 2005. Researchers have learned quite a bit about spaced retrieval therapy since the 2005 review.

Spaced retrieval therapy should help the person with dementia recall trained information for up to several months after training. Spaced retrieval therapy will not improve generalized memory function. Selecting specific and functional targets is key for the client to obtain improved independence.

The severity of dementia affects the spaced retrieval outcomes. The more advanced the dementia the less success with spaced retrieval therapy should be expected. Specifics regarding where the cut off point for use of spaced retrieval therapy was not discussed in this review.

Some information is easier to train than other information. Previously known information (e.g. family members’ names) are trained faster than new information (e.g. nurse’s name).

One of the things I found quite promising was the variability within the 12 studies. The authors reported, “Studies varied in: providing corrective feedback, the type of interval, retracting after incorrect responses, familiarity of training targets, the number of target words per interval, the content of filler tasks between intervals, and the intensity or number of training sessions.”

This variability is remarkable, because all the studies showed improvement with spaced retrieval therapy (despite the variability). As a clinician this makes me feel comfortable about using the technique, because I feel I cannot mess it up!

Tactus Therapy SRT app review

spaced retrieval therapy, app

Tactus Therapy’s SRT App

I am generally a fan of Tactus Therapy Solutions apps. But I will admit, when I heard Tactus Therapy had a spaced retrieval therapy app I thought it was poor use of app technology since my stopwatch on my phone could do the same thing. When it went on sale, I bought it out of curiosity.

Tactus Therapy won me over again. The app makes spaced retrieval therapy so easy. Yes, it is a fancy timer. But at $3.99 it is an affordable functional addition to my app collection that makes therapy easier for me!

How do you use spaced retrieval therapy? Or if spaced retrieval therapy is new to you, how do you envision using spaced retrieval therapy?

References
Camp, C. J. (2005). Spaced retrieval: A model for dissemination of a cognitive intervention for persons with dementia . In D. K. Attix and K. A. Welsh-Bohmer (Ed.), Geriatric Neuropsychology: Assessment and Intervention. (Edition ed., pp. Pages). New York, NY: The Guilford Press.

Orin, S., Willerton, C., & Small, J. (In Press). The effects of spaced retrieval training on semantic memory in Alzheimer’s Disease. Journal of Speech-Language and Hearing Research.

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Rachel Wynn
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Rachel Wynn

Speech-Language Pathologist at Gray Matter Therapy
Rachel is a speech-language pathologist and creator of Gray Matter Therapy. She started making noise as a patient-centered care advocate in 2013. She believes great care happens when patients are informed and engaged.
Rachel Wynn
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  • Todd R. Fix

    Thanks! I love your dedication!

    • http://www.graymattertherapy.com Rachel Wynn

      Thanks Todd! Do you use spaced retrieval therapy in your work?

  • Karah

    Thank you for this post. I use spaced retrieval paired with errorless learning daily, the tactus app is fantastic for SRT. I love to use it for patients to recall pertinent information to decrease their dependence on loved ones and caregivers! I’ve had success with recall of room numbers, phone numbers and directions to places in building. I’ve also used it to initially teach memory strategies (I tend to use WRAP, write, repeat,associate, picture) to high level patients and have the patients think of situations these strategies would help them to remember something better. Once they are able to recall their memory strategies/provide examples we utilize them for more functional means, remembering HEP from other therapies, phone numbers etc. If I may ask could you provide us with a sample goal you might write for SRT? I always like to take tips from others on goal writing to make my goals more measurable.

    Thanks!

    • http://www.graymattertherapy.com Rachel Wynn

      Karah- I also use SRT and Errorless Learning together. I’ll be writing about errorless learning next week. 😉

      Thanks for listing some awesome ways you’ve been successful with spaced retrieval therapy. I’m also glad I’m not the only one that has found some benefit in using the Tactus app.

      As far as goals go I usually don’t include the technique I’m using in therapy to target the goal. I focus on the outcome only, because like you mentioned we might use multiple ‘tools’ together like SRT and errorless learning. In addition I may want a patient to be able to recall their room number but SRT may not work for them. So if I want a patient to be able to communicate their room number I may write goals like this:

      Patient will communicate (specify verbally or non verbal strategy) awareness of orientation to place, including room number, with 80% acc given min cues to utilize environmental aids and compensatory strategies.

      Caregivers will demonstrate appropriate use of cueing and assistance to increase patient independence with orientation tasks with 80% acc.

      Karah- How do you write your goals?

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  • Tom Kellar

    Will spaced retrival learning occur if the hippocampi are damaged? Does spaced retrieval learning of room number use procedural memory? Is “what is your room number” with a response, constitute a procedure.
    Procedural memory does not require the hippocampus.

    Thanks in advance for any enlightment. Tom Kellar Hartville, Ohio

  • Rachel Scheidler

    I have used SRT to help residents recall their room number. I also incorporate having them use that recalled information along with environmental cues (room #signs) to actually navigate to their room from another common location (e.g. dining room) within the session. I believe this where you are building upon procedural memory and really making it functional.

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  • Christine

    I’d love to watch you video. It does not show in the article. Can you upload it again?
    Thanks much

    • http://www.graymattertherapy.com Rachel Wynn

      Christine-

      It looks like they have removed the video from YouTube. I’m not able to find it. Maybe one day I’ll create my own video examples.

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  • Tracie

    Wonderful article! Do SLP’s need to be specifically trained in spaced retrieval. Do we need a specific certification to use this with our patients? Thanks.

    • http://www.graymattertherapy.com Rachel Wynn

      Tracie – You do not need certification to use spaced retrieval with clients. I wrote some additional tips that will help you get started in a guest post for ADVANCE. Try it out and let me know how it goes! Good luck!

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  • john

    An app is available on android. It’s an easy and complete app

    https://play.google.com/store/apps/details?id=com.kreodev.neuro