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
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?
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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