Vanishing cues for memory impairment

vanishing cues

One of the guidelines for Research Tuesday is the article should be recent. I usually recommend in the last 10 years. Of course, there are situations where an older article will tell the story better. Today I have an article from 1986! I’ve been researching memory and wanted to write about vanishing cues for Research Tuesday. Unfortunately there are limited recent experiments using vanishing cues. Most of the recent articles mentioning vanishing cues merely mention or describe it, but they all mention Elizabeth Glisky. So I dug up one of Glisky’s articles about the method of vanishing cues.

What is vanishing cues?

The method of vanishing cues is a type of errorless learning. As a former teacher and university admissions counselor (who often had to deliver bad news), I am a big fan of errorless learning and the positive learning environment it creates. Glisky defines the method of vanishing cues as “the systematic reduction of cue information across learning trials”. Basically you start with the amount of cues for a client to be successful, then you slowly decrease the cues, so you are always working with the minimum amount of cues required. Many trials of the learning tasks are required in order to slowly decrease cues and maintain an errorless learning environment.

Do vanishing cues work?

The authors state their study is a “demonstration experiment in that its primary purpose was to demonstrate that vanishing-cues procedure can help a variety of memory-impaired patients to learn and retain some definitions of computer-related terms.” The authors thought “microcomputers” aka personal computers could be useful aids to people with memory impairment; however, people would need to learn to use them.

So this study utilized vanishing cues and standard anticipation method to teach computer vocabulary to people with memory impairment. The authors taught 15 computer related words with vanishing cues and 15 words with anticipation method, which allowed errors and guessing.

There were 4 participants with varying degrees of memory impairment. Two of the participants were unable to recall attended previous sessions. Three of the participants had suffered closed-head injuries, while the fourth participant had sustained memory deficits after viral encephalitis. They were all two or more years post onset. Two of the participants had “pure” memory disorders, while the other two had cognitive-communication disorders affecting other areas of learning.

Participants attended twice weekly sessions for four weeks with a total of eight sessions. Six weeks after the final training session, the participants returned for a delayed test. A few days after the delayed test the participants returned for a “transfer” production test, where each vocabulary word was targeted as the final word (blank) in a sentence containing the definition.

The results

It is no surprise to me a study I have seen referenced in at least a dozen journal articles had positive outcomes. The study found:

  • The proportion of vocab terms learned increased across the 8 sessions. This indicates people with memory impairment are capable of learning new vocabulary.
  • Words learned with vanishing cues yielded higher performance than words learned with standard anticipation method.
  • Overall gains were identified even when “a good deal of what patients learned in a given session was lost by the beginning of the next session.”
  • Retention of information was greater over the 6-week gap between training and delayed testing was greater for words trained using method of vanishing cues.
  • Participants were able to learn vocabulary about microcomputers, with which they had no previous familiarity.
  • Participants reported they enjoyed vanishing cues training more than standard anticipation training. “They generated a correct response on every trial, were encouraged by their success, and were eager to participate in the training.”
  • Words learned using vanishing cues were more likely to be produced with the transfer task.

Why I use vanishing cues

Who wants to be wrong all the time? Do you want to be unsure of your answers? How would you like to be told you are wrong, especially when you are living or staying in a place where limited things are within your control? I try to establish a positive learning environment for my clients. This leads to greater participation. Perhaps the greater participation is all it takes to make vanishing cues a successful method?

Vanishing cues treatment ideas

One of the things I frequently work on with my clients is compensatory strategy use for dysphagia. Prior to eating a meal, I discuss specific strategies with patient. In the case of training a chin tuck, vanishing cues might look like this:

  • Tuck your chin to protect your airway when you eat.(with visual cue)
  • What do you do with your chin to protect your airway when you eat?(with visual cue)
  • What do you do with your chin to protect your airway when you eat?(without visual cue)
  • What do you do to protect your airway when you eat? (with visual cue)
  • What do you do to protect your airway when you eat? (without visual cue)
  • When you eat you…(with visual cue)
  • When you eat you…(without visual cue)

The cues fade within a session and from session to session. I may not cue every variation with every patient as I tailor it to each client’s ability to learn. And I usually follow an affirmative response with a “wahoo” or “great” and “Exactly! You tuck your chin to protect your airway when you eat.”

I also work on memory associated with safe ambulation. I might partner with a PT who is working on the function of movement (e.g. climbing stairs and transferring to and from wheelchair). My clients will DO the action.Then during their rest break, they will verbally sequence to coach me through the steps to complete the task. I use verbal and visual cues to guide them in coaching me. I love partnering with the PT, because we can establish verbal and tactile cues to maintain the errorless environment while they are moving. It is collaboration at its best. The client, PT, and I are all targeting the same end goal.

How do you use vanishing cues with clients with memory impairment?

Glisky, E.L., Schacter, D.L., & Tulving, E. (1986). Learning and retention of computer-related vocabulary in memory-impaired patients: method of vanishing cues. Journal of clinical and experimental neuropsychology. 8:3. pp 292-312.

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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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