Improving Memory Using the Spaced Retrieval Technique

This text-based course is a written transcript of the course, "Improving Memory Using the Spaced Retrieval Technique", presented by Megan Malone and Jennifer Loehr on December 6, 2010.



>> Amy Natho: Welcome to this expert e-seminar entitled "Improving Memory Using the Spaced Retrieval Technique." At this time it is a pleasure and an honor to introduce both Megan Malone and Jenny Loehr. Megan Malone is a speech language pathologist working for Gentiva Health Services. She previously worked 9 years as a Senior Research Associate and Lead Trainer at Myers Research Institute in Cleveland, Ohio where she oversaw federally/ privately funded grants focused on implementing interventions with older adults with dementia. She has spoken numerous times at the annual conventions of the American Speech and Hearing Association, Gerontological Society of America, American Society on Aging and Alzheimer's Associations along with several state speech and hearing conventions. She has published articles in the Journal of Communications Disorders and Alzheimer's Care Quarterly and Gerontologist and Dementia.

Jenny Loehr is a speech language pathologist also employed by Gentiva Health Services. Her focus of practice in the past 15 years has been adult and geriatric neurology with an emphasis on dementia programming. She currently oversees and implements the rehabilitation program at Arden Courts of Austin, an Alzheimer's assisted living facility. Mrs. Loehr has presented numerous times at the annual convention of the American Speech and Hearing Association.

>> Megan Malone: Thank you everyone for being here today. Jenny and I are happy to be back on SpeechPathology.com and are looking forward to sharing some information with you today on the spaced retrieval technique, which both of us use on a regular basis with our patients. We're hoping to get the information out to you today and review a little bit of the nuts and bolts of what the technique entails and how you can use it in your practice.

We're also going to talk about a screening tool that you can pick up and start using today if you have some patients for whom it would be appropriate.

Acknowledgements

I want to start out by acknowledging several different people and organizations. One is Menorah Park Center for senior living in Beachwood, Ohio. That is where I spent the last 10 years of my practice, working on the research grants and specifically looking at spaced retrieval with many different patients. We would also like to thank the state of New York Department of Aging. We have a grant with them that looked at using spaced retrieval in long term care settings and my friends Ellen and Kelli were pivotal in that role. Hearthstone Alzheimer's Care is doing wonderful work related to this topic. Dr. Cameron Kemp is working with them, and they're a wonderful resource, as is Northern Speech Services. The National Institute on Aging and Retirement Research Foundation did a great job with supporting these procedures through many, many different grants. We would like to thank them as well.

Course Objectives

Today we're going to work on defining spaced retrieval. We're going to talk briefly about a model of memory that supports learning in persons with dementia. We will also talk about developing appropriate goals that can incorporate spaced retrieval using case studies.

Introduction

I always like to start off talking about assumptions we have about persons with dementia, because a lot of people out there have the mistaken idea that persons with dementia cannot learn or remember information. They think the best way to care for them is to make them comfortable, deal with the little idiosyncrasies that they have, and be patient. There is a huge body of research out there that says this is not true.

Persons with dementia can indeed learn, but it is important for us to present the information in a way that allows that learning to happen. Part of our job as speech language pathologists is to educate the family members and staff members at the facilities where we work that this is indeed something we can do. We're more than qualified, and research backs up the idea that persons with dementia should be enrolled in rehab therapies and can benefit from them.

We know exactly what dementia is. I'm sure many of you have been working with it for quite a long time. I would like to review the weaknesses as well as the strengths concerning a patient's abilities.
 

We know dementia is a loss of mental function and it involves memory, reasoning, and language to the extent that it interferes with a person's daily living. Dementia is a group of symptoms that can include:
Language disturbances such as aphasia, dysphasia, anomia.
Problematic behaviors such as repetitive questioning, wandering, etc., (which are the number one caregiver stressors).
Difficulties with ADLs such as dressing, grooming, eating, etc.
Personality changes, such as disengagement, not wanting to participate in activities, aggressive behavior, depression.The important thing to remember is that dementia is a group of symptoms. People frequently ask how to define the difference between dementia and Alzheimer's disease. Basically, what I like to say is that dementia is a set of symptoms, but those symptoms can be caused by a number of different things. We can see that dementia is caused by the plaques and tangles associated with Alzheimer's disease. We can see it as a result of a CVA, brain injury, cancer, or many different things. So these symptoms may be caused by many different things, including something like Alzheimer's. That is the important distinction: Dementia is really a group of symptoms.

We know that there are a lot of weaknesses that occur with dementia, but there are also a number of strengths. Those strengths are what we want to focus on. Our job as rehab therapists is to look for the abilities and circumvent the disabilities. Again, research has shown that learning of information and its retention is really heavily dependent on how it is presented. Factors such as how regularly it is presented and how meaningful the information is that is presented can make a huge difference in how well a person does on meeting their goals.

Figure 1. A Memory Model (Squire, 1994)



This is a model of memory that I use on a regular basis and I hope you will find it useful for your practice. It was developed by Dr. Larry Squire. He does a lot of wonderful work in neurology and neuropsychology and is a great resource if you want to learn more about memory and the research going on with it.

Basically what Dr. Squire is saying with this model of memory is that there are two types of memory. The first one here (on the left side of the diagram) is the declarative memory system. Declarative memory is also known as explicit memory. And it is really what we think about when we think about what memory is..... that running timeline of our lives. This represents our knowledge of facts and events, who we are, who our family members are, what we did this morning, what we did this weekend, all of those kinds of things. It also stores things like vocabulary and how we know what a word means, and how we understand and follow directions.
 

It also includes our knowledge of the world. Basically, that is information that we have acquired over our lifetime but isn't necessarily tied to us autobiographically; e.g., something like knowing that Paris is the capital of France. We learned it at some point in our life but we can't exactly remember when and/or where we were when we learned it.

When we think of declarative memory and that kind of description, think of those areas of deficit for persons that have dementia. Examples include: having trouble remembering the name of their daughter or son, what they had for breakfast, being able to follow verbal directions, being able to know that a fork is a fork, etc. All those kinds of things tend to be areas of deficit.

This doesn't mean we cannot get that information out of somebody with dementia if we cue them properly. If we're going to try to help a person with dementia remember their daughter's name, we may say, "It starts with the letter M," and try to give some phonemic or semantic cues to help them remember the information.

When I think of declarative memory I think of it as files in a file cabinet where the drawers are stuck. We can get at the information, but it is tougher to get to. We might have to cue quite a bit for the person with dementia to get to the information.

Dr. Squire and researchers have found that with dementia and Alzheimer's disease, the procedural portion of memory stays relatively intact. Procedural memory (also known as implicit memory) is our memory for procedures; how we perform certain skills and habits. For example, tying our shoes, feeding ourselves, getting dressed, etc., are all procedural memory tasks.

Reading is something that falls under procedural memory because it is something we practice day in and day out for many, many years. Priming is also...