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KeywordsMemory Impairment Metacognitive Skill Metacognitive Strategy Rehabilitation Strategy Cognitive Rehabilitation
Academic techniques are a set of rehabilitation strategies that are aimed at facilitating learning. While there are a myriad of techniques available to aid in learning, evidence continues to grow for the effectiveness of specific instructional strategies. These strategies assist individuals with cognitive impairments in learning new information and skills. Various models for improving learning and memory have been developed, some of which include TEACH-M(Task Analysis, Errorless learning, Assessment, Cumulative review, High rates of correct practice, Metacognitive strategies); PQRST (Preview, Question, Read, State, and Test); and the pediatric neurocognitive intervention (PNI) methods.
Much of the research for academic techniques and strategies stems from the special education field, which utilizes such techniques to teach those with learning disabilities (Sohlberg et al. 2005). Researchers in the neuropsychology field have continued to build upon such literature in order to highlight and develop effective interventions for individuals with neuropsychological impairments. The various models developed from such research have their own unique origin and history, but many have been developed in response to the needs of specific populations. For example, the direct instruction method was developed by Engelmann and Carnine (Sohlberg et al. 2005) as a model for teaching economically disadvantaged children. Other approaches such as the PQRST, stemmed from the notion that individuals with partially intact explicit memory capabilities, such as those with acquired brain injury, could benefit from strategies that are aimed at improving encoding and retrieval (Wilson 2009). Thus, while academic techniques, and the models that use them, are varied and diverse, they were developed to facilitate learning and in turn improve functioning in individuals with cognitive impairments.
Rationale or Underlying Theory
Acquiring new information and skills is an important part of recovery for individuals with cognitive impairment. It is through learning that individuals are able to remediate and/or compensate for impairments and improve their daily functioning. The underlying theory behind several rehabilitation strategies geared at improving learning and memory is to structure the input of information in a way that aids learning, and in turn memory (Ehlhardt et al. 2008). For some more extensive models, such as the PNI, hierarchal levels are designed so that higher-level skills are built on lower-level skills (Limond and Adlam 2015).
Goals and Objectives
Specific goals vary from technique to technique and within specific models of rehabilitation. Generally, academic techniques are meant to facilitate the learning process for individuals with cognitive impairments. General cognitive rehabilitation objectives include changing target behavior and/or restitution of cognitive abilities (Raskin 2010). Academic techniques can be viewed as targeting both objectives, depending on the technique and model, in that many strategies seek to change the individual’s approach to learning (e.g. PQRST) as well as restore certain learning and memory capacities. Academic strategies seek to structure the manner in which information or procedures are taught and practiced so as to facilitate learning (Ehlhardt et al. 2008).
Given their variety, academic techniques and strategies can be utilized across settings with different individuals. Specific applications include cognitive rehabilitation and special education instruction. Individuals with cognitive impairment due to developmental disabilities and neurological conditions would benefit from academic techniques and strategies. Additionally, various treatment approaches could be effective across populations with learning and memory impairments, including individuals with learning disabilities, psychiatric disorders such as schizophrenia, and dementia (Sohlberg et al. 2005).
Strategies for learning can be grouped into direction instruction, strategy-based instruction, a combined strategy and direction instruction approach, and nondirect/non-strategy techniques (Sohlberg et al. 2005). Direct instruction includes breaking down instructions into smaller steps, modelling of a skill, and providing frequent feedback. Strategy-based instructions involve teaching individuals to self-monitor, use prompts to foster self-assessment, summarize and elaborate, and outline important themes. A combined approach utilizes both a direct and strategy-based approach (Sohlberg et al. 2005). Examples of techniques include vanishing cues, a technique in which the amount of cuing is reduced over specific number of trials. Errorless learning is another example of a technique used for learning and involves reducing errors during learning by breaking down tasks into discrete steps, providing sufficient examples before the patient is asked to perform the task, and correcting errors immediately (Raskin 2010; Sohlberg et al. 2005).
Several models utilize academic techniques and strategies in their protocols. TEACH-M is an instructional package designed to identify a sequence of strategies that would be helpful in facilitating learning and memory in individuals with memory impairments, specifically related to an acquired brain injury (Ehlhardt et al. 2005). Techniques used include task analysis, errorless learning, assessment of skills, review of new and learned skills, frequent and distributed practice, as well as encouragement of active processing and self-reflection(Sohlberg et al. 2005). The PQRST model encourages individuals to develop questions about the information they are learning, read information carefully while thinking about their questions, summarize the information, and test the knowledge acquired (Wilson 2009). This method allows for a systematic review of information that encourages analysis and organization of information, which is thought to later improve retention. The PNI model consists of various levels that build on previously learned skills. The first level focuses on interventions and techniques designed to aid in learning and memory in addition to other cognitive skills (Limond and Adlam 2015). This model is unique in that in addition to the use of academic techniques and strategies, it also utilizes strategies to increase metacognitive skills and encompasses both compensatory and restorative strategies.
While specific strategies and models can be used with a variety of patients, it is important that individuals working to teach these strategies engage in careful and specific planning for their patients. Specifically for instructional strategies, Ehlhardt et al. (2008) recommend the following: clear specification of intervention targets, constraining errors, sufficient and distributed practice, using multiple examples, promoting effortful processing, and selection of ecologically valid targets.
Research on instructional methods suggests that they are effective, although questions regarding what and how specific strategies are implemented for maximum benefit remain to be answered (Glang et al. 2008; Ehlhardt et al. 2008). Several models utilizing academic techniques have been found to be effective in facilitating learning and the retention of information. The PQRST method has been found to be effective for individuals with memory impairments (Wilson 2009) and individuals with memory impairments due to prefrontal cortex lesions (Ciaramelli et al. 2015). The TEACH-M method was also found to be effective in facilitating learning in a group of four individuals, as discussed by Ehlhardt et al. (2005).
Qualifications of Treatment Providers
Those individuals teaching academic strategies or rehabilitation techniques should be individuals trained in special education and cognitive rehabilitation. Some professions include special education teachers, cognitive rehabilitation specialists, clinicians, and speech and language pathologists.
References and Readings
- Ciaramelli, E., Neri, F., Marini, L., & Braghittoni, D. (2015). Improving memory following prefrontal cortex damage with the PQRST method. Frontiers in Behavioral Neuroscience, 9 (211), 1–9. doi:10.3389/fnbeh.2015.00211.Google Scholar
- Ehlhardt, L. A., Sohlberg, M. M., Kennedy, M., Coelho, C., Ylvisaker, M., Turkstra, L., & Yorkston, K. (2008). Evidence-based practice guidelines for instructing individuals with neurogenic memory impairments: What have we learned in the past 20 years? Neuropsychological Rehabilitation, 18 (3), 300–342. doi:10.1080/09602010701733190.CrossRefPubMedGoogle Scholar
- Limond, J., & Adlam, A. L. (2015). Cognitive interventions for children with brain injury. In J. Reed, K. Byard, & H. Fine(Eds.), Neuropsychological rehabilitation of childhood brain injury (pp. 82–105). London: Palgrave Macmillan.Google Scholar
- Raskin, S. A. (2010). Current approaches to cognitive rehabilitation. In C. L. Armstrong, L. Morrow, C. L. Armstrong, & L. Morrow (Eds.), Handbook of medical neuropsychology: Applications of cognitive neuroscience (pp. 505–517). New York: Springer Science + Business Media. doi:10.1007/978-1-4419-1364-7_28.CrossRefGoogle Scholar
- Wilson, B. A. (2009). Memory rehabilitation: Integrating theory and practice. New York: The Guilford Press.Google Scholar