Dr Viki Teggart, Clinical Neuropsychologist – GMMH

Dr Natalie Arran, Clinical Neuropsychologist - SRFT

the process of helping an individual achieve the highest level of function, independence, and quality of life possible

does not reverse or undo the damage caused by disease or trauma

helps restore the individual to optimal health, functioning, and well-being.

Effective rehabilitation involves:

Learning by the patient

Teaching by the professional

(Smits et al. 2010)

Shout out your ideas please!

Information Skills and strategies

What a stroke is

How the stroke has affected them

Potential risks

Options for future support

A whole bunch of new words

Equipment ( e.g. Rota stand, walking frame)

Non-dominant hand in activities Public transport Diary / planner Communication book

Ability to learn can be affected by deficits in:

Processing speed

Attention

Comprehension

Memory

Self monitoring

Self awareness

Ideally: Detailed assessment of cognitive functioning Understanding of learning style / needs of each patient But, not always: Practical Possible Necessary So: Assume that all patients will benefit from enhanced learning Embed enhanced learning in all teaching activities

People with learning challenges benefit most from:

Explicit models

Minimisation of errors during initial acquisition (errorless learning)

Strategies to promote learner engagement

Guided practice

"to reduce substantially, if not eliminate, errors during the acquisition phase of learning". (Wilson et al. 1994; Baddeley & Wilson, 1994). By: Breaking down task into discrete steps Providing sufficient models before client is asked to perform Encouraging avoidance of guessing Immediately correcting errors Carefully fading prompts

Breaking down task into discrete steps - What does the person need to know? - How can this be split into small chunks Providing sufficient models before client is asked to perform - Tell rather than ask - Make sure information is given in a consistent way

Encouraging avoidance of guessing

- “If not sure, it’s okay to say I don’t know”

Immediately correcting errors

- “that’s not quite right, I said ….”

Carefully fading prompts

- spaced retrieval

- asking for last piece of information instead of telling

Example– Orientation programme

This is an errorless learning programme. We will be providing X with orientation information without asking him to recall or guess the answers for a few weeks to help his learning.

During this time, please avoid asking X questions about what

happened to him.

Please update the orientation date board in X’s room everyday.

When doing formal orientation work with X, please give information one sentence at a time. If using this information to answer questions at other times, pick the appropriate sentences to use.

Orientation script

Date “Today’s date is ……” Also show X this written on the board

Place “You are in X Hospital in X,

“You have been here (insert number) weeks”

Situation

“You are here because you have had a stroke”

“A stroke is an illness that affects your brain”

Insert key difficulties as appropriate for example:

“At the moment, your legs aren’t strong enough to hold you up” (point to or touch legs).

“Also your left arm doesn’t move very easily” (point to or touch left arm).

“You are finding it difficult to remember things that have happened recently. You might feel confused about what is going on.”

“Your wife / husband / children know that you are here and

visit you very often”

“We are working with you everyday to try to get you home

safely as soon as possible”

Repeat information as necessary.

Get into groups of 6 (ish) – try to get a good mix of different expertise

Each group will be allocated one of the following tasks:

Using a Rota Stand

Getting washed

Swallowing safely

Using a walking frame

Making a slice of toast with jam

Using a communication book

As a group agree on:

The component parts of the task

The order to complete them in

Make a note of:

Areas of discussion / disagreement

Additional information needed to make the activity person centred.

Information / steps to be taught need to be pre-agreed

Everyone needs to take the same approach – a script can really help

Don’t fade prompts too quickly

But

Don’t fade prompts too slowly

Look out for the ODN master class

Thank you for your attention and participation

Baddeley, A., & Wilson, B. A. (1994). When implicit learning fails: Amnesia and the problem of error elimination. Neuropsychologia, 32(1), 53-68.

Ehlhardt, L., & Kennedy, M. (2005, November). Instructional techniques in cognitive rehabilitation: A preliminary report. In Seminars in speech and language (Vol. 26, No. 04, pp. 268-279). Copyright© 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

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.

Smits, D. W., Verschuren, O., Ketelaar, M., & van Heugten, C. (2010). Introducing the concept of learning styles in rehabilitation. Journal of rehabilitation medicine, 42(7), 697-699.

Wilson, B. A., Baddeley, A., Evans, J., & Shiel, A. (1994). Errorless learning in the rehabilitation of memory impaired people. Neuropsychological rehabilitation, 4(3), 307-326.