How EL Strategies Improves Patient Compliance & Outcomes
What Is Errorless Learning?
Errorless learning is a technique based on the principles of implicit, or “incidental,” learning, in which complex knowledge is gained without significant conscious control. (2)
For example, we rely on implicit learning to acquire our first language and develop social skills. (2) This model is distinct from explicit learning, in which conscious control is required to internalize new knowledge, such as learning a dance routine or memorizing your times tables.
Because EL relies on the brain’s implicit learning and memory centers, it is a promising technique for individuals with impaired explicit memory, such as those with autism or dementia. (3) However, EL can still be a useful tool even for those without memory or learning deficits (more on that later).
EL requires the use of high repetition, low variability practice methods to teach a task or behavior. (3) Rather than allowing the client to learn by trial and error, the teacher provides very specific cues to ensure that the learner completes the task perfectly (or nearly so) from the first attempt.
The task is repeated multiple times (high repetition) with the same cues each time (low variability). When the learner can consistently perform the task perfectly with these initial cues, the teacher gradually begins to withdraw, or “fade,” the cues given, until the client can perform the task correctly without any external cuing.(4)
Errorless learning also reduces the number of negative corrections the teacher must give. (5) It can be discouraging for a patient to constantly hear comments like “no, that’s not right” or “no, you’re doing it wrong again” from their provider.
Ultimately, EL allows the provider to reward correct performance, rather than repeatedly chastising the patient for doing an exercise or task incorrectly.
How Can Errorless Learning Help My Patients?
The use of errorless learning in rehabilitation has been studied and proven effective in a variety of patient populations, from people with Alzheimer disease to those who have sustained traumatic brain injuries. (3, 6)
For patients left with memory deficits after a stroke, EL has been shown to enhance learning of and independence with basic tasks. (7)
Although data on the use of EL in the general population are lacking, it stands to reason that errorless learning techniques may also benefit patients that do not demonstrate memory impairments.
After all, errorless learning has been shown to reduce the likelihood that the learner will make mistakes during subsequent attempts at the learned task. (4) What therapist wouldn’t want to improve the chances that their patients are performing their HEPs correctly?
Additionally, the use of errorless learning techniques may foster a more positive experience for patients during their treatment sessions. Because EL does not require the therapist to provide negative feedback, it reduces the number of times the patient will hear “no” during a session. (5)
How Can I Start Using Errorless Learning with My Patients Today?
Regardless of your typical patient population, you undoubtedly have several patients who are struggling with one or more skills you’d like them to learn. If your previous attempts to correct their mistakes have not been successful, it’s worth giving EL a try.
Once you have identified a patient who may benefit from errorless learning, you can break down your teaching attempt into several discrete stages. (4)
With the help of teaching strategies such as this, you can help your patients become more confident and independent in their rehabilitative activities, both during and outside of treatment sessions. The AC Health app offers additional tools to reinforce the learning your patients are doing in sessions with you so they can achieve their goals sooner!
Errorless Learning Step #1: Identify the Exercise
Identify one specific skill or exercise you’d like the patient to learn.
By narrowing your focus to a single, discrete skill, you’ll decrease the potential for confusion and frustration.
Errorless Learning Step #2: Determine Cues
Determine the type of cuing you will use.
- Base your decision on the way(s) your patient learns best. Do they respond well to hands-on cuing? Are they more of a verbal/auditory learner? Do they prefer that you demonstrate a task before they attempt it?
- You should also decide how you will determine mastery of the skill. It is rare for a learner to perform every attempt with 100% accuracy. (5) Will you accept 8-9/10 perfect attempts as a sign of mastery?
Errorless Learning Step #3: Start Teaching
Begin teaching the skill/exercise, providing cues to prevent errors.
Consider the patient who is struggling to correctly perform a lateral deltoid raise.
Perhaps you start by demonstrating the exercise to provide an initial learning stimulus.
You then ask your patient to perform the exercise, while using your hands to manually cue scapular depression and full elbow extension.
- If you observe that the patient is about to make an error, attempt to manually correct it before the error occurs.
- If the patient performs the skill correctly, provide immediate positive reinforcement. (“Great job, that was exactly what I wanted you to do!”)
- If the patient does not perform the task correctly, avoid providing any negative feedback; instead, initiate another attempt at the task, using the same cues.
Errorless Learning Step #4: Repeat & Fade
Have the patient repeat the skill, gradually “fading” your prompts.
Once the patient consistently demonstrates correct performance of the task with the initial prompts you provided, you can begin to fade the prompts.
For example, rather than manually cuing a lateral raise at both shoulder and elbow, only provide the shoulder cue. Then, attempt to move your cue more proximally, perhaps to the scapula.
Errorless Learning Step #5: Error-free Exercise!
Repeat until the patient can correctly perform the skill/exercise without errors!
Eventually, the patient should be able to consistently perform the skill correctly without any external prompts from the therapist.
Don’t be discouraged if this does not occur in a single therapy session. It may require multiple attempts over several sessions to achieve independent mastery of a task.
With the help of teaching strategies such as errorless learning, you can help your patients become more confident and independent in their rehabilitative activities, both during and outside of treatment sessions.
(Incidentally, the AC Health app offers additional tools to reinforce the learning your patients are doing in sessions with you so they can achieve their goals sooner!)