Spaced Retrieval, Errorless Learning and Vanishing Cues in Retraining Sit-to-Stand in People Living with Dementia

Abstract

Inability to stand up independently has significant consequences for older adults and people living with dementia and can lead to dependency and institutionalisation. Physiotherapists frequently retrain sit-to-stand (STS) during rehabilitation, addressing underlying impairments, and teaching STS strategies with the aim of making the task easier (Carr & Shepherd, 2010, pp. 77-92). These strategies comprise sliding forward, moving the feet backwards, leaning forward and pushing through the armrests (Janssen, et al., 2002). However, there is limited empirical evidence regarding which STS strategies are actually used by older adults and people living with dementia when standing up unconstrained from a standard chair with or without a table in front. During therapy sessions physiotherapists use verbal instructions and feedback that are often ambiguous and extensive (Parry, 2005b; Talvitie & Reunanen, 2002). Providing extensive verbal instructions appears to be counterproductive when working with people living with dementia as they respond better to short, action based commands (Christenson, et al., 2011). People living with dementia have memory problems that have a detrimental effect on learning. However, as the decline in declarative memory occurs, implicit memory is preserved much longer and can be used in task retraining (Grandmaison & Simard, 2003; Hopper, 2003). Practicing over increasing time intervals (spaced retrieval) (Camp, et al., 1996), without errors (errorless learning) (Clare & Jones, 2008), using cues in a structured manner (vanishing cues) (Haslam, et al., 2010), and written instructions (Bouergeois, et al., 2003; Curtin, 2011) have been demonstrated as beneficial for learning in people living with dementia but have not been broadly used in physiotherapy (Creighton, et al., 2013; White, et al., 2014).