I had the opportunity this week to review a case with a couple of my colleagues. About three weeks ago, we admitted a woman to our facility for rehabilitation following a fall at home. During the fall, she sustained a hip fracture and needed surgery to repair it. Previously, she lived at an Assisted Living Facility but taking care of her basic self care needs without help.
When she admitted to our facility, we screened her functional cognition skills and identified a need for further assessment. We administered the Allen Cognitive Level Screen (ACLS) and found that her her performance on the screen was consistent with Allen Cognitive Level 3.2. Despite her relatively low ACL compared to her prior level of functioning, we hoped that her cognition was being temporarily limited by the effects of anesthesia, pain, pain medication, her mental health conditions, or the change of environment. Unfortunately, after three weeks of medical interventions and therapy to address functional performance including cognition, we have not seen a significant improvement in her condition. In particular, we are concerned that she still requires assistance with mobility because she can’t recall her doctor’s instructions to not put weight through her leg until it heals.
As we talked through this client’s case to make sure we have tried everything we can to help improve her memory and safety, I asked if we had tried spaced retrieval. I explained that spaced retrieval is a strategy that is used to facilitates client’s successful recognition of information for progressively longer periods of time and that it is effective because it takes advantage of retained procedural memory (Creighton, Van der Ploeg, & O’Connor, 2013). I shared this play with my colleague and we brainstormed prompts and responses for our client.
Improve client’s memory of a fact, motor pattern, or strategy
Great for 1:1 treatment – Good for co-treatment with Physical Therapy
10-60 minutes, can be repeated over multiple sessions
- Identify a desired goal
- Develop a verbal prompt and response to teach client the fact, motor pattern, or strategy identified in the goal.
- Give the client the prompt and response. Repeat it with them until they can give the response consistently when given the prompt.
- Gradually extend the time between giving the client the prompt (immediate, 10 seconds, 20 seconds, 30 seconds, 60 seconds, 90 seconds, 2 minutes, 3 minutes, 5 minutes, 8 minutes, 12 minutes, etc.)
- If client makes an error in giving the response, return to the previous interval and continue practicing until client can progress to the longer interval without error.
- Share the prompt and response with other caregivers and professionals working with the client.
Evidence has shown spaced retrieval has been shown to be effective with dementia, CVA, and TBI. It has also been shown to be effective for addressing a variety of goals, including teaching clients to use cognitive strategies.
Prompts and responses should be simple, succinct, and easy to repeat. Examples of prompts and responses that could be used include:
- Prompt: “What should you do when you stand up?” Response: “Reach for my walker.”
- Prompt: “What should you do if you need to go to the bathroom?” Response: “Push the call button.”
- Prompt: “What are your hip rules?” Response: “No bending, no lifting, no crossing my legs.”
During the intervals between prompts, therapists may engage in small talk or facilitate performance of another activity. When used during co-treatment, the therapist can coordinate timing of prompts around an activity that the PT is completing with the client.
Creighton, A., Van der Ploeg, E., & O’Connor, D. (2013). A literature review of spaced-retrieval interventions: A direct memory intervention for people with dementia. International Psychogeriatrics, 25(11), 1743-1763. doi:10.1017/S1041610213001233