Developing An Online Developing An Online Course in the Use of Course in the Use of

Spaced RetrievalSpaced RetrievalMegan Malone, M.A. CCCMegan Malone, M.A. CCC--SLP, Cameron Camp, Ph.D., SLP, Cameron Camp, Ph.D.,

Marcia Neundorfer, Ph.D., & Gregg Gorzelle, B.A. Marcia Neundorfer, Ph.D., & Gregg Gorzelle, B.A.

Myers Research InstituteMyers Research InstituteBeachwood, OHBeachwood, OH

www.myersresearch.orgwww.myersresearch.org

ObjectivesObjectives

1.1. Define the Spaced Retrieval (SR) technique Define the Spaced Retrieval (SR) technique and its application to cognitively impaired and its application to cognitively impaired individuals.individuals.

2.2. Summarize the research project involved in Summarize the research project involved in developing an online course on SR.developing an online course on SR.

3.3. Provide 2 of the findings of the research Provide 2 of the findings of the research project. project.

4.4. Identify 1 implication of the findings of the Identify 1 implication of the findings of the research project.research project.

Description of ProjectDescription of ProjectTwoTwo--year study funded by NIA entitled, year study funded by NIA entitled, ““OnOn--Line Line Training in Treating Dementia: Spaced RetrievalTraining in Treating Dementia: Spaced Retrieval””

Collaboration between Myers Research Institute Collaboration between Myers Research Institute & Northern Speech Services (P.I. T. Slominski)& Northern Speech Services (P.I. T. Slominski)

Focused on the development of a product line Focused on the development of a product line for dissemination of SR on a large scale to for dissemination of SR on a large scale to rehabilitation professionals to help enhance rehabilitation professionals to help enhance function for individuals with dementia and function for individuals with dementia and related cognitive impairments. related cognitive impairments.

What is SR?What is SR?

Refers to practice at recalling information over Refers to practice at recalling information over progressively longer intervals of timeprogressively longer intervals of time

First noted by First noted by LandauerLandauer and and BjorkBjork (1978) as an (1978) as an effective way to teach face/name learning to effective way to teach face/name learning to students. students.

Several studies since have shown the use of SR Several studies since have shown the use of SR to be an effective way to teach information to to be an effective way to teach information to persons with dementia.persons with dementia.

What is SRWhat is SR™™ ??The goal of SR:The goal of SR:

To enable individuals to remember To enable individuals to remember information for long periods (days, weeks, information for long periods (days, weeks, months, years) so that they can achieve months, years) so that they can achieve longlong--term treatment goals.term treatment goals.

Therapists teach clients strategies that Therapists teach clients strategies that compensate for memory impairments, using compensate for memory impairments, using procedural memory, including reading and procedural memory, including reading and repetitive priming.repetitive priming.

In addition, SR uses In addition, SR uses external aidsexternal aids to compensate to compensate for memoryfor memory

Why Does SR Work?Why Does SR Work?

It capitalizes on retained components of It capitalizes on retained components of procedural memoryprocedural memory

–– Ability to learn skills/habitsAbility to learn skills/habits–– Ability to use previously learned habits, such Ability to use previously learned habits, such

as readingas reading–– Repetition priming (learning through practice)Repetition priming (learning through practice)

What is SR?What is SR?Begin with a prompt question for the target Begin with a prompt question for the target behavior and train the client to recall the correct behavior and train the client to recall the correct answeranswer

When retrieval is successful, the interval When retrieval is successful, the interval preceding the next recall test is increased.preceding the next recall test is increased.

If a recall failure occurs, the participant is told If a recall failure occurs, the participant is told the correct response and asked to repeat itthe correct response and asked to repeat it

The following interval length returns to the last The following interval length returns to the last one at which recall was successful.one at which recall was successful.

SR ExampleSR Example82 year82 year--old female; Diagnosis: dementia; old female; Diagnosis: dementia; residing in a LTC facilityresiding in a LTC facilityMMSE: 12/30MMSE: 12/30Repetitive question askingRepetitive question asking

SR GoalSR Goal: ‘‘RR’’ will consistently utilize strategy of will consistently utilize strategy of looking at visual cue to recall facility meal times looking at visual cue to recall facility meal times in order to increase independence and decrease in order to increase independence and decrease repetitive question asking 80% of trials.repetitive question asking 80% of trials.–– SR Prompt :SR Prompt : ““Where should you look to find Where should you look to find

out when meals are served?out when meals are served?””–– SR Response:SR Response: ““I look at my cardI look at my card””; performs ; performs

strategy of taking card from purse and strategy of taking card from purse and reading it to know meal times.reading it to know meal times.

SR ExampleSR ExampleTrial 1 (0 Seconds):Trial 1 (0 Seconds): Client Client Responds Responds CORRECTLYCORRECTLYTrial 2 (10 Seconds):Trial 2 (10 Seconds): Client Client Responds Responds CORRECTLYCORRECTLYTrial 3 (30 Seconds):Trial 3 (30 Seconds): Client Client Responds Responds CORRECTLYCORRECTLYTrial 4 (60 Seconds):Trial 4 (60 Seconds): Client Client Responds Responds INCORRECTLYINCORRECTLYTherapist provides client with Therapist provides client with correct response (correct response (““I look at my I look at my card.card.””), asks the client the prompt ), asks the client the prompt question again, allows the client to question again, allows the client to respond, and returns to the respond, and returns to the interval at which the client was interval at which the client was last successful.last successful.Trial 5 (30 Seconds):Trial 5 (30 Seconds): Client Client Responds Responds CORRECTLYCORRECTLYTrial 6 (60 Seconds):Trial 6 (60 Seconds): Client Client Responds Responds CORRECTLYCORRECTLY

0102030405060

Seconds

1 2 3 4 5 6Trials

SR Therapy Session

SR ExampleSR Example

Initial Course DevelopmentInitial Course Development

2 Phases of Project2 Phases of Project–– Phase 1:Phase 1:

TextText--based version & a comparable classroom/live based version & a comparable classroom/live presentation version of the course were presentation version of the course were developed. developed.

Taken by SLP Graduate Students enrolled inTaken by SLP Graduate Students enrolled in3 programs (Florida State University, Case 3 programs (Florida State University, Case Western Reserve University, and Cleveland Western Reserve University, and Cleveland State University; N=100)State University; N=100)

Initial Course DevelopmentInitial Course Development

Phase 1 Continued:Phase 1 Continued:–– Students were randomly assigned to onStudents were randomly assigned to on--line line

course (taken as a group in university course (taken as a group in university computer labs, n = 56), or the classroom computer labs, n = 56), or the classroom presentation (presented by Principal presentation (presented by Principal Investigator Slominski of NSS at FSU or Investigator Slominski of NSS at FSU or Project Manager Neundorfer of MRI at the Project Manager Neundorfer of MRI at the Cleveland universities, n = 44). Cleveland universities, n = 44).

Course ContentCourse Content

OneOne--hour in lengthhour in lengthOverview of dementia, memory systemsOverview of dementia, memory systemsReview of SR, including discussion of screening Review of SR, including discussion of screening clients, case studies, and goal examples.clients, case studies, and goal examples.

Initial Course DevelopmentInitial Course Development

Phase 1 Continued:Phase 1 Continued:All students took a preAll students took a pre--test and a posttest and a post--test of test of 16 True/False items on SR and dementia. 16 True/False items on SR and dementia. PrePre--test and posttest and post--tests designed to measure tests designed to measure course content knowledge were used to course content knowledge were used to document that the course increased student document that the course increased student knowledge of SRknowledge of SRTMTM

Initial Course DevelopmentInitial Course DevelopmentPhase 1 Results:Phase 1 Results:

–– Scores increased from 7.9 at pretest to 9.4 at posttestScores increased from 7.9 at pretest to 9.4 at posttest

–– Statistically significant increases in knowledge were Statistically significant increases in knowledge were obtained in all versions of the course at all sites. obtained in all versions of the course at all sites.

–– No significant differences in knowledge gain between No significant differences in knowledge gain between the onthe on--line versus inline versus in--class versions, though scores were class versions, though scores were slightly better for the onslightly better for the on--line version of the course line version of the course overall. overall.

Initial Course DevelopmentInitial Course DevelopmentStudents rated the extent to which course content met Students rated the extent to which course content met course objectives on a 3 point scale (1 = not at all; 2 = course objectives on a 3 point scale (1 = not at all; 2 = somewhat; 3 = very well); the mean was 2.8 (SD = .4), somewhat; 3 = very well); the mean was 2.8 (SD = .4), with no significant differences in rating between online with no significant differences in rating between online and classroom groups, nor between sites. and classroom groups, nor between sites.

Rated the level of difficulty of the program (1 = too Rated the level of difficulty of the program (1 = too basic; 2 = appropriate; 3 = too complex); the mean was basic; 2 = appropriate; 3 = too complex); the mean was 2.0 (SD = .10), no significant differences in rating 2.0 (SD = .10), no significant differences in rating between online/classroom groups or between sites.between online/classroom groups or between sites.

Rated the quality of the program on a scale of 1 Rated the quality of the program on a scale of 1 –– 4, 4, with 1 = poor and 4 = excellent; the mean was 3.3 (SD with 1 = poor and 4 = excellent; the mean was 3.3 (SD = .63), with no significant differences between groups or = .63), with no significant differences between groups or sites. sites.

Course ModificationsCourse ModificationsUsed student test scores & written suggestions to revise Used student test scores & written suggestions to revise course, refine precourse, refine pre--posttest questions, and create posttest questions, and create comparable onecomparable one--hour online and classroom versions. hour online and classroom versions.

New group of graduate students (n = 56) (36 SLP New group of graduate students (n = 56) (36 SLP students from Florida State University and 20 students from Florida State University and 20 Occupational Therapy students from Cleveland State Occupational Therapy students from Cleveland State University) were randomly assigned to the University) were randomly assigned to the online/classroom version of the course. online/classroom version of the course.

StudentsStudents’’ knowledge scores significantly increased (from knowledge scores significantly increased (from 10.5 to 12.3), with no significant differences in 10.5 to 12.3), with no significant differences in knowledge scores by site or by online or classroom knowledge scores by site or by online or classroom version of courseversion of course

Online Course for Online Course for SLPSLP’’ss

22--hour webhour web--based course for professional based course for professional SLPSLP’’ss..

Additional content on documentation of SRAdditional content on documentation of SR™™therapy sessions, marketing SR within LTC care therapy sessions, marketing SR within LTC care settings and case studies with interactive settings and case studies with interactive questions were addedquestions were added

Knowledge gain from taking the course was Knowledge gain from taking the course was assessed through 16assessed through 16--item multipleitem multiple--choice prechoice pre--and postand post--course tests. course tests.

Examples of Pre/Post Examples of Pre/Post QuestionsQuestions

_______________memory is often preserved later into dementia._______________memory is often preserved later into dementia.a.a. ProceduralProceduralb.b. EpisodicEpisodicc.c. SpacedSpacedd.d. ShortShort--termterm

To implement SR therapy, ________________.To implement SR therapy, ________________.a.a. Make sure the client can execute the goal strategy before Make sure the client can execute the goal strategy before

starting.starting.b.b. Let clients choose information that is most important for them Let clients choose information that is most important for them

to recall.to recall.c.c. Use the clientUse the client’’s languages languaged.d. All of the aboveAll of the above

Online Course for Online Course for SLPSLP’’ss

193 licensed 193 licensed SLPSLP’’ss participated in online course. participated in online course.

28% increase in knowledge was found between the pre28% increase in knowledge was found between the pre--course and postcourse and post--course knowledge test performances of course knowledge test performances of the participants the participants

After two months, 91% of those who used SRAfter two months, 91% of those who used SR focused on focused on cognitive goals, 52% on swallowing related goals, and cognitive goals, 52% on swallowing related goals, and 25% on Voice/Speech goals. These numbers 25% on Voice/Speech goals. These numbers demonstrate that therapists used SRdemonstrate that therapists used SRTM TM with more than with more than one type of goal with clients.one type of goal with clients.

Online Course for Online Course for SLPSLP’’ss22--month followmonth follow--up survey given to assess impact up survey given to assess impact of course on professional practiceof course on professional practice

–– ““[[SR]wasSR]was an extremely helpful and useful tool to an extremely helpful and useful tool to learn. The dementia population is one that is of great learn. The dementia population is one that is of great interest to me, and knowing different techniques to interest to me, and knowing different techniques to use when working with them will only increase my use when working with them will only increase my confidence and competence.confidence and competence.””

–– ““[The course was] convenient, interesting and [The course was] convenient, interesting and applicable right away. I enjoyed the sessions, which applicable right away. I enjoyed the sessions, which I was able to do at my convenience and at my pace.I was able to do at my convenience and at my pace.””

ImplicationsImplications

Online courses are an effective way to teach Online courses are an effective way to teach therapy techniques to therapiststherapy techniques to therapists

Emphasis is needed on better preparation of Emphasis is needed on better preparation of students in graduate programs on dementia, students in graduate programs on dementia, memory, and therapy strategiesmemory, and therapy strategies

ImplicationsImplications

““ Today, as never before, practitioners Today, as never before, practitioners in speechin speech--language pathology and language pathology and audiology need to enter the clinical audiology need to enter the clinical setting from graduate school setting from graduate school immediately able to demonstrate the immediately able to demonstrate the value of their services.value of their services.”” (ASHA 2005)(ASHA 2005)

Future PlansFuture PlansUse course in curriculum of masterUse course in curriculum of master’’s level s level students in speechstudents in speech--language pathology language pathology

Further develop the SR course, and develop Further develop the SR course, and develop online courses focused on the diagnosis and online courses focused on the diagnosis and treatment of treatment of dysphagiadysphagia, and billing for services. , and billing for services.

It is our hope that these courses will serve to It is our hope that these courses will serve to better prepare the new speech therapist for better prepare the new speech therapist for serving persons with dementia, along with serving persons with dementia, along with providing experienced providing experienced SLPSLP’’ss with valuable with valuable information, which may help to impact the information, which may help to impact the quality of life of the person with dementia. quality of life of the person with dementia.

For More InformationFor More Information……

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