Bull Menninger Clin. 2004 Summer;68(3):213-30.

Cognitive enhancement therapy: A therapeutic treatment strategy for first-episode schizophrenia patients.

Miller R, Mason SE.

Senior research social worker at the Zucker Hillside Hospital, Glen Oaks, New York and a doctoral student in social work at Adelphi University, Garden City, New York.

    Cognitive enhancement therapy (CET) for first-episode schizophrenia combines supportive therapy with social skills and cognitive remediation training. It includes exercises aimed at ameliorating cognitive and negative symptoms in a purposefully motivational format. In this treatment model, the clinician takes an active role as coach, teacher, and therapist in order to engage patients in skills-enhancing work matched to levels of illness and abilities. The therapeutic alliance allows for a safe environment to utilize principles of errorless learning and positive reinforcement. Although this strategy is best implemented in groups, it can be adapted to the individual mode of treatment. Skills-building exercises are described in sufficient detail to be useful to clinicians working with patients in the first years of schizophrenia.


Brain, Vol. 127, No. 8, 1853-1867, August 2004

The scope of preserved procedural memory in amnesia

Sara Cavaco, Steven W. Anderson, John S. Allen, Alexandre Castro-Caldas and Hanna Damasio

            The finding that patients with amnesia retain the ability to learn certain procedural skills has provided compelling evidence of multiple memory systems in the human brain, but the scope, defining features and ecological significance of the preserved mnemonic abilities have not yet been explored. Here, we tested the hypothesis that subjects with amnesia would be able to learn and retain a broad range of procedural skills, by examining their acquisition and retention performance on five novel experimental tasks. The tasks are based on real-world activities and encompass a broad range of perceptual–motor demands: (i) the weaving task involves weaving pieces of fabric from woollen strings, using a manual weaver's loom; (ii) the geometric figures task consists of tracing geometric figures with a stylus as they move horizontally across a touch screen monitor; (iii) the control stick task involves tracking a sequence of visual target locations using a joystick control; (iv) the pouring task consists of pouring 200 ml of water from a watering can into a series of graduated cylinders, from a point 20 cm above the cylinders; and (v) the spatial sequence task involves learning an ordered sequence of pushing five spatially distributed buttons without visual guidance. Ten chronic and stable amnesic subjects (nine with bilateral medial temporal lobe damage due to herpes simplex encephalitis or anoxia, and one with thalamic stroke) and 25 matching normal comparison subjects were tested on three occasions: initial learning at time 1; retention at time 2 (24 h later); and retention at time 3 (2 months later). Despite impaired declarative memory for the tasks, the amnesic subjects demonstrated acquisition and retention of the five skills; their learning slopes over repeated trials were comparable with those of comparison subjects. These findings indicate that preserved learning of complex perceptual–motor skills in patients with amnesia is a robust phenomenon, and that it can be demonstrated across a variety of conditions and perceptual–motor demands. The comparability of the tasks employed in this study with real-world activities highlights the potential application of this memory dissociation in the rehabilitation of patients with amnesia.



Res Dev Disabil. 2004 May-Jun;25(3):295-307.       

Two methods for teaching simple visual discriminations to learners with severe disabilities.

Graff RB, Green G.

New England Center for Children, Northeastern University, 33 Turnpike Road, Southborough, MA 01772, USA.

    Simple discriminations are involved in many functional skills; additionally, they are components of conditional discriminations (identity and arbitrary matching-to-sample), which are involved in a wide array of other important performances. Many individuals with severe disabilities have difficulty acquiring simple discriminations with standard training procedures, such as differential reinforcement. Errorless training methods may be more effective with this population. We used multiple-probe designs to compare two potentially errorless procedures for teaching simple discriminations among three pairs of photos of preferred items (S+) and colored rectangles (S-) to three youths with severe disabilities. In Experiment 1, baseline trials conducted with differential reinforcement yielded near-chance performances on all stimulus sets. A progressive delayed prompt training procedure was then implemented, with stimuli presented flat on the tabletop for one participant and at a 45 degrees angle to the tabletop for the other participants. After 120 teaching trials, accuracy remained near chance. Next, a stimulus control shaping procedure was implemented using an adapted Wisconsin General Test Apparatus (WGTA), with stimuli at a 45 degrees angle to the tabletop. Accuracy increased when this procedure was implemented with each stimulus pair in succession. In Experiment 2, for the participant whose stimuli were presented flat on the tabletop during the progressive delayed prompt training procedure, baseline trials were presented on the WGTA as at the end of Experiment 1, with differential reinforcement; accuracy remained high. On probe trials with stimuli placed flat on the tabletop, accuracy decreased to near-chance levels, indicating that the orientation of the stimulus array was a controlling variable.



Brain Res Cogn Brain Res. 2004 Apr;19(2):160-73.

An electrophysiological study of errorless learning.

Rodriguez-Fornells A, Kofidis C, Munte TF.

Department of Neuropsychology, Otto von Guericke University, Universitatsplatz 2, Gebaude 24, 39106 Magdeburg, Germany.

    Errorless learning, i.e. learning under conditions that prevent the generation of false memory candidates, has been shown to lead to enhanced memory performance during retrieval compared to errorful, trial-and-error, learning. These two learning methods were implemented in a word-stem completion format and contrasted in young healthy subjects with stimulus-locked and response-locked event-related brain potentials (ERPs) being recorded during memory retrieval. Retrieval accuracy was enhanced for items studied under errorless conditions. Stimulus-locked ERPs showed a modulation of a right frontal effect that differed in amplitude and topography for items learned under errorful and errorless conditions. This effect is interpreted as reflecting post-retrieval processes. In the response-locked ERPs, a typical error-related negativity (ERN) was observed that was most prominent for false alarm trials in the errorless condition, of medium amplitude for hits and false alarms in the errorful condition, smaller for hits in the errorless condition and virtually absent for items correctly or incorrectly classified as new. We propose that the amplitude modulation of the ERN is related to the activity of an internal monitoring device checking the veridicality of a retrieved memory trace.



J Am Acad Child Adolesc Psychiatry. 2004 Feb;43(2):163-71.

Errorless academic compliance training: improving generalized cooperation with parental requests in children with autism.

Ducharme JM, Drain TL.

University of Toronto, Toronto, Ontario, Canada.

    OBJECTIVE: Children with autism often demonstrate distress and oppositionality when exposed to requests to complete academic or household tasks. Errorless academic compliance training is a success-focused, noncoercive intervention for improving child cooperation with such activities. In the present study, the authors evaluated treatment and generalization effects of this intervention on four children diagnosed with autism. METHOD: In a multiple baseline across-subjects design, parents delivered a range of academic and nonacademic requests to their children to determine the probability of compliance for each request. A hierarchy of academic requests ranging from those yielding high compliance (level 1) to those yielding low compliance (level 4) was then developed. Treatment began with the concentrated delivery of level 1 requests, with praise and reward for compliant responses. Over several weeks, children were gradually introduced to requests from subsequent probability levels with continued reward for compliance. RESULTS: High compliance levels were demonstrated throughout and following treatment. Evidence of generalization to untrained academic requests and nonacademic requests emerged. Treatment gains were maintained up to 6 months after treatment. CONCLUSIONS: Errorless academic compliance training appears to be an effective intervention for enhancing generalized compliance in children with autism.



J Clin Exp Neuropsychol. 2003 Sep;25(6):805-14.   

Implicit learning in memory rehabilitation: a meta-analysis on errorless learning and vanishing cues methods.

Kessels RP, de Haan EH.;

The objective of this study was to present a quantitative review on the treatment effects of memory rehabilitation techniques based on intact implicit learning capacity in amnesic patients, that is, errorless learning and the method of vanishing cues. English-language journal articles focusing on these rehabilitation techniques were examined using MedLine (1966-2002) or PsychInfo (1887-2002), as well as additional papers listed in the references of these articles. Studies had to meet the following inclusion criteria: (1) original data were reported, (2) memory rehabilitation was studied in memory-impaired patients, (3) a control intervention was included, (4) exact scores were listed for both intervention conditions, or the exact statistics were presented. Studies were classified on the basis of the to-be-learned material and the method of intervention (errorless learning, vanishing cues, control intervention), patient characteristics were determined, and the tasks that were used were taken into account. Effect sizes and variances were computed for each individual study compared to control treatment using within-group statistics. A "large" and statistically significant ES was found for errorless learning treatment, but no significant ES was demonstrated for the vanishing cues method. The results of the present study show that the errorless learning technique is effective in amnesic patients. The effects on the vanishing cues method are only small (and nonsignificant).



Age Ageing. 2003 Sep;32(5):529-33.

Mnemonic strategies in older people: a comparison of errorless and errorful learning.

Kessels RP, de Haan EH.;

OBJECTIVE: To compare the efficacy of errorless and errorful learning on memory performance in older people and young adults. METHODS: Face-name association learning was examined in 18 older people and 16 young controls. Subjects were either prompted to guess the correct name during the presentation of photographs of unknown faces (errorful learning) or were instructed to study the face without guessing (errorless learning). The correct name was given after the presentation of each face in both task conditions. Uncued testing followed immediately after the two study phases and after a 10-minute delay. RESULTS: Older subjects had an overall lower memory performance and flatter learning curves compared to the young adults, regardless of task conditions. Also, errorless learning resulted in a higher accuracy than errorful learning, to an equal amount in both groups. CONCLUSIONS: Older people have difficulty in the encoding stages of face-name association learning, whereas retrieval is relatively unaffected. In addition, the prevention of errors occurring during learning results in a better memory performance, and is perhaps an effective strategy for coping with age-related memory decrement



Neuropsychologia. 2003;41(9):1230-40.

An investigation of errorless learning in memory-impaired patients: improving the technique and clarifying theory.

Tailby R, Haslam C.

In rehabilitating individuals who demonstrate severe memory impairment, errorless learning techniques have proven particularly effective. Prevention of errors during acquisition of information leads to better memory than does learning under errorful conditions. This paper presents results of a study investigating errorless learning in three patient groups: those demonstrating mild, moderate, and severe memory impairments. The first goal of the study was to trial a new version of errorless learning, one encouraging more active participation in learning by patients via the use of elaboration and self-generation. This technique led to significantly better memory performance than seen under standard errorless conditions. This finding highlights the value of encouraging active and meaningful involvement by patients in errorless learning, to build upon the benefits flowing from error prevention. A second goal of the study was to clarify the mechanisms underlying errorless learning. Memory performance under errorless and errorful conditions was compared within and across each group of patients, to facilitate theoretical insight into the memory processes underlying performance. The pattern of results observed was equivocal. The data most strongly supported the hypothesis that the benefits seen under errorless learning reflect the operation of residual explicit memory processes, however a concurrent role for implicit memory processes was not ruled out.



J Neuropsychiatry Clin Neurosci. 2003 Spring;15(2):130-44.

A critical review of memory stimulation programs in Alzheimer's disease.

Grandmaison E, Simard M.

Geriatric Neuropsychology Laboratory, School of Psychology, Universit de Moncton, Moncton, New Brunswick, Canada.

            The authors describe the memory stimulation programs used in the treatment of Alzheimer's disease (AD) and review their efficacy. Visual imagery, errorless learning, dyadic approaches, spaced retrieval techniques, encoding specificity with cognitive support at retrieval, and external memory aids were the memory stimulation programs used alone or in combination in AD. Preliminary evidence suggests that the errorless learning, spaced retrieval, and vanishing cues techniques and the dyadic approach, used alone or in combination, are efficacious in stimulating memory in patients with AD.



Psychol Med. 2003 Apr;33(3):433-42.

Does 'errorless learning' compensate for neurocognitive impairments in the work rehabilitation of persons with schizophrenia?

Kern RS, Green MF, Mintz J, Liberman RP.

            BACKGROUND: Because neurocognitive impairments of schizophrenia appear to be 'rate limiting' in the acquisition of skills for community functioning, it is important to develop efficacious rehabilitative interventions that can compensate for these impairments. Procedures based on errorless learning may facilitate work rehabilitation because they effectively automate training of work and other skills, thereby reducing the cognitive burden on persons with schizophrenia. METHOD: The present study examined the ability of a training method based on errorless learning to compensate for neurocognitive deficits in teaching two entry-level job tasks (index card filing and toilet-tank assembly) to a sample of 54 unemployed, clinically stable schizophrenic and schizoaffective disorder out-patients. Participants were randomly assigned to one of two training groups, errorless learning v. conventional trial-and-error type instruction. Prior to randomization, all subjects were administered a neurocognitive battery. Job task performance was assessed by percentage accuracy scores immediately after training. RESULTS: For three of the six inter-relationships among neurocognitive functioning and training condition, the pattern was the same: the errorless learning group scored high in job task performance regardless of neurocognitive impairment, whereas the conventional instruction group showed a close correspondence between job task performance and degree of neurocognitive impairment. CONCLUSIONS: These findings support errorless learning as a technique that can compensate for neurocognitive deficits as they relate to the acquisition of new skills and abilities in the work rehabilitation of persons with schizophrenia.



Brain Cogn. 2002 Jul;49(2):237-41.  

Evaluation of prospective memory training for individuals with mild Alzheimer's disease.

Kixmiller JS.

    Prospective memory (PM) refers to the timely execution of a previously formed intention. PM deficits are one of the earliest measurable deficits in Alzheimer's disease (AD; Huppert & Beardsall, 1993) and yet, there has been little systematic research devoted to identifying ways in which these deficits can be compensated for or minimized. In this pilot study, individuals with mild AD participated in a new training program aimed at improving PM performance on an experimental PM task. PM training consisted of errorless learning and spaced retrieval techniques taught in six sessions in subjects' homes. Results showed that compared to untrained AD controls. AD patients who received PM training performed a PM task successfully across 7 weeks posttreatment (over 90% accuracy; controls 16-33% accuracy).



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


Glisky, E.L., Schacter, D.L., and Tulving, E. (1986). Learning and retention of computer-related vocabulary in memory-impaired patients: method of vanishing cues. Journal of Clinical and Experimental Neuropsychology. Volume 8, Number 3. p. 292-312.


Glisky, E.L., Schacter, D.L., and Tulving, E. (1986). Computer learning by memory-impaired patients: acquisition and retention of complex knowledge. Neuropsychologia. Volume 24, Number 3. p. 313-328.


Glisky, E.L. and Schacter, D.L. (1988). Long-term retention of computer learning by patients with memory disorders. Neuropsychologia. Volume 26, Number 1. p. 173-178.


Glisky, E.L. and Schacter, D.L. (1989). Extending the limits of complex learning in organic amnesia: computer training in a vocational domain. Neuropsychologia. Volume 27, Number 1. p. 107-120.


Leng, N.R.C., Copello, A.G., and Sayegh, A. (1991). Learning after brain injury by the method of vanishing cues: a case study. Behavioural Psychotherapy. Volume 19. p. 173-181.


Leng, N.R.C. and Parkin, A.J. (1988). Amnesic patients can benefit from instruction to use imagery: evidence against the cognitive mediation hypothesis. Cortex. Volume 24. P. 33-39.


Squires, E.J., Hunkin, N.M., and Parkin, A.J. (1997). Errorless learning of novel associations in amnesia. Neuropsychologia. Volume 35, Number 8. p. 1103-1111.



Keio J Med 1999 Jun;48(2):79-86
Current trends in cognitive rehabilitation for memory disorders.

Kashima H, Kato M, Yoshimasu H, Muramatsu T.

Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.

            Progress in the neuropsychology of memory disorders has provided a foundation for development of cognitive rehabilitation for amnesic patients. Accumulating evidence in the past two decades suggested that certain training techniques could be beneficial to many amnesic patients, such as teaching and acquisition of domain-specific knowledge, motor coding, reality orientation, and meta-cognition improvement. In this article we review and discuss the current trends in cognitive rehabilitation of memory disorders and provide a future direction in this emerging field. In addition, our experience in the successful rehabilitation of Korsakoff syndrome patients is also introduced.


Cortex 1998 Apr;34(2):297-303
Memory for subject performed tasks in patients with Korsakoff syndrome.

Mimura M, Komatsu S, Kato M, Yashimasu H, Wakamatsu N, Kashima H.

Department of Neuropsychiatry, Tokyo Dental College Ichikawa General Hospital.

We examined the ability of alcoholic Korsakoff patients to remember verbal and action-related information. Eight Korsakoff patients and eight alcoholic control subjects learned action phrases in either subject-performed tasks (SPTs) or verbal tasks (VTs). Free recall and recognition tests were then administered. Despite the severe anterograde amnesia observed in Korsakoff patients for VTs, their memory performance for SPTs was similarly facilitated over VTs as was the case with alcoholic controls. Domains preserved in this amnesic syndrome may account for the benefit seen when using SPTs in Korsakoff patients. The therapeutic utilization of action events for memory rehabilitation is discussed.


J Int Neuropsychol Soc  2001 Jul;7(5):615-30

Acquisition of skilled visual search performance following severe closed-head injury.

Schmitter-Edgecombe M, Beglinger L.

Department of Psychology, Washington State University, Pullman, 99164-4820, USA.

            This study used a semantic-category visual search task to investigate skill acquisition and automatic process development in a severe closed-head injured (CHI) population. Eighteen severe CHI participants (> I year post injury) and 18 matched controls completed over 3600 trials of training in both consistent mapping (CM) and varied mapping (VM) training situations. Transfer conditions were also used to test for development of an automatic attention response (AAR) that was independent of general, task-related learning. For both the severe CHI and control group, CM training, where individuals always responded in the same way to a specific class of stimuli, resulted in dramatic performance improvements and the development of an AAR. In the VM training condition, where individuals could not respond in the same way to a class of stimuli from one stimulus exposure to the next, there was little performance improvement and continued reliance on controlled processes. The visual search rates of the CHI

participants also remained slower than those of controls following extended VM but not extended CM practice. These results indicate that skill acquisition training guidelines can be used to teach severe CHI patients to develop a new automatic skill.


Brain Cogn  1990 Jul;13(2):178-92

Strategic and automatic priming of semantic memory in alcoholic Korsakoff patients.

Verfaellie M, Cermak LS, Blackford SP, Weiss S.

Memory Disorders Research Center, Boston University School of Medicine, MA.

            To examine whether the organization of semantic memory is intact in alcoholic Korsakoff patients, three semantic memory tasks which do not require active search for stored information were administered to a group of Korsakoff patients and alcoholic controls. The first two tasks used a perceptual identification paradigm in which patients had to identify briefly presented targets preceded by associatively (experiment 1) or categorically (experiment 2) related primes. On both tasks, Korsakoff patients demonstrated intact priming effects. Because priming in these tasks was thought to reflect the operation of strategic processes, experiment 3 was designed to assess automatic spreading activation using a lexical decision task. Here as well, Korsakoff patients demonstrated intact priming. Taken together, these results support the view that the

organization of semantic memory in Korsakoff patients has not been disrupted by their brain injury. The implications of these findings for understanding Korsakoff patients' impaired performance on semantic search tasks are discussed.





Volume 40, Issue 8, 2002, Pages 1167-1172

Perceptual learning in amnesia

Manfred Fahle, , a and Irene Daumb

a Department of Human Neurobiology, University of Bremen, Argonnenstr. 3, D-28211 Bremen, Germany

b Department of Clinical Neuropsychology, Faculty of Psychology, Ruhr University of Bochum, D-44780 Bochum, Germany




Evidence from experiments on perceptual learning, accumulated during the last few years, increasingly indicates that the relative `front end' parts of the visual system are more plastic even in adults than was previously expected. Hence, it might be possible that perceptual learning is similar in several respects to procedural learning and may be achieved even without (declarative) memory traces present. Results on six patients suffering from global amnesia due to damage to hippocampal¯diencephalic systems demonstrate, for the first time, that at least some amnesic patients are able to significantly improve performance in a visual hyperacuity task as a result of training, showing improvement as good as the observers in the control group. This result corroborates the notion of a relatively `front end' location of at least some forms of perceptual learning.





Volume 40, Issue 8, 2002, Pages 1324-1334

Dissociating habit and recollection: evidence from Parkinson's disease, amnesia and focal lesion patients

Janine F. Hay, , a, Morris Moscovitcha, b and Brian Levinea, b

a Rotman Research Institute, Baycrest Centre for Geriatric Care, Toronto, Canada

b Department of Psychology, University of Toronto, Toronto, Canada




We investigated the role played by the striatum and the medial temporal lobes (MTL) in memory performance by testing patients with Parkinson's disease (PD) and amnesia with Hay and Jacoby's habit-learning task [Journal of Experimental Psychology: Learning, Memory and Cognition 22 (1996) 1323]. Using equations from Jacoby's process- dissociation procedure [Journal of Memory and Language 30 (1991) 513], we were able to separate out the contribution of habit (automatic memory) and recollection (intentional memory) to performance within a single probability-learning paradigm. Amnesics showed the expected dissociation of impaired recollection and intact habit, highlighting the important role of the MTL in recollective processing. Mild PD patients did not perform differently than matched controls for habit or recollection, however, moderate PD patients were impaired in their ability to rely on habit and in their ability to recollect specific information. The performance of focal lesion patients further supported the interpretation that PD patients have a significant deficit in automatic, habit-learning due to striatal dysfunction while their deficit in recollection may arise from impoverished frontal lobe contributions.


Author Keywords: Nondeclarative memory; Declarative memory; Process-dissociation procedure; Probability- matching; Neurological populations



Corresponding author. Present address: Credit Valley Hospital, 2200 Eglinton Ave. West, Mississauga, ON, L5M 2N1, Canada; email:



J Exp Psychol Learn Mem Cogn 1996 Nov;22(6):1323-35

Separating habit and recollection: memory slips, process dissociations, and probability matching.

Hay JF, Jacoby LL.

Department of Psychology, McMaster University, Hamilton, Ontario, Canada.


Memory slips are errors in performance that result when an automatic basis for responding (e.g., habit) opposes the intention to perform a specific behavior. Prior research has focused on factors that influence the probability of a memory slip while neglecting factors that facilitate performance. Using L. L. Jacoby's (1991) process- dissociation procedure to examine performance in both a memory-slip and a facilitation condition, the authors separated the contribution of habit and recollection (intentional memory) in a cued-recall task. The authors found that manipulating the strength of habit affected its contribution to performance in a manner that produced probability matching, but recollection was unchanged. In contrast, manipulations of presentation rate and response time influenced recollection but did not affect habit. Such dissociations support a model of memory in which automatic and intentional influences make independent contributions to performance.





Delic, Manji, Rahim and Scher






Ÿ       Anterograde amnesia is one of the consequences of brain injury and disease

Ÿ       It affects many aspects of daily functioning and living and can disrupt an individual’s ability to learn new tasks

Ÿ       Characterized by normal STM and normal LTM for events prior to the onset of the disorder, but a diconnection between the two systemts after onset

Ÿ       Results from damage to the hippocampus and/or temporal regions of the brain

Ÿ       Some causes include AD, Korsakoff’s, encephalitis, anoxia and a ruptured aneurysm


Ÿ       Amnesics have intact procedural memory but a missing declarative memory

Ÿ       Procedural memory and declarative memory are separate components of long term memory.  The former stores information about how to perform tasks, while the latter stores information about facts

Ÿ       Although amnesic individual’s are unable to remember facts or instructions of a task, they should be able to use their procedural LTM to learn skills by implicit learning. Since procedural memory is task specific, amnesics should only be able to perform a task that has been already learned.  Any deviation in the skilled task should result in the amesic becoming confused and uninformed of what to do.

Ÿ       The method of vanishing cues proposed by Glisky et al (1986) has been demonstrated as an effective method of teaching amnesics new skills.

Ÿ       Other methods include standard anticipation, imagery and errorless learning.




Confirming Evidence - Method Vanishing Cues


Leng, Copello and Sayegh (1991)


Ÿ       Set out to replicate the vanishing cues technique in a case study of a patient who experienced a severe head injury.

Ÿ       They examined the rate of learning, retention, and generalization.

Ÿ       Two learning conditions: vanishing cues and anticipation learning.

Ÿ       The procedure used for vanishing cues was based on Glisky et al.’s methodology.

Ÿ       In the method for anticipation learning, the subject was presented with a definition and was required to type in the answer.

Ÿ       Results:

Ÿ       the subject was able to learn computer related vocabulary more rapidly with the method of vanishing cues

Ÿ       there was reasonable good retention after one month (87% correct responses in both learning conditions)

Ÿ       there was evidence of some degree of generalization (75% correct responses).



Glisky and Schacter (1989)


Ÿ       Showed how the method of vanishing cues was used to train HD, an amnesic worker, to perform the requirements of a simple clerical job.

Ÿ       This job involved entering data about rented copy machines into the computer.

Ÿ       Using the method of vanishing cues along with extensive repetition, HD acquired over 250 discrete items of new information, many of which were individually complex. She used this knowledge appropriately to perform the data entry task both in the laboratory and in the workplace.


Additional Learning Methods


Baddeley and Wilson (1994)


Ÿ       Tested the effects of errorless and errorful methods of learning on amnesic subjects.

Ÿ       They proposed that a major function of explicit memory is the elimination of learning errors, and therefore hypothesized that amnesic subjects would have great difficulty in learning under “errorful” conditions.

Ÿ       The learning measure was a stem completion task in which the subject was given the first two letters of a five-letter word and asked to produce the target word. Two lists of five letter words were generated. One list was presented in an “errorful learning” method and the other in a “errorless learning” method.

Ÿ       For a given target word in the errorful condition, subjects were told to guess what the completed word would be when a word stem was presented. The subject was given four opportunities to come up with the correct target word. After this, the experimenter would then relate the correct word to the subject and ask him/her to write the correct word down for later study. The procedure was repeated for the remaining words on the list.

Ÿ       In the errorless trials, subjects were presented with a word stem as well as the correct target word. Thus, they were unable to guess at the target word.

Ÿ       The results showed that error elimination was problematic for memory impaired patients.

Ÿ       Amnesics were found to benefit from an errorless procedure both in terms of enhanced learning and reduced forgetting.

Ÿ       It was suggested that the impaired explicit capacity of amnesic patients forces them to rely on implicit learning, which is less attuned to the elimination of strong competing responses.

Ÿ       Baddeley and Wilson’s results were consistent with Glisky et al’s method of vanishing cues. However, they go further in attempting to derive a general principle in the rehabilitation of patients suffering from memory deficits.



Squire, Hunkin and Parkin (1997)


Ÿ       Their first experiment compared the effectiveness of errorless and errorful learning on verbal paired associates.

Ÿ       Subjects had to learn the items designated as responses in the target list, and then learn the association of each response to a particular stimulus.

Ÿ       In the errorful condition, subjects were given the first word of a pair and were allowed three guesses to determine what word could be paired with the word provided.

Ÿ       In the errorless conditions, subjects were given the first word of a pair and then immediately told what the second word of the pair was.

Ÿ       Subjects then performed immediate oral cued recall tasks in which the subjects were given the first word and asked to recall the word that was paired with it. Subjects were also required to perform a delayed oral cued recall task after a one hour time period.

Ÿ       They found that under immediate recall conditions, the errorless learning method produced more accurate cued recall then the errorful learning method, but at delay conditions, there was no difference in recall between the two methods.


Leng and Parkin (1988)


Ÿ       Examined the effectiveness of two types of imagery learning on amnesic patients: one where images where provided for subjects in order to link pairs of words together and another where subjects generated their own images to link pairs of words together.

Ÿ       They compared the two types of imagery learning with other learning methods: rote learning and verbal mediation using the recall of paired associates.

Ÿ       The results showed that amnesic patients benefit significantly from the use of imagery when learning paired associates, with both “image-provided” and “ image-self-generated” trials.

Ÿ       Fewer errors were produced in these trials than either the rote learning condition or the verbal mediation condition.

Ÿ       However, it should be noted that earlier investigations of imagery effects in amnesic patients have contradictory findings.




Ÿ       The most common and most effective of these methods is the method of vanishing cues proposed by Glisky et al. (1983).

Ÿ       Evidence supporting the efficacy of teaching computer terminology to memory impaired patients has been confirmed by other investigators.

Ÿ       Leng et al (1991) replicated the method of vanishing cues with patient who had experienced a severe head injury. They found that the patient was able to learn computer related vocabulary more rapidly with the method of vanishing cues than with a second method, standard anticipation.

Ÿ       Other learning techniques tested on amnesics include errorless vs. errorful methods of learning, and imagery.

Ÿ       Baddeley and Wilson (1994) tested the effects of errorless and errorful methods of learning on amnesic subjects who are assumed to have good implicit but poor explicit learning. This study showed that the amnesic subjects had difficulty learning with the errorful method, but learning did occur with the errorless method. They explained that amnesics relay on implicit learning, which is less attuned to the elimination of strong competing responses. With the errorful method, interference occurs causing difficulties with learning.

Ÿ       Imagery was also demonstrated as an effective learning method by Leng and Parkin (1988).





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

Glisky, E.L., Schacter, D.L., and Tulving, E. (1986). Learning and retention of computer-related vocabulary in memory-impaired patients: method of vanishing cues. Journal of Clinical and Experimental Neuropsychology. Volume 8, Number 3. p. 292-312.

Glisky, E.L., Schacter, D.L., and Tulving, E. (1986). Computer learning by memory-impaired patients: acquisition and retention of complex knowledge. Neuropsychologia. Volume 24, Number 3. p. 313-328.

Glisky, E.L. and Schacter, D.L. (1988). Long-term retention of computer learning by patients with memory disorders. Neuropsychologia. Volume 26, Number 1. p. 173-178.


Glisky, E.L. and Schacter, D.L. (1989). Extending the limits of complex learning in organic amnesia: computer training in a vocational domain. Neuropsychologia. Volume 27, Number 1. p. 107-120.

Leng, N.R.C., Copello, A.G., and Sayegh, A. (1991). Learning after brain injury by the method of vanishing cues: a case study. Behavioural Psychotherapy. Volume 19. p. 173-181.

Leng, N.R.C. and Parkin, A.J. (1988). Amnesic patients can benefit from instruction to use imagery: evidence against the cognitive mediation hypothesis. Cortex. Volume 24. P. 33-39.


Squires, E.J., Hunkin, N.M., and Parkin, A.J. (1997). Errorless learning of novel associations in amnesia. Neuropsychologia. Volume 35, Number 8. p. 1103-1111.



Glisky, Elizabeth. 1992. “Acquisition and transfer of declarative and procedural knowledge by memory-impaired patients: A computer data-entry task.” Neuropsychologia, 30 (10), 899-910.




Neurological insults often result in selective, rather than global, memory deficits. Amnesic patients can acquire a variety of motor, cognitive, and perceptual skills in a nearly normal fashion but not remember the learning episodes. They also exhibit normal repetition priming: they show the effects of recent experiences with words, pictures, and other stimuli without remembering the prior experience. One hypothesis is that amnesia involves a problem with declarative knowledge (facts, specific information) but not procedural (sequences, routines). Amnesic patients may be using procedural means to learn declarative information; this might explain inefficient learning and context-dependency (“hyperspecificity”) of what is learned.


In a pilot project, Glisky and Schachter (1987) trained one amnesic patient for a data entry job. They used the method of vanishing cues to train declarative (factual) knowledge and provide hints during the tests of procedural (data entry routines) knowledge. The job was closely simulated in the laboratory. It transferred well to the workplace, but one should note that only the data changed, not the procedures or the document format. This study has more participants – including a control group – and looks in greater detail at hyperspecificity.


Ten people with memory disorders, varying in severity and etiology, and 5 non-disabled people participated. The controls did not differ from the patients in age or IQ (Wechsler Adult Intelligence Scale, or WAIS-R), but were significantly better on memory tests (Wechsler Memory Scale– Revised). The transfer tasks, 4 weeks after training, occurred in the laboratory rather than at a job site; both involved minor changes in materials like missing headings or reordered fields.


Patients varied greatly in their performance; two or three of them approached the performance of the control group. Overall, patients acquired declarative knowledge much more slowly (84.6 vs. 19 trials). In the procedural (skill acquisition) section, patients performed the data entry task much more slowly than controls did, and their errors persisted for more trials. However, improvement continued at the same rate for both groups; speed increased by 50% during part 1 and 15% during part 2. Patients also adapted to the transfer task at the same rate as controls.


Declarative knowledge can be acquired by patients with frontal lobe deficits or substantial intellectual impairments. The rate of acquisition is slower than normal, but the knowledge is available and does facilitate later task performance. Participants cannot state the knowledge when asked, but they can demonstrate it, implicitly. It may also be important that the knowledge is overlearned, or at least well-learned. Finally, this knowledge was shown to generalize (transfer) to several tasks with minor differences; it is less hyperspecific than previous studies would have suggested.


Glisky, Elizabeth L., Schacter, D.L. & Endel Tulving. 1986. “Computer learning by memory-impaired patients: Acquisition and retention of complex knowledge.” Neuropsychologia, 14 (3), 313-328.


Like Glisky (1992), (summarized above), this study looks at the acquisition of declarative and procedural knowledge by patients with memory impairments vs. controls. Eight people participated, with 4 in each group. The two groups were roughly matched on age and verbal IQ; patients were particularly impaired on delayed tests of logical memory and visual reproduction (WMS).


The more ambitious set of tasks in this earlier study included file and screen manipulations plus computer program writing and editing. This material was covered in three self-paced lessons. The system acted like an adaptive trainer (Egan, 1988), evaluating participants’ responses, providing vanishing cues for command names, and occasionally offering more direct prompts (Save what? or Did you forget the quotation marks?). Patients enjoyed this learning process.


Patients started out with the same knowledge as controls. They eventually made few errors and retained information over one or more months. However, they took much longer to reach criterion. They did less within- session learning and more between-session forgetting. They also had difficulty answering general or open-ended questions about what they had learned, or questions in which the wording differed from that in training. Finally, patients’ performance was severely disrupted by a transfer task in which they were asked to take knowledge about how to perform mathematical operations on a computer and embed it in a program. They required an hour of prompting to create a four-line program, whereas controls typically wrote the same program in 5 minutes.


Compared to Glisky (1992), this study made more demands on memory-impaired participants. The order of the procedures was more varied; participants were asked to state rather than to merely demonstrate their acquired knowledge; and the transfer task differed more from the training tasks.


Goldberg, Larry. 1996. “Access for People with Disabilities.” Position paper given in August 1996 at workshop organized by the Computer Science and Telecommunications Board (CSTB) of the National Research Council.


In this article, Goldberg suggests that video description might be useful for students and adults with learning disabilities, especially attention deficit disorder. In addition, Goldberg notes that video description might have an impact on information retrieval where masses of data and information could be reduced through descriptive guides.