By Billy Thompson, MS, CCC-SLP
Speech-Language Pathologist

Clinicians of all disciplines working with older adults must develop many skills and employ numerous strategies in order to address the variety of deficits we may encounter within this population. Oftentimes, our approaches focus on interacting with individuals diagnosed with dementia in order to facilitate greater independence and safety as they go about their day. 

However, there is a treatment approach that has been proven beneficial for helping patients with dementia not just continue their routines, but learn new information as well. It’s called  Spaced Retrieval (SR). This treatment is easy to utilize and can be modified for many treatment targets. Yet, despite its benefits, SR is often underutilized by physical, occupational, and even speech-language pathologists.

What is Spaced Retrieval?

The American Speech-Language-Hearing Association (ASHA) defines SR as “a technique for learning and storing information so that it can be easily accessed,” which “teaches new memory associations using the principles of classical conditioning and taking advantage of preserved implicit memory.” 

At its core, SR assists patients with creating associations between a stimulus and a desired response through repetition and errorless learning. This allows the treating clinician to be proactive, rather than reactive, in our cueing. For example, instead of waiting for patients to make an error and then correcting them, SR provides cues at intervals that are dependent upon the patient’s ability, thereby reducing the opportunity for errors.

What Does SR Look Like During Clinical Therapy Sessions?

If you’re a practicing clinician, it’s likely that this isn’t the first time you’ve heard of SR. You may even have an understanding of the procedure, as it is simple to implement. The basis for implementing methods of SR are as follows:

1. Identify the information or target action you want your patient to recall. This information should be functional, meaningful, and concrete (e.g., their room number).
   
2. Present this information to the patient (“Your room number is 217”).
   
3. Select a starting interval — typically 10-15 seconds initially — wait this time, and then prompt the patient to recall the target information (“What is your room number?”).
4. If the patient responds accurately, then the interval should be extended — often doubled. The initial prompt should then be repeated.
   
5. Each time your patient responds accurately, continue to extend the interval between prompts. If they provide an incorrect response, immediately provide the correct answer and revert back to the last correct time interval.

These steps can be adjusted to reflect your patient’s needs and abilities. For instance, while the time interval between prompts is usually doubled, you can use smaller increments to allow for more frequent repetition. Or, to add more difficulty to the task, you can switch to other activities in between prompts as a distraction.

How Can OTs, PTs, and SLPs Implement Spaced Retrieval?

The underutilization of SR doesn’t necessarily come from a lack of knowledge or understanding about the treatment. Rather, it stems from a lack of consideration for how SR could be applied to a given activity during treatment — especially among physical and occupational therapists who may not see how a speech-language pathology treatment translates to their own practices.

It is often the case that SR is utilized by SLPs to assist with the recall of a specific piece of information — a family member’s name or where they are currently residing. However, it can be equally beneficial for OTs and PTs’ treatment when training aspects of new skills and strategies. 

Consider the following ways in which SR can be used for OT and PT patients:

• When training a patient to lift their foot while ambulating, a PT utilizes SR to cue the patient during a walk around their home: “What type of steps should you be taking?”
• An OT working with a patient on feeding themself uses SR to cue the patient to use the correct hand during a meal: “Which hand should you use to hold your fork?”
• SR is implemented to help a patient who has recently begun using a walker to remember it whenever they ambulate: “What should you take with you when you want to walk?”
• A PT training a patient to use the armrests to push up to standing from a chair uses SR to help them remember where to place their hands: “Where should you push from when you stand up?”
• When working on dressing with a patient, an OT utilizes SR to assist the patient with remembering to use a dressing stick, or where to place the hook to aid with putting on a shirt: “What tool should you use to help you get dressed?” or “Where should this hook go?”
• When training a patient to tuck their chin when they swallow, an SLP employs SR throughout a meal: “What should you do when you swallow?”

These are just a few examples of the numerous ways spaced retrieval can be introduced to other treatments clinicians already use during their sessions. By introducing SR, we not only help patients with dementia live more independently but learn new information as well.   

Introducing SR to Therapy Sessions Benefits Patients and Clinicians

With adequate consideration, many tasks addressed by clinicians can be broken down into concrete, meaningful, and functional targets for which SR can be utilized. By thinking beyond the basic implementation of helping an individual with dementia recall specified information, and instead applying SR to aspects of targeted skills, clinicians of all disciplines can add another useful tool to their repertoire and become more proactive in training their patients to be more safe and independent in their daily lives.