Utilizing Errorless Learning as an Educational Intervention to Facilitate Independence with Functional Mobility Following a Stroke: A Case Report

Background & Purpose: Post-stroke memory impairments are not uncommon to see in post-acute neurological rehabilitation settings. Patients that present with these deficits have an increase in difficulty with learning new information or tasks and, as a result, limit their ability to gain independence prior to discharge. However, not all therapists are well familiar with a strategy called, errorless learning, that may be helpful in patients with memory impairments, and there is limited research on errorless learning within the stroke population. Thus, the purpose of this case report is to describe the implementation of an errorless learning plan and the positive outcomes, in terms of a patient’s level of independence, with even surface transfers prior to discharge that may have resulted in part from this intervention. Case Description: The patient in this case report was a 59-year old male in a post-acute neurological skilled nursing facility (SNF) following a left-sided thalamic hemorrhagic stroke who needed moderate assistance with even surface transfers at the time of the initial evaluation. The patient showed difficulty with remembering the appropriate cues and steps for safe transfers, requiring him to need more physical assistance. Intervention: An errorless learning plan was implemented in an effort to improve his level of independence with even surface transfers. This plan consisted of step by step cues to tell the patient with each transfer that was completed throughout each day, including when working with other team members, every day of the week. No errors in the learning process were allowed within the completion of the transfer to prevent the brain from processing the wrong information. Outcome Measures: Even surface transfers were assessed weekly, over 7 weeks, by determining level of independence using a modified version of the Functional Independence Measure (FIM) scale. Discussion: After utilizing an errorless learning plan, the patient was able to achieve a level of supervision by his discharge date, needing no physical assistance from others. This result may indicate errorless learning may be beneficial to patients who demonstrate memory impairments post-stroke.