Errorless learning based orientation retraining in acquired brain injury

Dr Clare Ramsden1, Ms Melissa Waugh1

1Tasmanian Health Service, Hobart, Australia

Following a severe acquired brain injury impairment of orientation to person, place and time is relatively common (Lezak 2004). For most individuals this improves quickly and spontaneously, although for some people impaired orientation persists and impacts on their length of stay and engagement in rehabilitation. Disorientation is associated with impaired new learning and memory difficulties, and is often related to impaired social engagement, challenging behaviours and can limit engagement in treatment or therapy (Kolb & Whishaw 2009).

Errorless learning (EL) is an evidence-based paradigm that aims to facilitate new learning in individuals with impaired memory (Clare & Jones 2008). By avoiding the production of incorrect responses, the person avoids having to retain the error and therefore reduces the chance of making it in the future. Memory strategies such as EL have been used in cognitive rehabilitation of acquired brain injury, however there is limited research into the application to orientation retraining. This project applied an EL methodology to orientation retraining, with the primary aim of facilitating engagement in treatment through increased awareness of person, place and time and a secondary aim of reducing challenging behaviours. The utility of EL based orientation retraining by the multidisciplinary rehabilitation team is discussed in both traumatic and non-traumatic brain injury through case review, including utilising existing measures of orientation such as the Westmead PTA scale and the Orientation Log, alongside the evidence base for EL protocols.


Clare, L & Jones, RS 2008, ‘Errorless learning in the rehabilitation of memory impairment: a critical review’, Neuropsychology review, vol. 18, no. 1, pp. 1-23.

Kolb, B & Whishaw, IQ 2009, Fundamentals of human neuropsychology, Macmillan.

Lezak, MD 2004, Neuropsychological assessment, Oxford University Press, USA.


Dr Clare Ramsden has worked as a clinical neuropsychologist in brain injury rehabilitation settings across the UK, New Zealand and Australia, including acute and post-acute services, residential rehabilitation and community services. She is currently Manager of Psychology Services at THS.

Melissa Waugh has worked as a Occupational Therapist in brain injury rehabilitation settings across London and Tasmania including acute services, inpatient rehabilitation and community services. She is currently working in inpatient rehabilitation at THS South.

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