Use of Learning Principles in Memory Rehabilitation Improves Self-efficacy in Children with Acquired Brain Injury

Abstract

Acquired brain injury (ABI) in the paediatric population has well-known cognitive and psychosocial sequelae. Of these, memory impairment is recognised as one of the most prevalent of the reported cognitive problems and disruptions to psychosocial functioning, particularly with respect to self-identity constructs have also been documented. Both memory impairment and low self-efficacy and -esteem beliefs have been shown to impact upon learning and academic achievement. As such, both areas of dysfunction are important to consider in the context of rehabilitation. However, there are few studies investigating both the efficacy of learning principles and their impact on the self-efficacy and self-esteem of young people with ABI. The present research addresses this gap in two ways. First, it aims to determine the relative efficacy of using errorless learning and spaced retrieval, in the context of the cognitive processes typically compromised in ABI, through the medium of Skype. Second, it investigates the general effect that involvement in such learning programmes has on perceptions of self-efficacy and -esteem. Nineteen children with ABI aged between 8 to 16 years took part in the study. All learned novel age-appropriate science and social science facts under three conditions: errorless learning (EL), spaced retrieval (SR), and trial-and-error (T&E) learning. Memory for these facts was then tested after 5 minutes, 30 minutes, 60 minutes and 24 hours. Prior to, and on completion of the three learning conditions, participants completed measures that indexed various components of self-esteem and self-efficacy beliefs. The effects of working memory on learning outcomes was also explored. Analysis revealed no effect of learning condition, with all found to be equally effective. However, there was a main effect of time, with significant loss of information after a one hour delay, but no further decline after 24 hours. Further interrogation of this memory loss also revealed EL and SR to have some superiority, in the short term, over T&E learning which was the only condition where significant loss of information was found. Additionally, the integrity of working memory capacity was found to differentially affect learning outcomes under EL methods, but not SR or the control T&E condition. Specifically, those participants whose working memory abilities were weaker were found to have poorer learning outcomes. Most striking was the significant increase in perceived self-efficacy – notably, global, academic, memory and emotional self-regulatory beliefs in response to a relatively brief learning intervention. The present findings highlight the value that engagement in memory rehabilitation focusing on learning, has on young people’s sense of self-efficacy. The implications of the failure to find no effect of learning condition on recommendations for use of EL and SR are discussed.