TEACH-M for Memory & Executive Functioning

By /

TEACH-M was designed to teach multi-step skills to patients with severe memory and executive functioning deficits, post-TBI.

A study tested this program—and it worked! Participants were able to learn a new, 7-step task, despite the severity of their deficits.

So how do you apply this evidence-based program to your real-life therapy?

In this post, we’ll walk you through the steps of TEACH-M, with links to other useful treatment resources.

For more EB materials, including patient handouts and worksheets, check out The Adult Speech Therapy Starter Pack!

Visit Our Shop!

More Helpful Articles

Table Of Contents
  1. How To Use TEACH-M
  2. T- Task Analysis
  3. E- Errorless Learning
  4. A- Assess Performance
  5. C- Cumulative Review
  6. H- High Number of Practice Trials
  7. M- Metacognition
  8. Another M – Meaningful
  9. 4 Phases of TEACH-M
  10. Speech Therapy Materials
  11. References

How To Use TEACH-M

TEACH-M

TEACH-M is an acronym for 6 ways to teach new cognitive skills. It was developed using best-practice in the cognitive-rehab space by researchers at Western Oregon University and the University of Oregon.

TEACH-M is a type of ‘systematic instruction.’ This is a step-by-step, structured way of teaching a new skill, versus teaching by trial and error.

That said, TEACH-M isn’t a strict protocol. When possible, use the steps to make your executive functioning and memory treatments more effective. But use your best judgment.

For example, a patient may be too fatigued for lots of practice trials. That’s okay! Focus on caregiver training.

While another patient may resist treatment because they don’t see the point of speech therapy. No worries! This may be a clue to focus on metacognition for a few sessions.

T- Task Analysis

task analysis speech therapy

Task analysis helps patients learn new skills by breaking down the task into smaller steps. Teach the patient each smaller step, then ‘chain’ them together.

For example, a goal to check and delete a voicemail can be broken down into these steps:

  1. Touch the phone icon
  2. Touch the voicemail button
  3. Touch play

Chaining: Step-By-Step

  1. Break down the task into key steps

  2. Fully prompt the patient through each step
    • Give cues and modeling as needed as they go through every step of the task

  3. Fade prompts for the last step only
    • Go through the entire task, but decrease cues for the last step
    • Keep fading cues until the patient can do the last step independently

  4. Fade prompts for the 2nd-to-last step
    • Go through the entire task, but decrease cues for the 2nd-to-last step and last step
    • Keep fading cues until the patient can do these last 2 steps independently

  5. Keep fading prompts for the entire task
    • Keep backward chaining until the patient does the entire task independently

E- Errorless Learning

The aim of errorless learning is for the patient to have as few errors as possible as they learn a new skill (or a step of the skill).

How to do errorless learning:

  • Model the skill or step before asking them to try it
  • Focus on accuracy
  • Emphasize not guessing by cueing as needed
  • If an error happens, give enough cues to get the correct response. For example, model the skill again

A- Assess Performance

The point of this step is to monitor patient progress. This is something you already do, as you need ongoing assessment to write notes and reports. But it’s a good reminder of the importance of data for effective cognitive treatment.

First, assess the patient’s performance on the skill before starting treatment. Then, on an ongoing basis, assess their performance before each treatment session and/or before teaching a new step.

For milder impairments, you can teach the patient to assess and monitor their own performance.

C- Cumulative Review

The patient should regularly review all of the steps they’re already learned at least once before attempting the task.

You can facilitate cumulative review with backward chaining.

H- High Number of Practice Trials

TEACH-M

Have your patient complete the entire task over and over again. But prioritize doing the task correctly (errorless learning) over the number of repetitions.

Spaced retrieval is a great way to get in a high number of practice trials while treating memory.

Read Spaced Retrieval For Adult Speech Therapy for step-by-step instructions.

M- Metacognition

For treatment to be the most effective, patients need to have at least some awareness of their cognitive deficits.

Help patients improve awareness about how they perform on a task by following these steps:

  • Before the task, ask the patient to predict how they’ll do
  • After the task, ask the patient to assess how they did
  • Discuss how their prediction compared to how they actually did

For more help with metacognition treatment, including a free patient worksheet, read How to Improve Awareness.

Another M – Meaningful

evidence-based memory treatment

We’ve tacked on another ‘M’ to add in meaningful. A few of the creators of TEACH-M went on to do a literature review of memory treatments. They found that meaningful treatment (functional, important to the patient) led to much better results.

This is not news to you! Meaningful activities are not only more functional for the patient but also more motivating. It’s a win-win-win!

4 Phases of TEACH-M

Again, TEACH-M is not a protocol that you need to follow with your patients. But if you’re interested in what protocol the original researchers used, here you go!

The Treatment Task: Teaching a new, 7-step email task to post-TBI participants with severe memory and executive functioning impairments.

  • Phase 1: Task-analysis, errorless learning, high rates of practice, assessment
    • Participants were taught the 7 steps of an email task

  • Phase 2: Meta-cognitive strategy training-Part 1
    • After learning the steps of the email task, participants were asked to predict how they would do on the task

  • Phase 3: Cumulative review, including spaced retrieval practice
    • Spaced retrieval was used to help participants remember the steps over longer periods of time

  • Phase 4: Metacognitive strategy training-Part 2
    • Participants were asked to compare how they predicted they’d do to how they actually did

Speech Therapy Materials

Visit our shop for evidence-based memory and cognitive handouts, worksheets, and treatment guides!

References

  • Cicerone, K. et al.(2019). ACRM Cognitive Rehabilitation Manual & Textbook Second Edition. American Congress of Rehabilitation Medicine. https://acrm.org/meetings/cognitive-rehab-training-second-edition/
  • Ehlhardt, L. A., Sohlberg, M. M., Kennedy, M., Coelho, C., Ylvisaker, M., Turkstra, L., & Yorkston, K. (2008). Evidence-based practice guidelines for instructing individuals with neurogenic memory impairments: what have we learned in the past 20 years?. Neuropsychological rehabilitation, 18(3), 300–342. https://doi.org/10.1080/09602010701733190
  • Ehlhardt, L. A., Sohlberg, M. M., Glang, A., & Albin, R. (2005). TEACH-M: A pilot study evaluating an instructional sequence for persons with impaired memory and executive functions. Brain injury, 19(8), 569–583. https://doi.org/10.1080/002699050400013550
  • Powell, L. E., Glang, A., Ettel, D., Todis, B., Sohlberg, M. M., & Albin, R. (2012). Systematic instruction for individuals with acquired brain injury: results of a randomised controlled trial. Neuropsychological rehabilitation, 22(1), 85–112. https://doi.org/10.1080/09602011.2011.640466
Scroll to Top