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Facilitating the Use of Implicit Memory and Learning in the Physical Therapy Management of Individuals With Alzheimer Disease: A Case Series

White, Laura PT, DSc, GCS; Ford, Matthew P. PT, PhD; Brown, Cynthia J. MD, MSPH; Peel, Claire PT, PhD, FAPTA; Triebel, Kristen L. PsyD

Journal of Geriatric Physical Therapy: January/March 2014 - Volume 37 - Issue 1 - p 35–44
doi: 10.1519/JPT.0b013e3182862d2c
Case Report

Background and Purpose: Physical rehabilitation of individuals with Alzheimer disease (AD) is often complicated by impairments in explicit memory and learning. Rehabilitation strategies that facilitate the use of the preserved implicit memory system may be effective in treating patients with AD. The purpose of this case series is to describe the application of these strategies, including high-repetition practice, errorless learning (EL), and spaced retrieval, to the physical therapy management of individuals with moderate AD.

Case Description: Three women aged 89 to 95 years with moderate AD who resided in an assisted living facility participated in physical therapy to address their mobility limitations.

Intervention: Twelve physical therapy sessions were scheduled over a period of 4 weeks. Interventions were individually designed to address the mobility needs of each patient, and rehabilitation strategies based on implicit learning principles were integrated into the interventions.

Outcomes: All patients participated in at least 10 of the 12 physical therapy sessions. Improvements in performance of objective measures of balance were observed in all patients, although only 1 patient's balance score exceeded the minimal detectable change. No significant clinical change was observed in any patients on the Timed Up and Go Test or self-selected gait speed.

Discussion: Principles of implicit learning were integrated into the interventions for these patients with moderate AD. However, the feasibility of applying the EL paradigm was limited. Further research on the effectiveness of EL, spaced retrieval, and other rehabilitation strategies that facilitate implicit learning of mobility skills in patients with AD is needed to promote optimal physical therapy outcomes in this patient population.

1University of South Alabama, Mobile.

2University of Alabama at Birmingham.

Address correspondence to: Laura White, PT, DSc, GCS, University of South Alabama, 5721 USA Drive North, HAHN 2011, Mobile, AL 36688 (

M.P. Ford receives ongoing payment for lectures on speakers' bureaus for the Northwest Parkinson Foundation and the Davis Phinney Foundation. C.J. Brown currently receives a VA Merit Award from the Department of Veterans Affairs (VA). C. Peel has served as a consultant for the Richard Stockton College of New Jersey. K.L. Triebel has served as a consultant for Federal Defenders of Middle Alabama, Watson Graffeo P.C., and Ajarnie LLP, and is currently receiving grant funding from NIH (NICHD #1RO1 HD503074 and #2R01 AG021927-06A1). K.L. Triebel has received past funding from NIH-NIA (P30 AG031054 and R01 AG021927). No conflicts of interest or sources of funding were declared by L.W. White.

© 2014 Academy of Geriatric Physical Therapy, APTA