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Neuropsychology. 2017 Feb;31(2):220-228. doi: 10.1037/neu0000318. Epub 2016 Oct 10.

Leveraging the test effect to improve maintenance of the gains achieved through cognitive rehabilitation.

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Department of Neurology, Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center.
Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center.



An important aspect of the rehabilitation of cognitive and linguistic function subsequent to brain injury is the maintenance of learning beyond the time of initial treatment. Such maintenance is often not satisfactorily achieved. Additional practice, or overtraining, may play a key role in long-term maintenance. In particular, the literature on learning in cognitively intact persons has suggested that it is testing, and not studying, that contributes to maintenance of learning. The present study investigates the hypothesis that continuing to test relearned words in persons with anomia will lead to significantly greater maintenance compared with continuing to study relearned words.


The current study combines overtraining with the variable of test versus study in examining the effects of overtesting and overstudying on maintenance of word finding in 3 persons with aphasia. First, treatment successfully reestablished the connections between known items and their names. Once the connections were reestablished (i.e., items could be named successfully), each item was placed into 1 of 4 overtraining conditions: test and study, only test, only study, or no longer test or study. Maintenance was probed at 1 month and 4 months following the end of overtraining.


The results are consistent with an advantage of testing compared with studying. All 3 participants showed significantly greater maintenance for words that were overtested than for words that were overstudied. This testing benefit persisted at 1 month and 4 months after completion of the treatment. In fact, there was no clear evidence for any benefit of overstudying.


The present study demonstrates that overtesting, but not overstudying, leads to lasting maintenance of language rehabilitation gains in patients with anomia. The implications for the design of other treatment protocols are immense. (PsycINFO Database Record

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