The prevalence and sequelae of moderate-to-severe (M/S) traumatic brain injury (TBI) are significant and pervasive problems, and effective rehabilitation techniques are key. Errorless learning is regarded as a useful tool for memory impairments; however, the efficacy of errorless learning in a M/S TBI population is unclear. The primary goal (aim 1) of this study was to evaluate the efficacy of a single session of errorless vs. errorful learning in a group of M/S TBI survivors and matched controls. A secondary goal (aim 2) was to investigate the neural time course of errorless learning in participants with M/S TBI by analyzing the error-related negativity (ERN) component of the scalp-recorded event-related potential (ERP). The ERN is an electrophysiological measure of error processing that is disrupted in M/S TBI survivors. Measures of neuropsychological performance, self- and informant-report of executive functioning, and affect further informed both study aims. Data from 28 M/S TBI survivors (9 female) and 28 controls (9 female) were analyzed for aim 1, with data from 19 M/S TBI survivors (6 female) and 20 controls (8 female) analyzed for aim 2. There were significant differences between the TBI and control groups with regard to executive, mood, and neuropsychological functioning. Results from aim 1 indicated that TBI participants were slower across learning conditions, while both groups had significantly faster reaction times in the errorless condition. Regarding accuracy, there was not a statistically significant main effect of learning condition (p = .07), group (p = .06), or Group x Condition x Accuracy interaction (p = .33). Indices of memory and executive functioning, and group (TBI, Control) used in regressions predicted accuracy in both learning conditions (ps < .01). The memory composite was a significant independent predictor of errorless accuracy. Results from aim 2 indicated a reliable ERN was present across conditions, although there were no main effects of Condition, Group, or Group x Condition interactions on ERN amplitude or latency (ps > .22). ERN latency was not predictive of accuracy for either condition (ps > .08). Group was a significant independent predictor of accuracy in the errorless condition (p = .05), but not the errorful condition (p = .45). Findings indicate that memory functioning was a better predictor of accuracy than executive functioning or group membership. This suggests that the errorless learning benefit may be specific to memory functioning, rather than other cognitive variables. This conclusion aligns with research reporting that benefits of errorless learning depend upon the severity of memory impairments. Results from ERN analyses are only partially supported by previous research, and further work is needed to clarify the role of neural representations of errorless learning in M/S TBI.



College and Department

Family, Home, and Social Sciences; Psychology



Date Submitted


Document Type





cognitive rehabilitation, errorless learning, errorful learning, traumatic brain injury, TBI, error processing, EEG, error related negativity, ERN

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Psychology Commons