We examined literature, within a 20-year period, regarding whether errorless learning strategies or trial and error strategies are more effective for adult patients, with a diagnosis of cerebrovascular accident (CVA) or cognitive deficit, when learning instrumental activities of daily living (IADL) and activities of daily living (ADL). We conducted this in collaboration with Hannah Baldwin, a local practitioner working in an acute care setting, at Swedish Medical Center, in Seattle. The results did not reveal overwhelming evidence to support either strategy, however, we were able to make recommendations within specific situations and for specific diagnoses. Generally, there are a greater number of studies with a more rigorous design that support the use of errorless learning strategies for patients with acquired brain injuries (ABI) than patients with other diagnoses or when using trial and error methods. The evidence that solely supports trial and error strategies is restricted to two level I studies that support its use for those with traumatic brain injury (TBI) to reduce cooking errors and increase functional independence measure (FIM) scores. Multiple studies also supported the idea that both methods can improve function or performance in ADL and IADL.

To translate this knowledge, we created a 16-minute webinar to identify when practitioners can implement trial and error and errorless learning strategies with their patients in the acute care setting using the current evidence. The webinar was sent to therapists at a Seattle hospital via email along with a pre-training and post-training survey. The pre-training survey was completed by two therapists, with no engagement on the post-training survey. The researchers would have liked to see the webinar have more reach and impact but struggled to incentivize therapists to engage with the material given their limited direct communication with the therapist population. To further the knowledge in this area of occupational therapy, practitioners should be able to distinguish application timings for trial and error, as well as errorless learning strategies, and are encouraged to conduct case series or case study research to contribute to the body of available evidence.

Publication Place

Tacoma, Washington


University of Puget Sound

Project Chairperson

Chih-Huang Yu, PhD, OTR/L

Publication Date



Capstone Project





Degree Program

Occupational Therapy

Degree Level

Master of Science


Occupational Therapy


University of Puget Sound