What has been researched about implicit memory in speech-language-hearing pathology? A scoping review

Silva, Fernanda Roberta de Faria Rocha da; Leal, Gilberto da Cruz; Barabás, Roberta de Carvalho; Nemr, Katia

doi:10.1590/2317-1782/e20250338pt

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Critical Review or Scoping Review • CoDAS 38 (5) • 2026 • https://doi.org/10.1590/2317-1782/e20250338en linkcopy

What has been researched about implicit memory in speech-language-hearing pathology? A scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose to map how implicit memory has been addressed in international scientific speech-language-hearing production.

Research strategies An electronic search was conducted in the PubMed, Web of Science, Scopus, Embase, CINAHL, and PsycINFO databases, supplemented by a manual search of references of the included studies. The scoping review was conducted based on the Joanna Briggs Institute Evidence Synthesis Manual, following the PRISMA-ScR guidelines. The protocol was registered in the Open Science Framework (10.17605/OSF.IO/PNDWF).

Selection criteria: Studies addressing implicit memory in speech-language-hearing contexts, in Portuguese, English, or Spanish, regardless of year of publication, were included.

Data analysis: Two reviewers independently extracted data, considering design, population, objectives, and main outcomes. The studies were grouped by area of application and synthesized by descriptive and narrative analysis.

Results A total of 2,565 documents were identified, of which 39 comprised this review. The studies were grouped into three categories (language, audiology, and voice). The most frequent themes found were the application of implicit learning in speech-language-hearing contexts; the use of implicit tasks for the assessment and characterization of disorders; and investigations of biases, prejudices, and/or implicit perceptions in speech-language-hearing practice.

Conclusion The literature deals with implicit memory in a limited and heterogeneous manner, mainly in language, audiology, and voice, focusing on implicit learning, assessment, and biases. Despite its clinical potential, there is a lack of conceptual and methodological systematization, indicating the need for future research to consolidate its use in the field.

Keywords:
Repetition Priming; Implicit Memory; Speech-Language Pathology; Bias; Implicit; Scoping Review

Article	Authors/year	Country	Study objective	Population	Study type	Main results	Relevance for the review
A1(¹⁶)	Hopper, 2003	USA	To discuss implicit learning in Alzheimer's disease, followed by a summary of the reality of implementing therapeutic programs in long-term care facilities.	Individuals with Alzheimer's disease in long-term care settings	Theoretical/ Review	Implicit learning may be preserved in individuals with dementia, even with impairments in explicit memory. Techniques such as repeated exposure and errorless learning show good results. The speech-language-hearing pathologist should act early and preventively, with a functional focus, including screenings and continuous reassessments. Intervention also involves guidance for caregivers and adaptation of strategies as the disease progresses.	Adult language
A2(¹⁷)	Anderson and Conture, 2004	USA	To use an age-appropriate version of the syntactic structure priming paradigm to experimentally assess the syntactic processing abilities of children who stutter and children who do not stutter.	Children who stutter and children who do not stutter	Experimental	The main results indicated that children who stutter exhibited slower SRTs in the absence of priming phrases and greater syntactic priming effects than children who do not stutter.	Fluency disorders
A3(¹⁸)	Turkstra and Bourgeois, 2005	USA	To describe a memory therapy technique, Spaced Retrieval (SR), designed to capitalize on preserved procedural memory processes.	An individual who suffered a traumatic brain injury with profound anterograde amnesia and received SR therapy.	Case study	The positive results support future studies on TBI and suggest considering the role of errors in speech and language therapy.	Adult language
A4(¹⁹)	Tomblin et al., 2007	USA	To test the hypothesis of deficits in procedural learning by examining serial reaction time learning in adolescents with and without specific language impairment (SLI).	Adolescents with and without SLI	Experimental	Both groups improved on the implicit learning task (SRT), but adolescents with SLI showed slower learning rates. This difference was observed when the impairment was defined by grammar, but not by vocabulary.	Child language
A5(²⁰)	Davis et al., 2008	USA	To introduce a novel approach to the treatment of apraxia of speech (AOS) with aphasia using implicit phoneme manipulation via rhyme, omission, and alliteration tasks.	Subject with AOS and mild aphasia.	Experimental	The study showed significant improvement in speech production in children, with small to medium effects for trained sounds (/ʃ/, /ʤ/, /s/). There was generalization to untrained words (T-MAC: 68% to 87%) and noticeable improvement in prosody and articulatory accuracy, confirmed by clinical evaluation by speech-language-hearing pathologists.	Adult language
A6(²¹)	Hedenius et al., 2011	Sweden	To examine the consolidation and long-term learning of procedural sequences in children with SLI.	Children with SLI and typically developing (TD) children	Experimental	Although both groups showed evidence of early sequential learning, only TD children had clear signs of consolidation, although the two groups did not differ in long-term learning. When the children were recategorized based on grammatical deficits rather than broader linguistic deficits, a clearer pattern emerged. While both the group with grammatical impairment and the group with normal grammar showed evidence of early sequential learning, only those with normal grammar showed consolidation and long-term learning. In fact, the group with grammatical impairment appeared to lose any sequential knowledge acquired during the initial testing session. These findings held even when controlling for vocabulary or a broad measure of non-grammatical language, neither of which was associated with procedural memory. When grammar was examined as a continuous variable across all children, the same relationships between procedural memory and grammar were observed, but not vocabulary or the broader measure of language.	Child language
A7(²²)	Leonard, 2011	USA	To present a tutorial on structural priming and its relevance to the study of grammatical development and language intervention.	Not applicable	Theoretical/ Review	Evidence from the literature on structural priming provides insights into the transition from early conservative grammatical usage to broader abstract grammatical usage in young children and suggests ways in which language intervention activities can be modified to promote greater grammatical changes in children with language difficulties.	Child language
A8(²³)	Gabriel et al., 2012	Belgium	To evaluate the Procedural Deficit Hypothesis in children with Specific Language Impairment (SLI) using the Serial Reaction Time (SRT) paradigm, establishing an experimental situation characterized by more learning attempts than in previous studies and using a learning sequence that, more specifically, would test the children's ability to learn complex (i.e., second-order) statistical regularities within the sequence.	Fifteen children with SLI and their typically developing (TD) peers	Experimental	Although in Experiment 1 the children with SLI demonstrated learning, they were slower and made more errors than their TD peers. However, these relative weaknesses disappeared when the nature of the response mode changed (Experiment 2).	Child language
A9(²⁴)	Silkes et al., 2012	USA	This Phase I study was conducted to investigate the potential effectiveness of masked repetition priming as a treatment for anomia.	Subject with moderate to severe non-fluent aphasia	Experimental	The results revealed a small training effect on the naming of trained items in one category and a pattern of improvement in the other category that did not fully meet the criterion for a small effect. There was also a moderate generalization effect across categories, although no generalization effect was observed for untrained items within semantic categories. Improvements were observed in some measures of general language function.	Adult language
A10(²⁵)	Rönnberg et al., 2013	Sweden	To examine the Ease of Language Understanding (ELU) model in light of new behavioral and neural findings on the role of working memory capacity (WMC) in unimodal and bimodal language processing.	Not applicable	Theoretical/ Review	The new ELU model is a meaning prediction system that relies on phonological and semantic interactions in fast implicit and slower explicit processing mechanisms, which depend on WMC, albeit in different ways. It is based on findings that address the relationship between WMC and (a) early attentional processes in speech listening, (b) signal processing in hearing aids and their effects on short-term memory, (c) inhibition of speech maskers and their effect on long-term episodic memory, (d) the effects of hearing impairment on long-term episodic and semantic memory, and finally, (e) auditory effort.	Audiology
A11(²⁶)	Valitchka and Turkstra, 2013	USA	To describe the communication patterns between hospitalized patients with declarative memory impairments and rehabilitation team members during the initial stage after injury.	Five adults with acquired brain injury and impairment of declarative memory.	Cross-sectional study	The results showed that staff and visitors frequently asked participants declarative questions whose answers were not verifiable (e.g., questions about events prior to the injury). The verifiable answers were often incorrect but were accepted by staff as correct. The results suggest that acute rehabilitation staff may need training to communicate with patients with declarative memory deficits.	Adult language
A12(²⁷)	Hedenius et al., 2013	Sweden	To examine the learning of procedural sequences in DD beyond a single practice session.	Twelve children with developmental dyslexia and 17 controls (typically developing children).	Experimental	The results suggest that the most pronounced impairment in procedural learning in DD may only emerge after prolonged practice, in learning stages beyond a single practice session.	Child language
A13(²⁸)	Farias et al., 2014	USA	To promote the understanding and validity of a new treatment for apraxia of speech: implicit phoneme manipulation.	An individual with apraxia of speech	Experimental	Behavioral: The response to implicit training of complex consonant combinations resulted in improvements that were maintained 6 weeks after treatment. Furthermore, this treatment was generalized to simpler consonant combinations in words. Imaging: Functional imaging during implicit phoneme manipulation showed significant activation in brain regions responsible for phonological processing, compared to the baseline semantic task.	Adult language
A14(²⁹)	Moring et al., 2014	USA	To investigate whether current measures for tinnitus are susceptible to increased error due to priming and, if so, to examine the feasibility of using the Implicit Association Test for an alternative measurement of tinnitus-related distress.	People with tinnitus	Experimental	Although participants with tinnitus did not consider sound-related words to be significantly more negative, and IAT scores did not predict scores on the Tinnitus Handicap Inventory, priming did affect negative implicit attitudes toward sound-related words.	Audiology
A15(³⁰)	Hsu and Bishop, 2014	Taiwan	To test the hypothesis of procedural deficit in specific language impairment (SLI) by comparing the performance of children on two motor procedural learning tasks and one implicit verbal sequence learning task.	Children aged 7 to 11 years with SLI (n = 48), typically developing children with corresponding age (n = 20), and younger typically developing children with corresponding receptive grammar (n = 28).	Experimental	In a serial reaction time task, children with SLI performed at the same level as children with matching grammar but were worse than age-matched controls in learning motor sequences. When tested with a motor procedural learning task that did not involve learning sequential relationships between discrete elements (e.g., chase rotor), children with SLI performed comparably to age-matched children and better than younger grammar-matched controls. Furthermore, poor implicit learning of word sequences was found in a verbal memory task (Hebb effect) in children with SLI.	Child language
A16(³¹)	Silkes, 2015	USA	To investigate the effect of repeated exposure to masked identity stimuli combined with images over multiple trials, sessions, and days on the ability of people with anomia to name these images.	Four participants with anomia	Experimental	All participants showed some progress in identifying the trained items, although to varying degrees, and the trained (prepared) items generally showed greater improvement than the untrained items seen the same number of times. Generalization between categories was observed in some participants, but little or no generalization within the category occurred. Minimal changes occurred in measures of overall language ability.	Adult language
A17(³²)	Lee and Man, 2017	USA	To examine the feasibility and effectiveness of implicit structural preparation treatment in an individual with agrammatic aphasia.	An individual with aphasia	Case study	MJ significantly improved the production of prepositional dative sentences, both trained and untrained, throughout the training sessions. These effects were maintained after 4 weeks of follow-up without intervention. He also improved notably in the syntactic complexity of connected speech production, such as increased production of verbs and lexical phrases.	Adult language
A17(³³)	Calder et al., 2017	Australia	To investigate the effectiveness of combined explicit and implicit intervention techniques applied by a speech-language-hearing pathologist to improve receptive and expressive grammar.	Three children (two boys, one girl) aged 6.2–7.0, with grammatical difficulties.	Experimental	Two of the three participants achieved statistically significant gains on standardized tests of receptive and expressive general grammar. Two of the three children showed statistically significant improvement in measures of expressive morphosyntax, with one participant continuing to improve 5 weeks after treatment.	Child language
A19(³⁴)	Walden and Lesner, 2018	USA	This study assessed implicit and explicit attitudes toward people who stutter among young adults with normal fluency.	Adults without stuttering, or with typical fluency, moving towards stuttered speech.	Cross-sectional study	The results corroborated the existence of a negative stereotype of stuttering. Participants demonstrated implicit and explicit negative attitudes toward people who stutter. Explicit attitudes toward stutterers, but not implicit attitudes, were significantly predicted by social desirability scores. Familiarity with stuttering was significantly associated with implicit, but not explicit, attitudes toward stuttering.	Fluency disorders
A20(³⁵)	Garraffa et al., 2018	United Kingdom	To investigate whether a group of children with Developmental Learning Disorder showed impairment in implicit syntax learning (syntactic priming) after individual syntactic experiences, and the temporal course of such effects.	Children aged 5 to 6 years, Italian speakers, with Developmental Learning Disorder and typically developing controls, matched for age and language.	Experimental	Children with Developmental Learning Disorder showed immediate syntactic priming, but it was less intense and less lasting than that of typically developing children of the same age. The effect did not persist after intermediate sentences, and there was no cumulative priming effect in any group.	Child language
A21(³⁶)	Lee et al., 2019	USA	To examine whether people with aphasia exhibit preserved and lasting structural priming effects during the interpretation of syntactically ambiguous sentences, and whether these priming effects occur independently or in conjunction with lexical (verbal) information.	People with aphasia and healthy older adults	Experimental	After reading a priming sentence with a specific interpretation, healthy older adults and people with aphasia tended to interpret an ambiguous priming sentence in a target sentence in the same way and with faster response times. Importantly, both groups continued to exhibit this priming effect over time (Experiment 2), although the effect was not as reliable in terms of response times. However, neither group showed lexical (verb-specific) priming enhancement, deviating from the strong lexical enhancement observed in young adults in previous studies.	Adult language
A22(³⁷)	Man et al., 2019	USA	To investigate whether lexically independent priming (abstract structure) and/or lexically specific priming (verb) produces an immediate and more lasting facilitation of syntactic production in people with aphasia.	Seventeen individuals with aphasia (PWA) and 20 healthy older individuals	Experimental	Healthy older adults demonstrated abstract priming in transitive and dative cases, not only in the immediate priming condition (Experiment 1) but also in the long-lasting priming condition (Experiment 2). They also demonstrated significantly increased priming by verbal overlap (lexical reinforcement) in transitive cases during immediate priming. Individuals with aphasia demonstrated abstract priming in transitive cases in both immediate and long-lasting priming conditions. However, the magnitude of priming was not increased by verbal overlap.	Adult language
A23(³⁸)	Kamhi, 2019	USA	To analyze how the development of speech and language can be viewed as proceduralization and skill learning.	Individuals with speech and language disorders.	Theoretical/ Review	Norm-referenced measures provide a good measure of deliberative speech and language processes, while social conversations and discourses on familiar topics with familiar listeners provide the best indication of proceduralized speech and language processes. Intervention goals and planning need to consider which speech and language operations should be proceduralized and which will primarily require deliberative processing. Further research and clinical application of these ideas are clearly needed to develop more precise criteria that define the dividing line between deliberative and proceduralized speech and language processes.	Child language
A24(³⁹)	Walden et al., 2020	USA	To assess implicit and explicit attitudes toward stuttering and those who stutter among speech-language-hearing pathologists.	Speech-language-hearing pathologists	Cross-sectional study	As a group, clinicians demonstrated negative implicit attitudes toward stuttering. Explicit attitudes toward a person who stutters were positive, although less positive than attitudes toward a person who does not stutter. The amount of prior exposure to stuttering among these experienced speech-language-hearing pathologists was not significantly associated with implicit or explicit attitudes.	Fluency disorders
A25(⁴⁰)	Wada et al., 2020	USA	To examine the use of structural priming combined with a focused reformulation procedure to obtain subject- and object-centered relative clauses, in students with developmental language disorders (DLD) and typically developing (TD) students.	26 children (13 DLD, 13 TD), aged 6;10 to 10;11 (years; months)	Experimental	DLD and TD children were more accurate in producing subject-focused relative clauses than object-focused ones. However, children with DLD required more attempts to achieve consistent performance in both types of structures, indicating a slower learning rate.	Child language
A26(⁴¹)	Evans, 2021	USA	To discuss the concept of implicit bias in the field of audiology.	Not applicable	Theoretical/ Review	This article discusses implicit biases and prejudices in audiological practice, including the underrepresentation of Black professionals, socioeconomic and linguistic bias, and audism. It highlights how these factors affect the way information is shared with families and proposes an affirmative and culturally sensitive approach to clinical communication.	Audiology
A27(⁴²)	Maziero et al., 2021	Brazil	To compare the performance of individuals with mild cognitive impairment (MCI) with that of healthy older adults in a text inference comprehension task, and to determine the best predictors of performance in this skill, considering a verbal episodic memory task and two semantic tasks.	Individuals with mild cognitive impairment and healthy older adults	Cross-sectional study	Patients with MCI performed worse than healthy older adults; there were no differences between the MCI subgroups (amnesic and non-amnesic). The best predictors for making inferences were verbal memory in the MCI group and semantic tasks in the non-MCI group.	Adult language
A28(⁴³)	Hedenius et al., 2021	Sweden	To examine whether prolonged initial practice in Session 1 would normalize procedural consolidation in children with developmental dyslexia.	Children with Developmental Dyslexia and typically developing children	Experimental	The amount of sequence learning was similar in both groups at the end of session 1 (p=0.797, η ρ 2 = 0.001). In the follow-up session after 24 hours, the DD group performed worse than the TD group (p=0.003, η ρ 2 = 0.129). The amount of sequence knowledge in Session 2 predicted a single variance in reading fluency (p=0.024, η ρ 2 = 0.083), independently of the children's phonemic awareness and inattention symptoms.	Child language
A29(⁴⁴)	Kautto and Mainela-Arnold, 2022	Finland	Deficits in procedural learning have been hypothesized to contribute to language, especially grammatical difficulties, in individuals with specific language impairment (SLI). This study tested this hypothesis by examining serial reaction time (SRT) learning in adolescents with and without SLI.	Adolescents who had been identified with SLI and adolescents with normal language.	Experimental	Adolescents with SLI showed slower learning rates during pattern learning than controls. When language impairment was defined in terms of grammatical impairments, similar slower learning rates were found, but when language impairment was based on vocabulary, no group differences were found.	Child language
A30(⁴⁵)	Baron and Arbel, 2022	USA	To present evidence of the interaction between implicit and explicit learning systems and to highlight the characteristics of the intervention that promote implicit or explicit learning, as well as outcome measures that explore implicit or explicit knowledge.	Not applicable	Theoretical/ Review	Many intervention features (e.g., instructions, elicitation techniques, feedback) can be manipulated to move an intervention along the implicit-explicit continuum. Given the bias toward the use of explicit learning strategies that develops throughout childhood and into adulthood, clinicians should be aware that most interventions (even those that promote implicit learning) will engage the explicit learning system. However, a greater awareness of both implicit and explicit learning systems and their cognitive demands will allow clinicians to choose the most appropriate intervention for the target behavior.	Child language
A31(⁴⁶)	Tabrizi et al., 2022	USA	Repetitive priming has been suggested as a method for addressing implicit processes in the treatment of anomia. Previous studies have used masked priming for this purpose. This study expands on that work with visible priming, a more clinically feasible approach.	Three participants with aphasia.	Experimental	All participants improved in identifying trained items immediately after treatment, with greater improvements for trained items than for untrained items. All participants maintained some degree of improvement on trained items 3 months after treatment, although the degree varied among participants. Inconsistent generalization occurred for unexposed items. Improvements were observed in some areas of broader language, although these varied.	Adult language
A32(⁴⁷)	Norotsky et al., 2023	USA	To understand the role of implicit racial bias in auditory-perceptual evaluations of dysphonic voices, determining whether there is a bias effect for novice listeners in their auditory-perceptual evaluations of Black and White speakers.	Postgraduate students in speech and language pathology at Boston University	Experimental	Both Black and White speakers were classified as less severely dysphonic when their race was labeled as Black.	Voice
A33(⁴⁸)	Lopez et al., 2023	USA	To determine how the manner of L2 acquisition can affect interlinguistic generalization after L2 treatment, focusing separately on lexicon (object naming) and grammar (sentence construction).	Two Spanish-English bilinguals with aphasia.	Experimental	As predicted, P2 showed interlanguage generalization after verb/grammar treatment (VNeST), while P1 did not. However, contrary to the prediction that both participants should show interlanguage generalization after noun treatment (SFA), only P1 showed interlanguage generalization in object naming.	Adult language
A34(⁴⁹)	Silkes, 2023	USA	To expand the evidence for the treatment of anomia based on repetition priming.	Five participants with chronic aphasia	Quasi-experimental	Items previously activated by priming resulted in greater improvements in naming than those that were only practiced but without priming. The data suggest that the gains may extend beyond the direct association with the trained stimuli. There was variation in the maintenance and generalization effects.	Adult language
A35(⁵⁰)	Lee et al., 2024	USA	To examine the impact of aging on the strength and longevity of the effects of abstract structural priming and lexical reinforcement.	Younger and older adults	Experimental	In immediate priming, older adults showed abstract structural priming and lexical increase in transitive and dative cases, similar to that observed in younger adults. In long-term priming, only the effects of abstract priming were significant in both groups of participants, with no evidence of age-related priming reduction.	Adult language
A36(⁵¹)	Beadle et al., 2024	Canada	To investigate the perceptions of older and younger adults about older and younger adults who use hearing aids.	Thirty older adults and 30 younger adults who reported not having hearing aids or diagnosed hearing impairment.	Cross-sectional study	In both IATs, older and younger participants responded faster and more accurately when images of individuals using hearing aids were paired with negative words compared to positive words. Photo ratings did not vary in relation to the presence or absence of hearing aids for any age group.	Audiology
A37(⁵²)	Montgomery et al., 2024	USA	We propose that implicit learning, including syntactic preparation, holds therapeutic promise for improving the syntactic knowledge of children with developmental language disorder (DLD).	Children with developmental language disorders (DLD).	Theoretical/ Review	Statistically induced block-based learning is a powerful driver of syntactic learning, and syntactic priming is one form of this learning. Repeated episodes of priming during everyday linguistic interactions lead children to create abstract and global syntactic representations in long-term memory. We offer some reflections on an implicit language intervention approach focusing on syntactic priming.	Child language
A38(⁵³)	Balthazar and Scott, 2024	USA	To present key concepts that highlight the importance of guiding schoolchildren and adolescents with developmental language disorders (DLD) through complex sentences.	Schoolchildren and adolescents with DLD	Theoretical/ Review	Complex sentence structures represent a fundamental challenge for students with DLD when dealing with discipline-specific academic and linguistic tasks. Sentence complexity treatment programs employ one or more treatment methods, including priming, modeling, reformulation, contextualization, metalinguistic instruction, and sentence combination. Although studies have consistently demonstrated measurable improvement in complex sentence production in proximal outcomes, regardless of the treatment approach, evidence of lasting functional changes in students with DLD remains scarce. We encourage new treatments that target the comprehension and production of complex sentences in real-life academic contexts, clinical practice, and research.	Child language
A39(⁵⁴)	Morton-Jones and Sund, 2024	USA	To explain the impactful role that speech-language-hearing pathologists and voice clinicians can play in daily clinical practice to promote health equity, mitigating the well-documented negative effects of implicit personal biases in the health field and offering culturally responsive practices.	Speech-language-hearing pathologists and voice clinicians	Theoretical/ Review	Evidence suggests that implicit bias has a serious impact on daily clinical practice and dialogue. Within the complexities of accessing healthcare, a clinician creates barriers or enablers that determine the acceptability and accessibility of the care offered. Unaddressed implicit bias and a lack of culturally responsive practices can reduce the quality of care and ultimately prevent a patient from seeking behavioral voice services.	Voice

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[1] Source: The authors

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