I'm an OTA student and recently read the article "The Dementia Care Difference" from the July 12, 2010 publication of OT Practice. It discusses a more focused and individualized treatment approach which has been advocated by Kathleen Cram and her team at Genesis Rehab Center in NC. The article mentioned the importance of a very structured routine for dementia patients as well as a functionally driven approach to get the patient to a max level of functionality. Consistant cue delivery for each patient was also stressed. It seems they are making great strides at Genesis in giving these patients the best care possible. Unfortunately, the article did not outline any specific activities or give examples of what types of activities/cues were being used at Genesis. If you have worked with dementia patients ANYWHERE in your field, please share any specific examples of activities your patient performed, what is typical and/or what seemed to work well.
Cuing is anything from verbal/tactile/visual cues and documenting a % amount of cues provided helps to show progress in daily documentation if levels of ADLS have not improved. The cognitive training that is to be provided would include: Elaboration, Anchoring Techniques, Saturationg Cuing, Error Prevention, etc. These techniques would be used in teaching a patient on how to locate the nurses desk when using their room as the "Anchor" once they learn their room location as the anchor then you can proceed to areas that are of interest to them. Same goes if they need to learn to locate the bathroom you would anchor them at their bed.
The structure of a routine is because many of our Dementia resident's if they are a level 3.0 on the Allen then their level of understanding is relative to the age of a 2 year old; therefore, we know how well children do with structure when they know what to expect each day or what will happen next if someone hands them a shirt.
Good Luck and hope this helps.
Thank you so much Kimberly for all of your examples. It does help a great deal
Please give more examples of using "Elaboration, Anchoring Techniques, Saturationg Cuing, Error Prevention" I have not heard of such verbal cue techniques. Very interesting! Do you have a source?
I'm a third year OT student. At my level II fieldwork, I learned the 90 second rule for dementia patients. That is, when you ask the patient a question you should wait about 90 seconds to receive a response before attempting another question. Patients with dementia has a delay in response. I also learned that in the latter stages of dementia, patients start to look down and begin to have somewhat of tunnel vision. So, to get a patients attention you kneel down in front of them to establish eye contact then proceed to conversing. I have actually experienced this technique first hand and it worked.
I hope this was helpful!
From: oddfunk <firstname.lastname@example.org>Sent: 8/19/2010 12:07:14 AM
I am currently an OTA student and have been researching therapies that have and may work with individual with dementia. Obviously the first thing an OT must do is evaluate the client and figure out what is important to the client. For example, while doing fieldwork an older lady with dementia paired matching socks that were thrown in a basket, after she had finished matching all the socks she was so proud of herself and stated that her husband was going to be so happy. Here are a few therapeutic activities: dancing or just moving to music (music therapy is a form of sensory stimulation that may form neurological connections. However, music may cause agitation and possibly cause the patient to remember sad times in their life), simple games using balls and balloons, folding, rummaging (using items with life relevance). For some reason I am thinking of the movie "Patch Adams" were Robin Williams goes to a nursing home and treats the patients like people not objects. He then listens to what they have to say then help the patients perform the activities they have always wanted to do. Now I am not suggesting swimming in spaghetti noodle like a lady did in the movie but what I am saying is just listening to the client can assist you on what direction to take. I hope this helps and again these are just ideas.
I wanted to post this link about animal therapy:
Research has shown that pets are good for your health. Heart attack victims who have pets live longer. Petting a pet reduces blood pressure. Pets in nursing homes boostmorale and promote social interaction. Watching fishin an aquarium is relaxing and reduces stress symptoms.http://www.holisticonline.com/stress/stress_pet-therapy.htm