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by Ciara Cox, PhD, Therapy Resource –

Six Samuel Merritt University OT students and I just completed a study on rehab professionals’ self-reported knowledge of dementia and self-reported competency in treating clients with dementia. We wanted to see if there was a gap between knowledge of dementia and feelings of competency in treating clients with dementia. We collected data for our study via a web-based survey. Many of those who responded to our survey work at an Ensign-affiliated operation, and we thank you for your participation.

Although the response rate to our survey was low (27 OTs, five COTAs, 20 PTs, eight PTAs and five SLPs), we had some interesting findings:

• As a group, OTs, COTAs, PTs, PTAs and SLPs feel both knowledgeable and competent.
• There was no significant difference between self-reported knowledge of dementia and self-reported competency in treating clients who have dementia.
• There was no significant difference in self-reported knowledge and competency between the three different rehab professions.
• There were significant differences between groups of rehabilitation professionals who received different types of dementia care training and also differences related to years of experience working with clients with dementia.

Training

Therapists who received training in one or more of the following approaches reported a higher level of knowledge of dementia and competence in treating clients who have dementia than therapists who did not have the training:

• Allen-Cognitive Levels
• Behavioral Training
• Cognitive Stimulation
• Reality Orientation

Experience

• Therapists and assistants with more than five years of experience with clients who have dementia reported significantly higher competency in training caregivers than those who had less than five years of experience.
• Therapists and assistants with more than 10 years of experience with clients who have dementia reported significantly higher competency in treating clients with dementia than those with less than 10 years of experience.

The results show what you may already instinctively know: Experience and training lead to expertise.

With the baby boomers entering older adulthood and life expectancy continuing to increase, the number of people living with dementia is predicted to increase from 5.4 million currently to 16 million in 2050. As a profession, we will need more therapists who have expertise in working with this population. The majority of residents in our nursing homes have some cognitive deficit. If you have not received specific training for treating residents with decreased cognition, we recommend that you plan to do so.

The SMU OT students who worked on this study are Michelle Chan, Kristin Dunn, Laura Heinemann, Carly Keller, Cynthia Lyssikatos and Jennifer Warner. They are delighted to share our results with people who are interested. If you currently have OT, PT or SLP students in your department, ask them about their research. It is a great way to learn new information.

by Ryan Hough, Therapy Resource – What is the first thing that comes to mind when you think of a patient who has dementia? Many people tend to think of what dementia patients typically can’t do — such as remember names, get dressed, brush their teeth and so on. However, I had the opportunity recently to take the Dementia Capable Care Instructor Program with the desire to bring the training I received back to each of the homes in my region. This training is designed to help anyone who is involved in caring for our residents to develop a new mindset and ideas on how to work and interact with patients who have dementia. This awesome training helps you to understand where a patient is at cognitively so that you can then formulate a plan — whether you are a therapist, an activity director, a nurse, an executive director or a maintenance worker.

As a physical therapist, I think back to all the times when I was trying to walk a patient but not having success. Through this course, you will learn spatial, verbal and tactile cues to assist you. Most important, the training inspires you to learn all you can about your patient and his or her past. The more you know, the better equipped you are to help your patient be successful. As your patients experience success with activities such as walking, getting dressed, playing cards and even feeling overall happiness, you’ll discover that dementia patients have so much potential. We all strive every day to offer the best care to our residents, and this course offers tools that will help you to change these patients’ care experiences for the better.

by Franco Yap, PT, Alta Vista Rehabilitation & Healthcare, Brownsville, TX –

The 1990s has been considered the decade of the brain. With advancements in neuro-imaging and the publication of more and more research in the realm of neurologic recovery, there has been a greater awareness and understanding into the mysteries of the brain. Recovery after a stroke is possible. The centuries-old notion that the adult brain is fixed and unchanging is now being reexamined and questioned. “Arguably, the most important breakthrough in neuroscience since scientists first sketched out the brain’s basic anatomy is the revolutionary discovery of Neuroplasticity. This concept that the brain is malleable and able to recover and change, even after an injury, continues to show a lot of hope for those dealing with neurologic injury.

Recently, the University of Alabama has been offering a week-long constrained-induced (CI) therapy training course for clinicians. CI therapy has been derived from basic behavioral neuroscience research with primates, pioneered by Dr. Edward Taub of the UAB CI Therapy Research Group. Typically, CI therapy involves constraining (usually with a mitt restraint) the unaffected arm in patients with hemiparetic stroke or hemiparetic cerebral palsy (HCP) for 90 percent of waking hours while engaging the affected “weaker” limb in a range of everyday activities. The treatment sessions are usually six hours per day for two weeks, although recently there also have been reports that three hours of therapy per day has been shown to be of equal benefit for patients.

This concept is revolutionary in that over the past few decades, conventional rehabilitation therapy has focused more on compensatory measures and use of the unaffected “good side” in the performance of functional motor tasks. The idea of CI therapy is to force the patient to use the affected extremity more in order to facilitate motor recovery. With the use of objective measures, close monitoring and behavioral techniques, it has been shown that about 80 percent of stroke patients who have lost arm function can improve substantially. Over the last 20 years, a substantial body of evidence has accumulated to support the efficacy of CI therapy for hemi paresis following chronic stroke; i.e., more than one year post-injury.

The training seminar involved an introduction to CI therapy, screening/recruitment of patients, treatment protocols, outcome measures and a home skill assignment package. Participants attended lectures given by Dr. Taub and his team and lab training exercises with actual patients. CI therapy protocol involved the use of behavioral techniques like shaping and task practice, adherence enhancement strategies and constrained use of the affected UE with a mitt restraint.

It is common in the rehabilitation world for patients to exhibit a decline in function once discharged from skilled therapy. Education and problems with compliance to home exercise programs given to patients often are overlooked by most therapy approaches. Therapists would work hard to get patients to a certain level appropriate for discharge, only to see them readmitted after several months or days. CI therapy is unique in its repeated focus on bridging the gap between progress made in the clinic and the carryover of continued use of these functional skills at home. Instruments like the Behavioral contract (a written document detailing the patient’s sworn compliance to the use of the constraint (mitt restraint) and Home Skills Assignment (a list of tasks the patient had to perform at home using the affected limb) were always emphasized for enhanced compliance. Every day before each treatment session, the Motor Activity Log, a structured interview instrument, would be used to measure and monitor the use of the affected limb on a list of daily activities. The patients would also have follow-up interviews scheduled after their discharge from CI therapy. This robust protocol, along with the use of Shaping and Massed practice, enforces a strong adherence and retention of learned motor skills.

CI therapy is but one of the many approaches that is part of the current renaissance in neuro-rehabilitation, and it is one of the few that is supported by randomized control multi-center trials. It continues to be refined by ongoing research and is currently being developed for use in the improvement of speech pathologies, lower extremity rehabilitation and other neurological diseases like Traumatic brain injury and Multiple sclerosis. It definitely shows a lot of promise for the future, and there has never been a more exciting time for physical medicine and rehabilitation.

by Gina Tucker-Roghi,Therapy Resource

One of the most exciting aspects of the Dementia Capable Care Model for me has been the ability to tap into the unique personhood that remains in each of our residents and longs to be acknowledged. Even those at the late and end stages of the dementia process have the ability to connect in a meaningful way. Our skill lies in finding what type of stimulation will awaken our clients, and teaching others effective methods, cueing strategies and techniques to elicit this same positive response.

During a recent dementia training I attended, I was brought to tears watching a video clip of a client who was being met right where he was in his dementia by a therapist using sensory stimulation techniques to bring him to life. To see this individual, who had previously been cared for in body but not in soul, awaken to the therapist’s techniques was a moving experience. The types of stimulation she used were customized to the client, based on his past experiences, interests and habits in order to have the greatest impact. By using stimuli that tie into the client’s long-term and procedural memories, we tap into the strongest and most durable types of memory.

The client’s responses to these powerful and meaningful stimuli are used to promote health and well-being and to prevent many of the complications that are frequently related to dementia. The responses that are elicited might include vocalizations, which can decrease the risk of aspiration; and partial ROM of the trunk, head or extremities, which can prevent contractures and promote improved positioning. In addition to these valuable responses, we are able to tap into the humanity of our clients.

Sharing this gift of human connection with families, loved ones and caregivers is a powerful intervention. The facial expressions, vocalizations and eye contact that are elicited in response to a purposeful stimulation are indications of the client’s remaining abilities to connect to another person. At the end stages of dementia, it can become difficult for families to find ways to interact with their loved ones. The client has usually lost the ability to relate with spoken language. By developing a targeted sensory stimulation program, the therapists also are preventing complications and further decline in the client. This increased sense of purpose in their interactions, as well as the increased sense of connection, will surely result in more rewarding visits for both the client and the loved ones.

 

This annual event provides opportunities to raise awareness about communication disorders and to promote treatment that can improve the quality of life for those who experience problems with speaking, understanding, or hearing. We have many resources to help you celebrate BHSM every day. The American Speech-Language and Hearing Association (ASHA), provides a variety of awareness activities and tools that our therapy programs can incorporate into improving the education and understanding surrounding Speech-Language Pathology and the services our SLP’s have to offer.

To reinforce the important messages about communication disorders during Better Hearing and Speech Month, the American Speech-Language-Hearing Association (ASHA) has released tips to raise awareness to help more than 70 million Americans age 55 and older identify and prevent a speech, language or hearing disorder.

As people age, normal changes occur in hearing, speech, language, memory, and swallowing. Once an individual turns 55, their chances of having a hearing loss, suffering a stroke, developing dementia or Parkinson’s disease increases which can lead to a related communication disorder.

Warning signs of speech, language, and hearing problems include:

• Sudden trouble talking, thinking, or moving parts of your body—this could be a sign of a stroke, and you should see a doctor immediately
• Turning the TV louder or asking people to repeat themselves
• Trouble remembering appointments or how to do familiar tasks
• A hoarse voice or easily losing your voice
• Trouble speaking clearly that gets worse over time

Tips for preventing communication disorders:

• Reduce your risk for stroke—stop smoking, control your blood pressure, exercise regularly
• Use helmets and seat belts to prevent brain injury
• Get regular checkups, including hearing tests, to stay in top form
• Protect your voice—don’t yell or talk in noisy places, drink plenty of water, and avoid smoking
• Turn down the TV or radio when you talk with others—you’ll hear each other better and you won’t have to speak loudly
• Keep your mind sharp—do puzzles, read, and keep up with current events
• Stay active and social—do things with friends and get involved in your community

For most Americans 55 and older, unlike many disabilities, speech, language, and hearing problems can be prevented. The key is early identification and intervention; the earlier a problem is identified the sooner treatment can begin.

If you suspect that you or family members have a communication disorder, consult a certified speech-language pathologist or audiologist. Speech-language pathologists and audiologists play an important role in working with individuals who are 55 and older. These professionals can assist this age group in differentiating between normal aging and having a communication disorder. They can provide tips and techniques to prevent communication problems and keep your speech, voice, and language in top form.

For more information about speech, language, and hearing disorders and prevention, visit www.asha.org.

 

Did you know that April is National Occupational Therapy Month? What a perfect time for us to share a closer look at this important profession helping to make a difference in the lives of so many. On the American Occupational Therapy Association site (www.aota.org), the theme for Occupational Therapy is “Living Life to its Fullest”. Occupational Therapists and Occupational Therapy Assistants play an integral role in the lives of many. Let’s take a closer look at some of the areas impacting productive aging. Occupational Therapy is provided in a variety of settings. The skilled nursing and rehabilitation setting provides us the opportunity to more closely address the needs of the aging population, as this is the setting that many seniors choose for their rehab services. Our goal is to help the senior return to his or her prior level of living and functional ability as safely and efficiently as possible. We work closely with the patient’s family members to prevent and reduce the possibility of re-hospitalization. Reduced function in thinking, memory and problem-solving can create some challenges for the aging patient. Occupational Therapy addresses the areas of cognition in the following ways:

– Intensive, daily therapy to improve all aspects of function

-Intervention to address attention, problem solving, and perceptual deficits, and to manage impulsive behavior

-Intervention initially to address basic activities of daily living (ADLs) such as eating, bathing, dressing, grooming, and sequencing tasks. If basic skills are achieved, progression to more difficult tasks may include:

• preparing meals;
• managing medication;
• balancing a checkbook/paying bills;
• organizing daily routines;
• doing laundry and light housekeeping;
• responding to an emergency situation, using the telephone, and engaging in socially appropriate behavior; and
• preparing for community re-entry, driving, and workplace assessment as appropriate for the client’s level of progress.

To learn more about the role of occupational therapy with cognitive disability in the aging population, please check out the The American Occupational Therapy Association fact sheet entitled Cognition.

Give your OT and COTA a “high five” for making a difference in the lives of so many!! And please BLOG a shout-out to your favorite OT’s and COTA’s!!