Cognitive Rehabilitation Reversing the symptoms of dementia Jackie Pool Dementia Lead Affinity Training www.affinity-training.com

GREAT Goal-oriented cognitive Rehabilitation in Early-stage Alzheimer’s disease: multi-centre single-blind randomised controlled Trial great.bangor.ac.uk

Review the underpinning skills and knowledge required to plan and implement goal oriented therapeutic interventions with patients Have a framework for planning cognitive rehabilitation interventions and improving occupational performance Be able to use a range of therapeutic strategies: Compensatory rehabilitation Restorative rehabilitation Anxiety management Understand the importance of therapeutic relationship with the participant and carer

What do we mean by ‘dementia’? away from the mind a condition DE MENT IA

The Disability of Dementia Neurological Impairment Interaction with others Person’s situation

What can we achieve with CR? To do again, repeat the mind a condition RE MENT IA

The Role of the Therapist To create a “just right” environment so that the person with memory impairment is not disabled Consider your role as a Care Worker….. Assessor? Therapy provider? Activity Provider? Facilitator? Enabler? Educator? Resource? Discharge planner? It is possible that you have several roles, but all of them involve helping the individuals in your care setting to live meaningful and fulfilling lives. Jackie Pool Associates Ltd ©

Cognitive rehabilitation Recognising objects Getting started with an activity (initiation) Understanding writing Planning what to do Finding items

Compensatory strategies: environmental adaptations

Compensatory strategies: environmental adaptations

Restorative strategies: errorless learning Semantic Memory Visualisation Mnemonics Activity Grading Positioning: Self Objects Communication: Speech Body Language Pace Working Memory Expanded Rehearsal Effortful Processing Procedural Memory Tapping into old patterns of movement Learning new patterns

Using semantic imagery finding the potato masher in ‘that’ drawer Tip: Think blue (Visual semantic memory)

Visual mnemonics

Restorative strategies: The just right challenge for activity grading Ability of the individual Demand of the Activity

A person displays function when he is able to choose, organize, and perform occupations that are personally meaningful Volition Source of motivation Habituation Patterns and routines Performance Cognitive and physical abilities

The Model of Information Processing Attention captured Intact Input Throughput Information Processing Output Impaired

The Pool Activity Levels of Ability PLANNED EXPLORATORY SENSORY REFLEX PLANNED – orientated to obvious goals EXPLORATORY – more concerned with the process of an activity than the goal SENSORY – concerned with the impact on own senses REFLEX – Sub- conscious responses to direct stimulation Using the PAL Checklist on p. 12 and 13, think of a person with dementia with whom you work and who you know well. Complete the checklist based on their performance over the last few weeks. Total the score for each level at the end. What is the persons Activity level?

The Pool Activity Levels Method of engagement Reflex Sensory Exploratory Planned Sensory cues   Subliminal Proprioceptive/ Tactile Tactile/Visible Related Motor actions Automatic Postural Goal-directed Process Effect on body Several actions for effect on environment Overt trial and error Purpose Arousal Comfort/Movement Interest Touching Self-control Reasoning Perceptibility of media Penetrate Subliminal state Own body Colour Shape Space and depth Related intervention Setting of media Internal Arms reach Visual field Task environment Tool use Stimulated body Part Spontaneous use of body part Chance use of found objects Hand tools as a means to an end Verbal directions Pronouns, Names of body parts Verbs Verbs, Names of material objects Adjectives Adverbs Prepositions Explanations Demonstrated directions Physical contact Guided movements Action on an object Each step in a series Each step & precautions for errors Adapted from: Allen CK, Earhart CA, Blue T (1992) Occupational Therapy Treatment Goals for the Physically and Cognitively Disabled The American Occupational Therapy Association, Inc. Rockville, MD

The easy-to-complete PAL© Checklist works out the level of cognitive and functional ability of the individual

Cognitive Rehabilitation GOAL: Complete daily chores without being distracted Compensatory Intervention: White boardI Create ‘workstations’ with all objects needed placed in the visual field. RESTORATIVE: GRADED ACTIVITY Write a ‘method’ in stages for each task and place at the workstation. Use expanded rehearsal and gradually withdraw written cues Anxiety and stress management: Existing strategy of deep breathing reinforced and refined to include slow out-breath Pacing of chores Cognitive Rehabilitation ATTENTION AND concentration: Focused on divided attention: Plan tasks for when wife at day care Take control when unable to give full attention e.g. ring back, rearrange appointments.

Cognitive Rehabilitation GOAL: Independently use the en suite toilet RESTORATIVE: GRADED ACTIVITY Establish a new pattern of moving from bed to toilet using expanded rehearsal Compensatory Intervention: Toilet sign on door Plain flooring Anxiety and stress management: None needed Cognitive Rehabilitation ATTENTION AND concentration: Colour contrast toilet seat and toilet paper Have a fun reminder notice opposite the toilet for readjusting clothing

www.affinity-training.com jackie@affinitycm.co.uk