The Power Of OT Applied To Dementia

By Denise Crowley, OTR/L

Occupational Therapist

Dementia is a progressive neurologic disease process that, according to the Alzheimer’s Association, one in three older Americans die with some form of the disease. Dementia has a significant impact on our patients, their caregivers, their family and friends.

When a patient has dementia, every aspect of their life is touched by the disease: physical, social, and emotional. Dementia’s impacts can be mitigated through the disease’s progression with proper intervention. Occupational therapists can have a positive impact on those living with the disease in many ways.

To do so successfully, our focus and expectations must be on what our patients are able to do and not on the skills and abilities lost to the disease.

Helping those with dementia can be challenging. Yet, this can also be the most rewarding experience we can have in our career. Occupational therapists have the opportunity to provide specialized care throughout the disease’s progression, enabling the patient to function at their highest level of independence in all aspects of their daily life and routines.

UNDERSTANDING DEMENTIA’S PROGRESSION

Understanding the disease process allows clinicians to appreciate the changes occurring in the brain and to provide accurate education to caregivers. For family members acting as caregivers, this education can help lead to acceptance of changes throughout the disease.

Occupational therapists’ knowledge of the physiologic changes to the brain provides insight into ability deficits. The best statement taught to me referring to dementia was the patient is in brain failure. This simple statement enables family, caregivers, and even the patient to understand that the changes occur essentially because of organ failure.

This seems to enable a more empathetic and compassionate understanding of the disease. So often, the fluctuating skills, abilities, and behaviors are misunderstood. This can lead to frustration, anger, and stress. Becoming familiar with the most common forms of dementia and their basic characteristics and presentation helps us to understand what skills and abilities will be affected.

HOW THE DISEASE PRESENTS IN patient DETERIORATION

To assist in the medical management of our patients, occupational therapists need to understand the gradual progression of the disease and how that compares and is different to an acute delirium due to a medical condition.

Basic knowledge of dementia pharmacology, such as Aricept, Namenda, Exelon, and Razadyne, allow practitioners to provide physicians and family members information on the effectiveness of medication and side effects.  This can also help occupational therapists assist in finding options for behavior management as the disease progresses.

Evaluating for cognitive limitations through standardized tests will provide insight into the extent of cognitive impairment. By doing this, accurate and achievable goal setting is possible.

The global deterioration scale was developed in 1965 delineating the disease progression into seven stages. Each phase has characteristics specific to a stage of dementia. Understanding each of these stages — its characteristics and the patient’s available abilities and skills — means OTs can access the best techniques for communicating with a patient who has dementia. The deterioration scale assists the practitioner in planning for successful treatments and achievable goals.

A comprehensive assessment of the skills and abilities that remain at each phase will allow the clinician to develop a plan of care and treatment session that meets the patient’s level of cognition. This enables clinicians to focus on abilities retained and set meaningful and achievable goals. Doing so will allow for success in strengthening the therapeutic relationship that is essential when working with patients who live with dementia.

COMMUNICATION TECHNIQUES

Those with dementia relate to others on an emotional level. As their cognition declines, their sensory systems are heightened, becoming more sensitive to the emotional connections and experiences with ours.

Mastering this concept allows clinicians, family, friends, and caregivers to communicate effectively at the patient’s cognitive level of understanding. This helps reduce the patient’s stress, anxiety, and agitation.

Through FOX Rehabilitation’s partnership with MedBridge, our clinicians have access to several resources for references on communication strategies throughout the seven stages of dementia.

PERSON-ENVIRONMENT OCCUPATION MODEL

This theory guides the clinician to assess the impact of the relationship between people, their occupations, and their environment.

These environmental factors include culture, economic, legal, political, physical, and social.  This model focuses on how the environment impacts someone’s ability to perform tasks.  The person is defined as a unique being who assumes a variety of roles simultaneously.

The person is a combination of mind, body, and spirit. They bring a set of abilities and experiences.  Occupation is defined as activities and tasks one engages in over a lifetime.  Occupations are activities and tasks a person participates in for self -fulfillment and self-expression.

This model is a dynamic process therapists monitor and assesses interventions for optimal occupational performance.

ERRORLESS LEARNING THEORY EXPLAINED

Errorless learning is a teaching technique that prohibits patients from making mistakes.  The occupational therapist ensures success in all activities by setting them up at the proper level of cognitive functioning.

If errors occur, the therapist doesn’t point it out or correct. Rather, they modify the activity for success based on performance.

This concept is also known as brain-activating rehabilitation and consists of five principles.  Training activities must enjoyable and comfortable in a non -threatening atmosphere.  Interactions between the occupational therapist and patient must be a two-way, empathetic communication exchange.  Occupational therapists should offer praise throughout the activity to increase motivation.

This should engage patients in a social role that takes advantage of their abilities.

“The aim of brain‐activating rehabilitation is to enhance patients’ motivation and maximize the use of their remaining function, recruiting a compensatory network, and preventing the disuse of brain function.”

Increasing a patient’s self-respect can improve motivation, in turn, can increase cognitive function.

FOX RESOURCES AVAILABLE

FOX University has a variety of research articles and presentations that provide information on the disease process, interventions, communication strategies, and documentation needed for developing a comprehensive plan of care for our patients with dementia.  MedBridge provides several courses covering many topics for dementia care.

With these resources and a well-trained quality assurance department, FOX strives to equip its clinicians with the best evidence-based care. This helps enable our patients to then achieve what they once thought impossible.

While the people in this photo are a real FOX clinician and patient, they are not mentioned in this article.