Takeaways From Becoming A Certified Dementia Practitioner

Dr. Megan Shulman OTD, OTR/L: So I did a shadowing experience and instantly fell in love and it completely changed my perception of working with geriatrics and older adults. I immediately fell in love and I’ve never turned back.

Dr. Jimmy McKay PT, DPT: This is FOXcastOT, a podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org.

Dr. Jimmy McKay PT, DPT: Welcome to FOXcastOT. I’m your host Jimmy McKay. On the show today: a colleague at FOX Rehabilitation, Megan Schulman. Megan welcome to the show.

Dr. Megan Shulman OTD, OTR/L: Hi thank you.

Dr. Jimmy McKay PT, DPT: Megan how long you’ve been an OT?

Dr. Megan Shulman OTD, OTR/L: About seven years now but seven years.

Dr. Jimmy McKay PT, DPT: How long have you been with FOX and our practice here?

Dr. Megan Shulman OTD, OTR/L: That full seven years. I started with FOX as a new graduate.

Dr. Jimmy McKay PT, DPT: And where do you work geographically and in the footprint of the practice?

Dr. Megan Shulman OTD, OTR/L: I am in the state of Delaware.

Dr. Jimmy McKay PT, DPT: We wanted to bring you on the show because we were actually at a leadership meeting and we got to say hi I found out you just completed a certification program and what was that?

Dr. Megan Shulman OTD, OTR/L: So I did a certification to become a certified dementia practitioner through the National Council of certified dementia practitioners.

Dr. Jimmy McKay PT, DPT: And I didn’t know what that was. So of course it’s interesting to me and I wanted you to talk a little bit about it but when you work with geriatric clients you’re bound to work with individuals who are suffering from dementia. So this is something that you see pretty frequently in geriatric care. We wanted to give some maybe some takeaway points that you could bring to us some things that you picked up at the at the certification.

Dr. Megan Shulman OTD, OTR/L: Yeah that would be excellent. So we know that working with geriatrics on older adults. We definitely run into and see a lot of the same things every day and a lot of the stuff we learned is things that I talk to caregivers about everyday too. Hopefully some of that can help some other people.

Dr. Jimmy McKay PT, DPT: All right. So we get some takeaway points for everybody listening if you happen to be working with a patient with dementia. Where do you want to go to first? What’s something to take away from that certification you want to start with?

Dr. Megan Shulman OTD, OTR/L: Sure the 90 second rule.

Dr. Jimmy McKay PT, DPT: OK.

Dr. Megan Shulman OTD, OTR/L: This is a really interesting takeaway that I don’t think a lot of people realize with individuals with dementia or Alzheimer’s or any type of cognitive impairment that someone with dementia can take up to 90 seconds to process information. And they have a processing delay of up to 90 seconds. That’s a minute and a half. That’s a really really long time.

Dr. Jimmy McKay PT, DPT: That is a long time.

Dr. Megan Shulman OTD, OTR/L: Yeah I’m one of my favorite things to do with somebody when I’m educating on this essay. All right I’m going to ask you to do something and I’m going to say anything for 90 seconds and I’ll say stand up. And then I just sit there and look at them. And after about 15 seconds the caregiver usually gets really awkward and uncomfortable because they start to realize OK. And then after 30 seconds and then 45 and I usually stop it by then. But I say you know for your loved one or your family member they’re still processing that really simple command, and that task you just ask them to do. I said on our end, “We have to be aware of that processing delay and give it time. Let them absorb that information and that task that you just asked them to do and let them process it and then they will act on it.” But every time that we become impatient as a loved one or caregiver we just repeat it again. Stand up, or Jimmy can you stand up for me? And every time we restate it, it just restarts that clock and starts over with them again. So when we work with them giving them that time and allowing them in realizing that 90 seconds could be a really really long time for them to process this information, can be really beneficial with helping them to maintain independence because they can still do the task and it helps reduce some of the burden on the caregiver too.

Dr. Jimmy McKay PT, DPT: Yeah I know in PT school I was told to give them time but I don’t think anybody ever actually put a value on it and said 90 seconds. So it’s good to know that it can take up to 90 seconds for actually someone to process.

Dr. Megan Shulman OTD, OTR/L: Right. Right. It’s much longer than we than we give it.

Dr. Jimmy McKay PT, DPT: OK. So the second rule is first where you want to go to next?

Dr. Megan Shulman OTD, OTR/L: Sure. So one of the biggest things has to do with their visual changes and how we approach and communicate with someone with progressing dementia too. We don’t often realize that visual changes are a huge part of progressing in dementias. In the early stages of dementia your vision loss is pretty wide periphery. So imagine wearing a dog cone. That’s the best way to think about it where you know if you had a dog cone over your head you can kind of see generally in front of you with big wide blinders but you start to lose some of that outside periphery. So in very early stages they already start to have that quick visual change, as it progresses to middle stages of dementia. We start to see that closing in and it’s like looking through a viewfinder. So if you kind of cup your hands in “C’s” and them put them around your eyes. That’s what it’s like in middle stages already, so they’ve really significantly narrowed their visual field. And then in late stages it’s like narrow tunnel vision. So if you put your hands and circles over top of your eyes and you’re looking directly ahead in that very narrow space that’s what late stage dementia visual changes just can look like. We’re approaching someone or talking with them or working with our caregiver. We have to be aware of those general vision changes so we can appropriately stand in front of them and be slightly off center and hope to help them acknowledge us and see and respond to us.

Dr. Jimmy McKay PT, DPT: That’s a great point. With paying attention to those visual changes and different ways to approach it like that.

Dr. Megan Shulman OTD, OTR/L: With that to kind of how we approach someone and work with them. And the biggest thing is always making sure we stand in front of them or if they’re in a wheelchair get down to their eye level and always be at eye level with them, don’t stand over them or off to the side of them. We know when they’re in wheelchairs a lot we come up from behind them or put their hand on our shoulder. But it’s really really important to get around in front of them and be about five to six feet in front of them for that initial encounter. Additionally you just want to be slightly off center from them too, not directly blocking them and in their line of view there. And then use a gentle touch, use that hand over hand and about 93 percent of our communication is going to be in our body language. Between our facial expressions our eye contact or gesture to them being in front of them. And how you respond they will respond and pull off that as well. And that’s going to go a long long way with having that initial encounter with someone and having it go really well from the start instead of really defensive or agitated right away.

Dr. Jimmy McKay PT, DPT: OK. Some great points. Last takeaway we want to bring up to the audience for working with patients with dementia.

Dr. Megan Shulman OTD, OTR/L: This wasn’t necessarily working with it but this is a really really neat thing. It’s called a memory cafe. So if you have a loved one or you know somebody with dementia or any kind of cognitive limitation it’s really welcoming place for individuals with cognitive deficits where family members, caregivers can bring them to have a gathering of enjoyable activities. So it can be things like where you go and listen to music or play games or it’s a simulated restaurant. But it’s all geared around somebody with dementia or Alzheimer’s. It’s a really unique scenario and set up. Because at this memory cafe all of the workers are trained to work with somebody with dementia. So they know how to respond slowly. They know how they approach someone. Just say it’s a restaurant they’ll have a menu with very few options. They’ll be pictures on it. They pay attention to the stimuli in the environment. So is there a lot of music? Is there a lot of noise? They’ll kind of be aware of all that. It’s a memory cafe that allows family members and caregivers to go out and do those enjoyable meaningful activities that they once did with their family. But in an environment that’s safe and accepting and welcoming and it’s going to make for a pleasurable outing.

Dr. Jimmy McKay PT, DPT: Working with clients with dementia-that 90 second rule. A minute and a half is a long time to just sit there and wait. But realize that you’re doing it to give that person that you’re working with some time to process. Visual changes: be cognizant of that and make sure you know how you’re approaching those individuals and are you doing that to maximize a productive and safe session. And those memory cafes will be a great environment for people not only individuals with dementia but also for caregivers to, to relieve some of their burden as well. I love that.

Dr. Megan Shulman OTD, OTR/L: Great.

Dr. Jimmy McKay PT, DPT: Megan, last part of the show is your FOXtale. Why did you decide to work with older adults?

Dr. Megan Shulman OTD, OTR/L: This is actually kind of a funny story. When I was in school I actually swore that I would never work in geriatrics. And in my mind I had this misperception of it just being a balloon type activity then just not occupation me. And I went into OT to really do occupation based functional tasks and things like that and then I learned about FOX and I realized it was in the home and it was outpatient and our setting was just really unique and different than anything I had heard about. So I did a shadowing experience and instantly fell in love and it completely changed my perception of working with geriatrics and older adults. I immediately fell in love and I’ve never turned back.

Dr. Jimmy McKay PT, DPT: I love when it happens organically and to be honest, talking to PTs, OTs and SLPs you hear that more often than you think. It’s when people say “Oh absolutely I would never ever work in this setting,” and next thing you know that individuals been working there for five ten or fifteen years.

Dr. Megan Shulman OTD, OTR/L: Yeah exactly. That’s definitely what happened to me. I always encourage everyone to give it a shot or do a rotation while they’re in school or just trial everything because you never know what you’re going to fall in love with.

Dr. Jimmy McKay PT, DPT: You never know. Megan Shulman OT from Delaware with FOX Rehabilitation. Thank you for taking your time out and sharing some of your insight with us.

Dr. Megan Shulman OTD, OTR/L: Sure, thank you for having me.

Dr. Jimmy McKay PT, DPT: Thanks for listening to FOXcastOT. A clinically-excellent podcast. It’s brought to you by FOX Rehabilitation. Listen to other episodes or read articles and position papers at foxrehab.org.