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Abilities Based Approaches to Treatment of Persons with Dementia

Abilities Based Approaches to Treatment of Persons with Dementia
Renee Kinder, MS, CCC-SLP, RAC-CT
December 20, 2016

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Introduction

Thank you to everyone for attending this webinar to learn about abilities-based approaches to the assessment of persons with dementia. Today, we will review new research in the world of single versus dual tasking. We will also reinforce the importance of interdisciplinary team collaboration, and we will discuss methods for improving functional abilities within the dementia population. Working together, we can help patients achieve greater levels of success during mobility dual-tasking activities, meal times and dining, and across the IADL, ADL and late loss ADL continuation.

Objectives

1. Describe methods for identification of functional changes in residents which are present secondary to dementia disease process.

2. Define single versus dual task activities and clinical decision-making process for determining which is most appropriate for their patients.

3. Discuss current evidence-based interventions for improved functional communication, meal time success, ADL functions, and mobility tasks.

4. Develop cohesive functional maintenance programs to promote carryover of newly learned skills across caregivers.

Overview

First, we need to review impairments and abilities for mild, moderate, and severe dementia. We know that dementia by definition is progressive in nature. However, regardless of where someone is in the disease process, we always want to tap into their functional abilities. Next, we will discuss interventions to compensate for cognitive impairment. Throughout the dementia continuum, there will be times when we can restore function, and then there will be times when we have to compensate for function. We will review interventions for both measures. In interventions that compensate for cognitive impairment, we will do a review of techniques for error-free learning to promote success, we will review ADL tasks, gait-specific interventions, and then finally interventions for low-level patients. Additionally, we will review interventions to restore/rehab cognitive impairment. This is where the dual tasking piece comes in (i.e., adding a cognitive task onto a physical task). We will also discuss one of the single evidence-based practices that we have for restoring cognitive function, and that is spaced retrieval therapy.

Benefits of Interdisciplinary Collaboration in Dementia Treatment

As therapists, we know that we need an interdisciplinary team approach. Unfortunately, we often operate under the “silo mentality.” In other words, siloing occurs when departments or groups within an organization do not want to share information or knowledge with other individuals within the same organization. You may have occupational therapy working on a task, you have speech language pathology working on a task, and then you have physical therapy working on a task, with no cross-communication. For our persons with dementia, it is so crucial that we have all disciplines intervene in their appropriate areas to achieve the best functional result for those patients.

Dementia Facts and Statistics

There are 70 types of dementia. It is estimated that among people 65 years or older, 5% have a dementia diagnosis. For individuals 90 years or older, it is estimated that over 50% have dementia. Globally, it is estimated that 35 million people have dementia. Within that group of individuals that we serve between ages 65 and 90, that is a drastic increase in the incidence of dementia.

Cognition on the Move

There are some important elements related to cognition that occur when a person physically moves. Gait control in and of itself is a complex brain process, with recent reviews confirming the importance of the CNS to gait in non-demented older adults. Interestingly, one of the first outward signs which may suggest a cognitive impairment is a change in gait pattern. Physical therapists may be the first discipline to recognize that something is happening cognitively, based on a person’s change in gait pattern. Additionally, global cognition has been shown to longitudinally predict gait speed decline, so sometimes one of the first signs that we see is a slowing in that gait pattern. We also know that poor short-term memory and executive function has been associated with slow gait speeds during simple gait tasks, with some studies including attention and global cognition. For reference, short-term memory is typically anything between 24 and 48 hours. Also, during the course of this event, anytime I use the term executive function, that includes higher level cognitive tasks (e.g., memory, sequencing, problem-solving). Finally, early motor changes associated with aging predict cognitive decline, which suggests that there is this motor signature in gait that can be detected in pre-dementia states. In summary, if you are a physical therapist, you do play a role in identifying cognitive changes, because it may be that you're the first person to notice that "motor signature" or an actual change in the gait pattern.

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renee kinder

Renee Kinder, MS, CCC-SLP, RAC-CT

Renee currently serves as Director of Clinical Education for Encore Rehabilitation where she provides education for interdisciplinary team members related to clinical programming, Medicare regulations, documentation requirements, and evidenced based practice patterns. She maintains certification as a resident assessment coordinator (RAC-CT) from the American Association of Nurse Assessment Coordination (AANAC). She is an active member of the American Speech Language Hearing Association currently serving as Editor of Perspectives on Gerontology and acting as a member of ASHA’s Healthcare and Economics Committee. Additionally, she is a member of community faculty for the University of Kentucky College of Medicine, serves as an Ambassador for the Alzheimer’s Association of America, and acts as Vice President of Healthcare for the Kentucky Speech Language Hearing Association.

 



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