Download Interventions for Treating Persons with Dementia Objectives

2/9/2012
Objectives
Interventions for Treating Persons with Dementia
Megan L. Malone, M.A. CCC‐SLP
Presented at the annual convention of the ohio speech language and hearing association
March 9, 2012
Acknowledgements
1. Describe a model of memory and learning in dementia.
2. Describe two functional goals that are appropriate for patients with dementia
appropriate for patients with dementia.
3. Provide three different intervention ideas to use in treatment with persons with dementia.
Why Am I Here??
• Information shared in this presentation is provided through the work of various organizations & professionals:
– Menorah Park Center for Senior Living/Myers Research Institute, Beachwood, OH
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– State of New York, Department of Aging
– Ellen Somers, St. Camillus; Kelli Hawver, Teresian House
– Hearthstone Alzheimer’s Care, Woborn, MA.
– Northern Speech Services
– National Institute on Aging
– Retirement Research Foundation
Some Things to Ponder…
• Memory... is the diary that we all carry about with us. ~Oscar Wilde, "The Importance of Being Earnest“
• Memory is a way of holding onto the things you love, the things you ,
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~From the television show are, the things you never want to lose.
The Wonder Years
• Memory is what tells a man that his wife's birthday was yesterday. ~Mario Rocco
• The man with a clear conscience probably has a poor memory. ~Author Unknown
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Population Overview
• For every 100 elderly patients in a nursing home in a given year, 38 will recover or stabilize so they can be discharged.
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• About 91% of the 1,650,000 US nursing home residents are over the age of 65.
• The average length of stay for a resident in a LTC setting is 2.44 years.
• The average stay for a Medicare rehabilitation patient is about 23 days.
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Population Overview
• Some common diagnoses addressed in the older adult population:
– Dementia
– CVA
– Brain Injury
– Mental Illness
– Dysphagia
– Additional Disabilities
Dementia Review
Dementia Review
• Dementia is not a specific disease
• Dementia is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain
of disorders that affect the brain.
• Diagnosis is made if two or more brain functions such as memory and language skills are significantly impaired without loss of consciousness.
Mistaken Beliefs About Dementia
• Diseases:
– Alzheimer’s disease
– Vascular dementia
– Lewy Body dementia
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– Huntington’s disease
– Creutzfeldt‐Jakob disease
– Alcohol related dementia
– Brain Injury
– Cancer
Research Tells Us…
• Dementia is the loss of mental functions involving thinking, memory, reasoning, and language to such an extent that it interferes with a person’s daily living.
• Dementia is a group of symptoms that can include:
– Language disturbances (e.g., aphasia, dysphasia, anomia)
– Problematic behaviors (e.g., repetitive questioning, wandering)
– Difficulties with activities of daily living (e.g., dressing, personal grooming)
– Personality disorders (e.g., disengagement, aggressive behaviors)
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• Individuals with dementia cannot learn or remember information
• Best way to care for persons with dementia is to make them comfortable, accept their idiosyncrasies, and be patient with them
Circumvent the Deficits
• Persons with dementia do have weaknesses in the areas of learning and memory BUT a number of strengths exist as well. – Ability to learn procedures
Ability to learn procedures
– Ability to read
• Research has shown that the learning of information and its retention depends heavily on how it is presented.
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Video Example: Learning in Dementia
Learning & Memory in Dementia:
Model of Memory (Squire, 1994)
Declarative
Memory
Procedural
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Memory
Facts
Events
Skills
Habits
World
Knowledge
Vocabulary
Simple
Classical
Conditioning
Priming
What We See in Many Facilities…
• Caregivers in facilities (nurses, rehab therapists, activities professionals, nursing assistants) tend to base their interventions on abilities/skills found in declarative memory
• This leads the person with dementia to experience:
– failure
failure in given tasks
in given tasks
– a reduction in self‐esteem,
– a reluctance to take an active role in facility programs and in their own lives
Research Tells Us…
• Problematic Behaviors can stem from unmet needs in the areas of:
– Physiology (undiagnosed/untreated pain)
– Safetyy ((fear of being hurt)
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– Love and Belonging (fear of being abandoned)
– Self‐actualization (lack of having a meaningful role in the community)
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The Challenges of Challenging Behavior: Breaking Down A Case
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Questions
• To effectively address a problematic behavior and develop an appropriate course of action, we need to ask “Why
Why did the person with dementia did the person with dementia
demonstrate this behavior?”
• Keep in mind…Behavior is never random.
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Finding the “Why”
• Brainstorm all possible reasons for behavior
– Physiologic
– Environmental
– Lack of meaningful engagement
Lack of meaningful engagement
– Personal (need for attention, social contact, reassurance, etc.)
• “Who Owns the Problem?”
• Ask person directly!
Challenging Behaviors Associated with Dementia
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Wandering
Repetitive Question Asking
Decreased Intake
Medication Adherence
Circumvent the Deficits
• Maximize remaining abilities to overcome challenges & develop appropriate interventions
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• Find individual strengths for each resident and build on them
– Observe resident
– Ask family & staff
– Provide opportunities
• Engage in activities/Provide roles
Challenging Behavior Brainstorm
1. Wandering
What strategies have you used or seen work for this common challenging behavior??
Challenging Behavior Brainstorm
Challenging Behavior Brainstorm
2. Repetitive Question Asking
3. Decreased Intake
What strategies have you used or seen work for this common challenging behavior??
What strategies have you used or seen work for this common challenging behavior??
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Case Study: Decreased Intake
Case Study Video Example: Decreased Intake
• 82 year‐old female
• Dementia; 8 MMSE
• Seen by speech therapy for assistance with self‐feeding
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• Example Goal: ‘R’ will consistently respond to cue to recall presence of food tray and initiate self‐feeding 80% of trials.
Challenging Behavior Brainstorm
GOAL: Remembering to place pills on a pill template every Sunday evening.
4. Medication Adherence
What strategies have you used or seen work for this common challenging behavior??
PROMPT: Trainer asks,
“What do you do every
Sunday?”
RESPONSE: Participant
responds, “I place my
pills on my chart.”
Low Vision Issues
• Many older adults encounter difficulties with vision (glaucoma, macular degeneration, cataracts, etc.) • Must create therapy activities & instructions Must create therapy activities & instructions
that are visible & clear for the client
• May need to make recommendations to adapt environment to encourage communication, engagement, & enhancement of oral intake
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Low Vision Issues
• Keep in Mind:
– Patients with low vision need well lit areas to read & eat. Position clients near natural light (window) if possible or use a full spectrum light (Tensor light) to flood area where they will be focusing. – Use primary colors and high contrast materials
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Black print on white background (or pastel colors) Reds, blues, greens easiest to discern Use tactile materials (sandpaper, puffy paint)
Use non‐slip materials to reduce errors and embarrassment
Think high contrast when it comes to food and plate and utensils
Make sure print is large enough to read easily (Reading Test)
Find and utilize resources
– National Federation for the Blind (http://www.nfb.org)
– Local Sight Centers
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Can you go
We are here
Where is it
One and only
Not now
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Vision Test Documentation Form
CLIENT: _______________
UNIT: _____________________
DATE: _____/_____/______
EXAMINER: ________________
INSTRUCTIONS: ** STOP when the person makes ANY mistake.
Evidence‐Based Treatment: Montessori & Spaced Retrieval
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We are trying to find out how big to print words so people can read them easily. Would you please help us by
reading this first sentence [POINT to “Can you go”] out loud? (Client reads sentence).
Thank you! Please read the next sentence
[Point to “We are here.”]. (Client reads). **
Now this one [Point to “Where is it?”]. (Client reads) .**
How about this one? [Point to “One and only.”] (Client reads.) **
And this one. [Point to “Not now.”] (Client reads.) **
Thank you so much for helping us.
Please indicate the smallest size lettering that the client was able to read by placing a check mark (√) next to the
sentences read correctly.
If the client was only able to read individual words during the test, circle the words they were able to read.
72 point
(Can you go)
48 point (We are here)
36 point
(Where is it)
24 point (One and only)
16 point
(Not now)****Vision test results:____________________________________
© Myers Research Institute 2009
Vision Test
Montessori
• Montessori‐Based Programming
He who is served is limited in his independence. p
‐Maria Montessori
Who was Montessori?
Maria Montessori
Maria Montessori
– Programming method that use Montessori educational principles to provide constructive engagement, meaningful activity, and practice of skills to older adults.
– Uses principles from the Montessori classroom to help older adults maintain independence and learn new skills
older adults maintain independence and learn new skills.
– Camp and other researchers have documented the use of this programming method with persons with Alzheimer’s Disease and have found that it increases overall participation in activities, as well as rates high in staff satisfaction (Camp, 2002; Skrajner, 2007).
– Therapists can use these methods to address goals in treatment.
Who was Montessori?
Montessori worked with underprivileged children thought by
underprivileged children thought by some to be “insane”
(1870‐1952)
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Who was Montessori?
– The Key to a Better Life For Children:
• Education
• Active roll in the classroom
• Proper environment (Children’s Houses)
Montessori‐Based Dementia Programming®
Montessori‐Based Dementia Programming®
Method of CREATING and PRESENTING
activities based
activities based upon models of learning and rehabilitation
Video Example of Montessori Programming
GOAL
To create persons who are as independent as p
possible, able to make ,
choices, and who are treated with respect and dignity
Key Montessori Principles
Key Montessori Principles
Montessori‐Based Activities Should:
Montessori‐Based Activities Should:
• Consist of materials that are aesthetically pleasing and are taken from the everyday environment
• Have a clear objective that is meaningful to the person
• Use external cues/templates
• Be demonstrated first, at a slow pace with as little vocalization as ,
p
possible
• Consist of materials are free of unimportant letters, numbers, words, or markings
• Be placed in a single container or on a single tray
• Be an error‐free source of success for people
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• Begin with an invitation
• Be broken down into their component parts and practiced
• Have closure, ending with asking the person if they enjoyed the activity and if they would like to participate in it again sometime
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Five Classes of Montessori‐Based Activities
Activities of Daily Living
Montessori‐Based Dementia Programming®
• Categorization
• Word finding
• Reminiscence
Sensorial Experience
– Access long‐term memory
– Stimulate language usage
Cognitive Stimulation
Cognitive Stimulation
• Reading
• Using cues‐verbal and visual
Motor Activities
Group Activities Treatment: Montessori
• Materials are taken from the everyday environment (familiarity)
Treatment: Montessori
ƒ Slow down your movements
ƒ Match your speed to the person with dementia
LET GO of idea that an activity has to be done
ƒ LET GO of idea that an activity has to be done the “right” way
• Materials are designed to p
promote independence in p
daily living and positive engagement
ƒ Goal is engagement & stimulation
ƒ Encourage reminiscence
• Each activity is presented at its simplest level. Each activity that follows builds upon the previous activity.
ƒ Activities should be an error‐free source of success for people
Treatment
Reading Roundtable
• More Goal and Activity Examples:
– Goal: Recalling family member’s names to increase communication and socialization in visits
• Obtain family pictures and have client assist you in cutting and gluing them to flash cards
and
gluing them to “flash
cards” with their names for with their names for
face/name recognition practice and matching.
Emily
John
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Memory Squared
Memory Squared
Video Example
Spaced Retrieval
• Spaced Retrieval (SR)
– Technique used to help persons with cognitive impairments recall important information over progressively longer intervals of time.
– First used to address face‐name learning in non‐impaired individuals
– Has been used successfully with patients with Alzheimer’s Disease, Traumatic Brain Injury, Parkinson’s Disease, and Dementia related to HIV (Bourgeois et. al, 2001; Camp, et. al, 2008; Neundorfer, et. al, 2004; Malone et. al, 2007)
– Is an effective tool that therapists can use to help clients reach their goals in rehab therapy and is billable and reimbursable. – Takes advantage of the procedural memory system and is success‐based.
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Spaced Retrieval Screen
Treatment: Spaced Retrieval
• Goal: “Client will recall location of daily schedule to complete ADL’s independently & improve participation in meals and with peers 90% of trials ”
90% of trials.
– Question: “Where should you look to find your daily schedule?”
– Answer: “Look at my walker”
Treatment: SR
Trial 1 (0 Seconds): Client Responds CORRECTLY
Trial 2 (10 Seconds): Client Responds CORRECTLY
Trial 3 (30 Seconds): Client Responds CORRECTLY
Trial 4 (1 Minute): Client Responds INCORRECTLY
Therapist provides client with correct response (“Look at my walker”), asks the client the prompt question again, allows the client to respond, and returns to the interval at which the client was last successful.
• Trial 5 (30 Seconds): Client Responds CORRECTLY
• Trial 5 (1 Minute): Client Responds CORRECTLY
• Client continues session; Therapist then probes through other therapy activities to see if carryover of skill is occurring.
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Problem Behaviors with SR Solutions: Prompt Question/Answer Examples
• Disorientation
– “Where do you live?” (Answer: Name of Facility)
– “What is your room number?” (Answer: Room #)
– “What
What is your address?
is your address?” (Answer: Client
(Answer: Client’ss address)
address)
• Repetitive Questioning
– Dependent upon question being asked
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Problem Behaviors with SR Solutions: Prompt Question/Answer Examples
• Naming
– “If you don’t know the name of something, what should you do?” (Answer: “Describe It”)
– What is your husband/wife/son’s name? (Answer: Target name)
– Who runs the activities here? (Answer: Staff member’s name)
• Disengagement
– What can you read to remind you of your family? (Answer: “Read my memory book”)
– What can you check to see what is planned for the day? (Answer: “Activity Schedule”)
– What can you look at to find something to do? (Answer: “My list of activities”)
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SR Case Study One
Case Study 1: Video Clip
• Goal: ‘R’ will recall strategy to improve safety when going from stand to sit position to improve safety and decrease fall risk at the initial trial of 3 consecutive therapy sessions
initial trial of 3 consecutive therapy sessions using spaced‐retrieval. “
– Question: “What should you do before you sit down?”
– Answer: “Reach for the arms of the chair”
Treatment: SR
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Spaced Retrieval Video Example
SR Case Study 2
90 year‐old female; 12/30 MMSE
Alzheimer’s Disease; CHF
Goal areas: disorientation, anomia, executive function
Goal: “Client will demonstrate strategy of describing items when unable to directly name them in order to increase communication of wants and needs to staff and family 80% of trials. – Prompt Question: “If you don’t know the name of something, what should you do?”
Response: “Describe it.”
Spaced Retrieval
• Goal possibilities are endless
• SR goals are NOT written any differently than other goals.
FUNCTIONAL GOAL = SR GOAL
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Spaced Retrieval
• Measurement of goal attainment can be by percentage (“80% of time”) or by recalling and demonstrating target response for a set number of sessions (3 sessions recommended) depending on the type of goal.
– “Client will recall strategy of inhaling prior to speaking in order to demonstrate appropriate vocal volume during 80% of structured sentence production”
OR
– “Client will demonstrate strategy of locking wheel chair brakes prior to standing to increase safety at the beginning of 3 consecutive therapy sessions using SR”
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Spaced Retrieval
Building A Caseload Using SR
• SR is considered to be a MODALITY or APPROACH that therapists may use to help clients reach their goals.
• SR does not fit one particular diagnosis SR does not fit one particular diagnosis
category
– Use the ICD 9 Code that corresponds to the goal area you are addressing
• How long do SR sessions generally last and how often should they occur?
• The length and frequency of SR treatment sessions is dependent on many factors
• There is no set standard time limit or frequency of sessions that with SR treatment
of sessions that with SR treatment. • Most SR sessions are between 30 or 45 minutes long. • In general, the more often a person is seen for SR the more quickly he/she will attain SR goals. • Use SR to teach compensatory swallowing strategies = Use the ICD 9 code for Dysphagia
Speech Therapy Weekly Treatment Note
Name: Susan Jones
Date:
6-6-08
to
Physician: Dr. Smith
6-12-08
S: Client has been pleasant and responsive to treatment sessions.
O: 1. Recall and demonstrate chin tuck strategy during meals: 30/50 trials
average per session (60%) [Baseline 0; Goal: 80%]
2. Recall and demonstrate safety strategy of taking smaller bites during meals:
35/50 trials average per session (70%) [Baseline 0; Goal 80%]
A:Client can recall both swallowing safety strategies utilizing the spaced
retrieval technique (approach for recalling information for longer periods of time). Client able to recall use of both strategies for
up to 24 hours. No visual cueing necessary.
P:
Using What You’ve Learned
Continue plan
Type of Treatment
92506
Speech Evaluation
92507
Speech Therapy
92610
Dysphagia Evaluation
92526
Dysphagia Treatment
97532
Cognitive Skills
Development
(each 15 min)
Date
6-6
Date
6-7
Date
6-8
Date
6-9
X
X
X
X
Date
6-10
Date
Date
X
Functional Goal Setting & Writing • Case Study
• 82 year‐old male; Dementia, CHF, Asthma; Diabetes; Former Musician; Wife is deceased; Children live out of town
• Assessment Results: MMSE : 13/30; able to read 48 pt. sized Arial font; Client passed Spaced Retrieval Screen
Functional Goal Setting & Writing
• Base goals on findings of evaluation, client interviews, & staff/family input
• Must be individualized, functional, and measureable
• Must show that goal is appropriate for skilled services of SLP • Patient history and level of functioning should warrant goal i
hi
dl l ff
i i
h ld
l
being addressed
• Goals should utilize “evidence‐based” and “best practices” for treatment • Explain “why” the goal is being addressed within the goal (Caniglia, 2003)
(Caniglia, 2003)
– “Client will recall and demonstrate use of chin tuck during swallowing 80% of trials in order to decrease risk of aspiration”
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Functional Goal Setting & Writing
Functional Goal Setting & Writing
• COGNITION:
• Client will navigate path to room by using landmarks independently to reduce wandering and increase safety 85% of trials.
• Client will correctly recall names of family members to increase communication and socialization during visits 80% of trials.
• Client will use a calendar to orient self to date, time, and daily ,
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activities to decrease disorientation & increase attendance and participation in facility activities 90% of trials.
• Client will utilize personal list of leisure activities to constructively engage self to prevent wandering and agitation 80% of trials.
• Client will correctly match names with peers on unit to promote socialization and interaction during meals 80% of trials.
• Client will recall strategy to name items through description 90% of trials.
• Client will recall strategy of utilizing call button to alert nursing staff and prevent unassisted ambulation 85% of trials.
• Client will recall reason for needing medications to promote compliance with nursing staff 80% of trials.
• Client will recall strategy to properly match own clothing to increase independence in ADL 90% of trials.
• Client will utilize a personal diary to log daily events/thoughts to facilitate conversation with staff and family 85% of trials.
• Client will recall strategy to feed self with one verbal cue 80% of trials to increase independence and caloric intake. • Client will utilize personal memory book to remain constructively engaged and promote conversation with others 90% of trials.
• Client will recognize caregivers to promote compliance during bathing 80% of trials.
Functional Goal Setting & Writing
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SWALLOWING:
Client will recall strategy of using chin tuck during meals to prevent aspiration 90% of trials.
Client will recall strategy of clearing pocketed food in buccal cavity to prevent aspiration 90% of trials.
Client will recall strategy of alternating solids and liquids during meals to decrease risk of aspiration 90% of trials.
p
Client will utilize strategy of supraglottic swallow during meals to decrease risk of aspiration 80% of trials.
VOICE/SPEECH:
Client will recall strategy of taking deeper breaths prior to speaking to promote increased volume and sub‐glottal pressure and increase communication 90% of trials.
Client will recall proper placement of articulators to produce alveolar sounds and increase communication abilities and intelligibility in conversation 80% of trials.
Client will utilize strategy to use optimal vocal register to prevent the reoccurrence of vocal polyps 80% of trials.
Functional Goal Setting & Writing
• Goal must be meaningful to the client
• Activities to meet goal must be interesting, match abilities, and be success‐oriented
• Use terminology that the client, staff, and family can understand
– EExample: Ask client what they would call a “Memory Book” l A k li
h h
ld ll “M
B k”
before terming it that; Use client response to work on goal, increasing the likelihood they will remember and use it.
• Circumvent deficits
Functional Goal Setting & Writing
• Avoiding Appeals
– Following the aforementioned guidelines, you should not experience a denial of your claim.
– If, however, you are denied, be sure to:
• Provide appropriate documentation where needed (explain pp p
( p
rationale for goal; why and how it is being addressed and cite why client is likely to benefit from treatment)
• Further explain necessity of the need for the skilled service
• Provide citations of treatment intervention, medicare guidelines, etc. if needed
– 2001 CMS Program Memorandum “Medical Review of Services for Patients with Dementia” – http://www.cms.hhs.gov/Transmittals/downloads/AB‐01‐135.pdf
Functional Goal Setting & Writing • Client Input: Client wants to do more “on his own” and doesn’t enjoy being around “all of the sick people”. Feels “bored” and misses his family and old way of life.
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• Staff Input: ‘R’ found napping in other residents’ rooms; often leaves cane in room; tends to take large bites of food when eating, leading to choking; wears cologne, sometimes in “excessive amounts”
– Work around areas of weakness
• Example: Dementia
– Inattention may lead to client forgetting what they are working on in treatment and why. Remind them throughout session or write down treatment activities so he/she knows what to expect and when they will be finished.
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• Family Input: Satisfied with care; would like a way to communicate with their father and update him on family events beyond talking on the phone 13
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Functional Goal Setting & Writing Functional Goal Setting & Writing • Where should we start?
y Evaluate assessment results, clients strengths/weaknesses, staff and family input
y Which areas warrant the most need? Prioritize! • Safety
• Disorientation
• Communication; Socialization
y Which areas are most effectively treated by a skilled service?
y Forgetting cane when walking
y Taking too large of bites during meals
y Addressing disorientation to help client locate room
– Always ask the question “Why is this happening?” in order to get to the root of the issue.
• Are repetitive questions being asked because client is seeking information (actual answer to question) or seeking attention?
• Is the client wandering because they do not know where their room is or because they are seeking social contact, attention, etc.?
• SLP’s can target behavioral challenges in treatment as long as the intervention is evidenced‐based, functional, and warrants the expertise of the therapist. SLP can also assist in making behavioral intervention recommendations to staff and family to target behaviors
Goal Setting & Writing
• Keep in mind…BEHAVIOR IS NEVER RANDOM! • May discover reasons for behavior by:
– Observing the client
– Tracking incidence of behavior (are there triggers or patterns?)
– Talking with staff/family
– Asking the client directly! Functional Goal Setting & Writing
• Safety goals are client’s highest priority for treatment – Once we understand “why” the client is exhibiting the behavior, we can set a realistic and more effective goal to treat the problem.
• Swallowing:
– Problem: Client takes too large of bites
– Why? Client’s tray was taken many times before he was finished, leading him to eat more rapidly
– Strategy: Teach client too look at visual cue placed near tray that reads “Take your time and enjoy your meal. No one will take your tray until you are done. Take small bites”
– Goal: “Client will recall and demonstrate ability to recall strategy of taking smaller bites during meals 90% of trials using a visual cue.”
Take your time and enjoy your meal. No
one will take your tray until you are done.
Take small bites.
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Functional Goal Setting & Writing • Case Study: Behavioral Challenges
– What are some possible reasons the following behaviors are occurring?
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Napping in other residents’ rooms?
Taking too large of bites of food?
Forgetting cane?
Wearing too much cologne?
– Also important to analyze: “Who owns the problem?”
• Is it a legitimate safety or communication issue that needs to be addressed in treatment?
• Is the “problem” more for staff and family than for the actual resident?
Goal Setting & Writing
• Remembering Cane
– Problem: Client is unsafe to walk without cane; high fall risk
– Why? Client not used to having to use cane to walk safely; does not fully understand why he needs the cane & therefore chooses not to use it
chooses not to use it
– Strategy: Educate client on why he needs the cane; write down reasons, biggest being to stay safe and not fall; choose area with client to keep cane so he sees it and remembers it; use Spaced Retrieval technique to teach him to remember the cane; instruct staff to offer LOTS of positive reinforcement when he uses the cane to encourage its use
– Goal: “Client will recall and demonstrate use of cane to remain safe during walking and decrease fall risk 90% of trials.”
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Treatment
• Case study client: Treatment session focused on remembering to use cane
– Treatment session in client’s room since this is where he forgets to take his cane with him
– Begin by stating to client that you are working together to keep him
are working together to keep him safe by remembering cane.
– Ask client what he calls the cane. May call it a “walking stick”, etc. Use client response to practice goal
– Write down session activities and mark off when you complete each one.
Goal Setting & Writing
Today:
1._X__ Review goals: Use cane
to keep safe
2. ___Decide where to keep
cane
3. ___Practice remembering to
use cane
4. ___Work on memory book
5. ___Take a walk to lunch with
cane
Case Study
• 90 year‐old female
• Dementia, Parkinson’s Disease; Right Foot amputation; Former artist
• Loves children (used to teach art to elementary school children)
• 10/30 on MMSE; Passed SR Screen
• Locating Room
– Problem: Client is disrupting other residents; becomes disoriented and may end up in unsafe areas
– Why? Client is napping in other rooms because he cannot locate his own consistently; also enjoys the social contact and attention he receives when does this
– Strategy: Teach client to look for landmarks to locate room; use meaningful cues (music note on door, since client was a musician); PRACTICE locating room using landmarks starting from different locations on unit; find activities he enjoys and increase involvement to provide social contact & attention.
– Goal: “Client will learn landmarks in unit environment in order to locate room independently and decrease wandering into unsafe areas 80% of trials.”
Case Study
• STAFF INPUT: ‘R’ often refuses to take part in activities; often found tugging at protective covering over amputation trying to remove it; often asks about family and when they last
often asks about family and when they last visited
• FAMILY INPUT: None, no children, never married; rarely receives visits from extended family or friends
Case Study
• Where should we start?
• What are the priority treatment areas?
Your Questions Answered…
• How should we address these goals?
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References
“We take note of all the details of a disease and yet make no account of the marvels of health.” •
‐Maria Montessori
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Thank You!
For more information, please contact [email protected]
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Hardy, E. (1995). Bedside Evaluation of Dysphagia. Austin, TX: Pro-Ed.
Smith, W., Rosen, A. Dellarosa, D. (1997). Dysphagia Evaluation Protocol. Harcourt
Assessment
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