Harmony Healthcare Blog

OT Skilled Treatment Techniques for Dementia (Part II)

Posted by Kris Mastrangelo on Wed, Sep 12, 2018


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Older disabled woman on wheelchair in nursing homeTo reiterate from Part I of the blog, Occupational Therapy skilled interventions require the expertise, knowledge and judgment of an Occupational Therapist. Often, clinicians underestimate the value of their input/treatment and perceive the interaction as unskilled because the treatment or action is so obvious to the therapist. Yet, the Occupational Therapist may not realize the task, modification or recommendation is a game changer to the functionality of the patient.

Treatment techniques are multi-faceted and not unilateral. The Occupational therapist views many aspects the impact the patients’ overall functional performance. Some areas include, but not limited to: 

  1. Environment

    The Occupational Therapist always surveys the surroundings of a patient’s world. This includes lighting, flooring, cabinets, clutter, noise, people and milieu.

    For example, when conducting a feeding group, the OT is mindful of sounds (noise) from overhead paging, staff conversations and television sets, to name a few. This type of stimuli can overload the dementia patient and arouse hostility, agitation and decrease participation in the task (eating). Hence, setting the stage for activities of daily living and ensuring the daily caregivers prepare an optimal environment for patient performance is a skilled service.
  2. Mobility

    When treating on the Alzheimer’s units at Hillhaven, the therapy team established groups for movement. Standing is far better than sitting in a chair all day. You have heard me say “the slower you walk, the sooner you die.”

    One approach used with a dementia group included taking balloons and throwing them in the air. Alzheimer’s patients of all levels naturally stood up and batted the balloon to keep it in the air. Onlookers clearly questioned the intent of the group. Little did they know we were increasing range of motion, increasing balance, increasing strength and engaging with the resident. In other words, improving the patients quality of life.
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  1. Social Interaction

    The spike in depression across the U.S. is no doubt directly related to less face to face interactions from cell phone usage. A clear majority of the population looks down at their phone versus gazing at the person standing next to them. This same loss of interaction occurs with the aging population and this is magnified for those with dementia and hearing loss. Strategically organizing group activities with a defined demographic can create a forum conducive for participation and optimal social interactions.
  2. Person-Centered

    Occupational Therapists seek out the interests, hobbies and daily purpose which is most important and specific to the resident. Extracting these details and incorporating them into the treatment session infuses a sense of purpose that is relatable to the patient. As an internal quality assurance mechanism, best practices recommend including a statement on the evaluation which cites a quote from the family/resident defining a patient specific goal of treatment.
  3. Music

    Music has a powerful effect on our emotions. Familiar songs evoke memories and emotions, happy and sad. Toe tapping, humming or even straight out dancing is a magnificent technique used to address mobility, mood, socialization and behaviors. Skilled Occupational Therapy addresses, observes and gauges success in relation to patient specific goals.
  4. Cognition

    Each patient may be at varying stages of cognition. The Occupational Therapist identifies the patient’s capability for new learning or retraining and identifies when it is clinically appropriate to develop a restorative rehabilitation plan of care.

    The focal areas within cognition are related to an individual’s abilities in the area of: memory, communication and self-care. The stages to consider include mild cognitive impairment, mild dementia, moderate dementia, severe dementia and profound dementia.

    There is a decreased ability to perform basic and instrumental ADL tasks as dementia progresses. This is due in part to a decline in the ability to screen out and interpret environmental stimuli. Behaviors that further interfere with the ability to complete a task manifest as the result of the patients’ inability and frustration. This creates a risk for safety and disturbs others who share the environment with the individual. Inaccurate interpretation of the environment and stimuli can also lead to behaviors that interfere with task completion, safety or a disruption of others. A patient may withdraw from meaningful activities and occupations. Being able to engage in occupations that the elder enjoys is important for the elder’s quality of life. Humans are occupational beings and the lack of meaningful occupations has been associated with poor health, maladaptive behavioral patterns, depression and stress-related medical problems.

    Abundance of unstructured time can lead to an increase in behavior problems.

    Treating a patient with dementia requires an environment that is structured in which daily routines are established and followed, while familiar tasks are incorporated to support the individual’s ability to engage successfully in meaningful occupations.

    Do not negate the value and potential benefit from therapy intervention despite a decreased the perceived perception of the patient’s inability to retain information and demonstrate or verbalize understanding.

The role of Occupational Therapy in dementia care is to assist the patient, family, and caregivers with activities that are functional in maintaining and slowing physical declines, including but not limited to the following areas:

 * Maintaining Muscle Strength

* Balance

* Mobility

* Fall Prevention

* Contractures Prevention

* Pressure Ulcer Prevention

* Communication

* Education

In summary, Skilled Occupational Therapy identifies the patient’s strengths and weaknesses and establishes a plan to modify and enhance the environment or the patient’s functionality with the overarching goal to maintain function, improve function or mitigate functional decline.

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Tags: Dementia

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