Friday, November 24, 2017

THERAPISTS GUIDE TO DEMENTIA

Today I wanted to chat with y'all about Dementia. As an Occupational Therapist in a skilled nursing facility setting, this is a diagnosis I see all of the time. I decided to do a blog post about it because it is something I truly am passionate about and I would love to spread knowledge as best as I can. To start, you can read my last blog post here about Lanny Butler's book & the 7 stages of dementia. It is one of my personal favorites and I recommend this book to every family member that is caring for someone with dementia. There's also a questionnaire at the end of the book that I like to either give patients and/or caregivers to better understand someones habits and routines. I always get questions from different therapists about my recommendations for assessments, goal writing, activities, etc. I decided to break it down as best as I could. The first thing that I do when I see a dementia diagnosis is interview the patient (if they are able to recall facts about their past) or interview a family member if they are unable to tell me facts about their past. I find out specific things about their past (jobs, leisure interests, routines) so I can either modify activities to increase their engagement or use this information to help the caregiver care for the patient.

Assessments I love: MOCA, SLUMS, GDS, Trail Making Test, ACL, Clock drawing test, Personal Interest Inventory, Spaced Retrieval, PAINAD scale. Obviously, I use my best judgment on what assessment I want to administer. For example, I wouldn't use the MOCA on someone with severe dementia.

Goal writing Therapists: I'm going to just list a bunch of goals that I find helpful and you can be the judge when they might be appropriate based on their abilities, pt/caregiver goals. Most of these goals were given to me by my mentor in NC named Marissa (she's my OT role model-amazing!)
1. Pt will increase short term recall to refer to external memory aides with __% accuracy with __ assist for completion of ADL task.
2. Pt will demonstrate recall of safety precautions with __% accuracy with __ assist to perform ADLs safely.
3. Pt will demonstrate recall to use a checklist with __% accuracy with __ assist to complete ADL self care task of ___.
4. Pt will independently scan environment to locate needed supplies with __% verbal cues.
5. Pt/caregiver will complete personal interest inventory to identify and increase leisure IADL engagement.
6. Pt will increase attention to task up to __minutes with ___ amount of cueing to increase leisure IADL engagement.
7. Pt will allow caregiver to perform AAROM/PROM 2 x 10 ea __UE for increasing joint flexibility and comfort for ADL completion.
8. Pt will perform trunk flexion ther act ___x with __assistance and __verbal and/or tactile cueing for increasing trunk flexion for ADL performance.
9. Pt will engage in rhythmic movements to chair dance, march in place for gross motor stimulation with maximum assistance to initiate and sustain attention for 5 minute intervals.
10. Pt will self feed finger foods and drink from a cup with __ assistance when placed in hand given maximum tactile and verbal cues.

Activities for each stage: I decided to break down some activities you can try related to each stage. These are just some ideas of things you can do. Make sure to take into consideration the patient's interests, dislikes, etc.
GDS stage 4 activities can include but are not limited to: crafts, bingo, puzzles, cooking activities, games
GDS stage 5 activities can include but are not limited to: folding clothes, setting the table, stuffing envelopes, sorting activities, bingo, coloring, stringing beads (verbal cueing and assistance as needed)
GDS stage 6 activities can include but are not limited to: gross motor games such as balloon volleyball, bean bag toss, simple coloring, stirring, dusting tables, photo albums, swaying to music, parachute activity
GDS stage 7 activities can include but are not limited to: tactile stimulation, head and postural control, kneed bread dough (you can always use putty)

As always, let me know if y'all have any questions for me and if you enjoyed this post:)

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