occupational therapy and dementia-specific tools

8/20/2019 Occupational Therapy and Dementia-specific Tools

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Presented by

Barbara BROCK , PublishedResearch Author, President Communication Art,Inc. Toledo, Ohio

and

Mary Beth LAVEY COTA/LWoodland Adult Services. Bowling Green, Ohio

OHIO OCCUPATIOANL THEARPY CONFERENCE 2008

and the

Reality ComprehensionClock Test (RCCT)

A standardized assessment .

Ideal for Alzheimer’s and other

types of dementia.

And Dementia Specific Tools

Communication Art Programs

A Social Model for dementia populations thatcontains a brain stimulating curriculum.

Reality Comprehension Clock TestIdentifies cognitive skills and abilitiesof Alzheimer and other dementiaresidents/clients.

Communication Art ProgramsSocial Model contains BrainStimulating Curriculum forAlzheimer’s and other types of dementia.

“Focus is on skills that remain, not those that are lost.”

Reality ComprehensionClock Test (RCCT)

To become certi fied to administer the RCCT you are required to complete the 4 hr RCCT educational workshop.

RCCT does notdiagnose dementia.

Reality Comprehension

Clock Test

Assesses:

CognitionMemoryFall Risk Continence Status

The Reality Comprehension Clock Test was developed to pick up where the F olstein Mini Mental Status Exam leaves off.

1999 RCCT Brock,B. et al


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If resident scores 23 or lower on the Folstein MiniMental Status Exam administer the RCCT

While viewing a sample drawing of a clock,

resident is asked to replicate it.

Test contains a specific scoring method .

Evaluates Four Functional Categories

What makes the RCCT diff erent f rom other clock drawing tests?

And actual clock drawing by the resident helpscaregivers and family members reduce thedifference of opinions as to….

How much their loved oneunderstands…..

And how capable they are of taking care of themselves.

Functional Age

(FA = remaining brain power)

Global Deterioration Stage

(GDS = stage of the dementia)

Risk of F alling(visual spatial score on RCCT)

Continence Status

Appropriate Level of CognitiveActivities

Potential Memory Deficits

-Administrator of RCCT is required to be certified bycompleting the RCCT 4 hr. educational workshop.

12 month certification.

-Annual re-certification is required.

Must administer the RCCT one with one.

Person who gives RCCT must score RCCT

RCCT Reality Comprehension Clock Test

FA Functional Age

GDS Global Deterioration Stage

VSS Visual Spatial Score – Fall Risk


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of

Let’s look at the RCCT scoring pages

RCCTnicknamed the

“ PINK”

clock test.

Matt’s RCCT

Let’s find out what theRCCT tells us about Matt.

How does the RCCT identify Fall Risk ?

Journal of Gerontological Nursing

“Visual Spatial A bilities and Fall Risk.An Assessment for I ndividuals Wi th D ementia”

Published Sept. 2005

Research funded by a grant from

HCRManorCare Foundation

Reality Comprehension Clock Test

ValidityReliabilityReveals


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Drives appropriate interventionson care plans for dementiaResidents or Clients

Matt completed the RCCT.

We have valuable information to care for Matt on his level of understanding but he is still sitting there looking at us.

He needs brain stimulation.

RCCT score (43) revealed Matt is a good candidate

for Level II Communication Programs

Each Communication ArtProgram contains 18 brainstimulating exercises

All the WORK is done for You!

Popular, nostalgic themes.

Designed specifically for

Stages 3,4,5, and 6 dementia

Ideal for use with Occupational and Speech Therapy!

Client’s/Resident’s participation ineach brain exercise is monitored by atrained Communication ArtProgram staff member.

Copyright 2008 Communication Art, Inc.


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The most IMPORTANT part for theResident or Client

Brain ExercisesEach task is designed on resident/clients level of understanding.

Give ME a PURPOSE! WOOD COUNTY BD. OFMR/DD

• Adult Services (22 yrs and older)

• Shelter Employment (WLI)Community Employment

• Non Vocational ServicesDay Services / Day Hab. / Older Adult

Down Syndrome & Alzheimer’s

• In 1997 a study of 307 patients withDown Syndrome revealed the following:

• 11% of individuals with Down Syndromedeveloped Alzheimer’s between the agesof 40 – 49

1997 Study

• 66% between the ages of 50 – 59.

• 77% between the ages of 60 –69-100% had Alzheimer’s by the time theywere over 70.

•Prospective Study of the Varianceof Alzheimer's/Dementia in InstructionalIndividuals with Downs Syndrome”American Journal Mental Retardation – Vol. 101 pages 400 – 412 Visser, FAldenKapa, A, Huffelen

1997 Study

Down Syndrome &Alzheimer’s

• Down Syndrome havehigher risk of

developing AD.

• Symptoms begin atearlier age.

• Decline is quicker.

• Two diseases share aneuropathology.

• Leading hypothesis is based on chromosome21.

Sally Albrecht –AID workshop


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Assessment of DS in AD

• Difficult due to presence of mentalretardation.

• An approx. 1 –2 year elapse exist beforediagnosis is confirmed.

Sally Albrecht–A ID workshop

Statistics

• First symptoms observed ages 36 and 62, withmean the mean age of 50.

• Diagnosis is confirmed between 37 and 62, withmean age of 52.6.

• Death occurs between ages of 46.7 and 69.8with mean age of 60.11.

• Duration from 1 st symptom to death 9 years(range 6 to 11)

Sally Albrecht –AID workshop


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Early Stage of AD in DS

• Confusion, disorientation and wanderingusually not recognized and commonlymisdiagnosed.

• Behavioral Changes

• Visual DeficitsSally Albrecht –AI D workshop

Middle Stage of AD in DS

• Marked deterioration of ADL

• Communication skills decline.

• Behavioral problems are exaggerated,and psychotic behavior may be displayed.

Sally Albrecht–A ID workshop

Advanced Stage of AD in DS

• Patients are almost at a vegetative level.

• They totally depend on others andinteract minimally with environment.

Sally Albrecht –AI D workshop

Special Considerations for DS

• Diagnosis is complicated by the MR.

• Common neurocognitive test not useful.

• Depression may be mimicking AD

• Hypothyroidism (30% of DS) may

simulate dementia.Sally Albrecht –AID workshop

• SOCIAL MODEL AND RCCT

• LOW IMPACT WATER AEROBICS

• SWEAT ‘N’ TO THE OLDIES

INTERVENTIONSSOCIAL MODEL

Communication Art Programs

• Reminiscing

• Choices

• Which One?

• Drawing


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Reminiscing

• Questions on the topic of the day.• Different levels of questions.

• Sharing of memories.

• Turn taking skills.

• Listening skills.

Choices

• Which type of bird would you prefer towatch?

A RobinA Red Cardinal

Which One?

• Circle the picture that does not belong.• Leve1 – has 5 pictures

• Level 2 – 4 pictures

• Level 3 – 3 pictures

WHICH ONE? Level 1

• 5 PICTURES

• HARDER

• MOST CAN CIRCLE THE ONE

THAT IS NOT THE SAME.

WHICH ONE? Level 2

• 4 PICTURES – EASIER

• THEY CIRCLE THEPICTURES THAT ARETHE SAME.

• CIRCLING THEPICTURE THAT IS NOTTHE SAME IS AHARDER CONCEPT.

DRAWING

• EYE HAND

COORDINATION.• SPATIAL PLACEMENT

• CREATIVITY

• RISK TAKING


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Socialization- PUZZLE

• Drawing maybe overwhelming for

some.

• Putting a puzzle together can beless threatening.

• Problem solving.

• Spatial placement.

COLORING

• Choosing the correct colors

• Staying within the lines.

• Writing name

• Writing date

WATER EXERCISEPROGRAM

• Taking risks

• Learning new skills

• Formingfriendships

• Recall of routine

WARM UP EXERCISES

•Leg exercises

•Hand walking

•Cardio activity

Competitive Drive

•Races

•Teamwork

•Turn taking

DEEP WATER EXERCISE

•Pool now at 3 ½ foot deep.

•Go in one direction, once we get agood current going we stop turn andgo the other way – resistive exercise.


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RESISTANCE

•Strength

•Endurance

•Increases balance

•Cardio Workout

COGINTIVE SKILLS

• Leading the group through a countingexercise.

• The swimmer who counts then has topick the next person to count by callingout their name.

Walk walking 5 ft deep waterholding on to the wall.

Work down the wall untilthey get to the steps.

Data – ObjectiveInformation

• Rating swim sessions on participation,following directions, verbal prompting.

• Monthly Weights

• Body Fat and Body Mass Measurements

SWEAT ‘N’ TO THE OLDIES

• ROUTINE

• MUSIC• BODY IN SPACE• PROPRICEPTIVE INPUT• COUNTING• RECALL

Moving with Music

• Following directions.

• Dancing like movements.


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Feedback

• Body in Space.

• Proprioception

– Movement – Stomping – Shaking – Clapping

Sweat ‘n’ to the Oldies

• Music makes you want to move!

• Accomplishment.

• Focus for the the job!

How Have the InterventionsImpacted Their Lives

• Increase incommunicationskills.

• Increase in socialskills.

• Increase personalappearance.

• Increase in self esteem.

• Increase in socialconnectedness

• Sensory Integration

Reality ComprehensionClock Test

• NUMBER AWARENESS

• VISUAL/SPACIAL

• MEMORY

• EYE HAND COORDINATIOON

Case Study #1

• Age: 46• Wt. Jan. 2001 275 / Aug. 2008 195 (80 lbs)

• Diagnosis: Down Syndrome

• Medical issues: pre-diabetic, obesity, poor circulation, poor breathing, poor eating habits.

• General Comments: Harder worker, supportivefamily.

Case Study # 2

• Age: 48• Gender: Female

• Wt.: Jan. 2001 144 / Aug. 2008 160 (16 lbs)• Diagnosis : Downs Syndrome, Mod. MR

• Medical Issues: Headaches• General Comments: Very low muscle tone, and

low motivation. Moves very slowly in allactivities.


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Case Study # 3

• Age : 48• Gender: Male• Wt:Jan. 2001 203 / Sept. 2008 174 (29 lbs)• Diagnosis: Down Syndrome, Obese• General Comments: Has an extended

stomach due to hernia surgery, enjoys thewater & playing basketball.

Case Study 4

• Age: 50• Gender: Female• Diagnosis: Down Syndrome, Mild MR • General Comments:

Case Study # 5

• Age: 57• Gender: Male• Diagnosis: Downs Syndrome• Comments: Not involved with the water

exercise program

Case Study # 6

• Age: 53• Gender: Female• Diagnosis: C.P, Parkinson like symptoms -

medications• Comments:

• The RCCT provides us with a standardize toolfor monitoring cognitive skills.

• The RCCT gives us feedback on how ourwater exercise program, cognitive groups andsweat n to the oldies group is impacting theparticipant's life.

• The RCCT gives validation to subtle changesnoted by staff of a consumers decline.

WOOD COUNTY BD. OFMR/DD

11160 East Gypsy Lane Rd. Bowling Green, Ohio

Mary Beth Lavey, COTA/L & Stacy Schumacher, COTA/L


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Barbara BROCK , PublishedResearch Author, President Communication Art,Inc. Toledo, Ohio

and

Mary Beth LAVEY COTA/LWoodland Adult Services. Bowling Green, Ohio

OHIO OCCUPATIOANL THEARPY CONFERENCE 2008

For attending this presentation

occupational therapy and dementia-specific tools

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