Académique Documents
Professionnel Documents
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Aims
Introduction to psychosocial OT practice in relation to persons with dementia (PWD). Personhood; new ways of working NICE guidelines Pool Activity Level
Exercise
Neuropsychology of Dementia
(Wisconsin DOH, 2003)
Thinking processes: Judgement* Attention* Perceptions* Reasoning* Organisation* Memory recall* Communication* Abstract thinking* Disorientation Disrupted social functioning
* >2 Occupational & Social functioning.
Perceptual disturbance Stimulation level Cliffs Heightened intuition Tunnel vision Depth perception Reading Out of sight .... / cues Fluffy Sundowner syndrome
Neuropsychological Factors
(Finkel, et al, 1998)
Perceptual Affective
20 - 73 32 - 50 15 - 49 up to 81 3 - 15 ? ? up to 90 up to 50 up to 20
Personality
Questions
Why is the degree of expressed Dementia and performance in tasks not linked to extent of brain pathology we see in scans and autopsies (Kitwood, 1993) & (Snowdon, 1996)? Do psychometric assessments offer the best prediction of real world functional performance (Lowenstein & Acevedo , 2010)?
Is Dementia a process of degeneration with little hope of improvement in functional performance (Gail Mountain, unpublished)?
POEM
D=P+B+H+NI+SP
D dementia P personality B biography H physical health NI neuropathology SP social psychology
Dementia: a psychological response as a means of coping with brain damage Tom Kitwood (2003)
Attachment LOVE
Physical health/medication
Social/family history
Mental Health ax
COPM
Occupational performance Psychiatric inventory
COTES
PAL AMPS Interest checklist
The Pool Activity Level (PAL) Instrument for Occupational Profiling (Pool, 2008)
PAL Personal History Profile PAL Checklist Individual Action Plans for personal care activities PAL Activity Level Profile Outcome Sheet for recording results
PAL checklist
1 2 3 4 Bathing / washing Getting dressed Eating Contact with others 5 Groupwork skills 6 Communication skills 7 Practical activities (craft, domestic chores, gardening) 8 Use of objects 9 Looking at a newspaper / magazine
PAL Levels
Planned; Can work towards goal directed activities with a tangible outcome, but may not be able to solve problems that arise Exploratory; Can carry out familiar activities in familiar surroundings, but more concerned with the effect of doing the activity than the final outcome. Sensory; Primarily concerned with experiencing the sensation of the activity and moving their body in response Reflex; Often unaware of surrounding environment, moves as a sub conscious, reflex response to direct sensory stimulation.
Exercise
In groups complete the PAL checklist based on your observations of the video OBJECTIVE: Decide on the overall level the client is functioning at.
Going Home
Discussion
Final Statement
As we become more emotional and less cognitive, its the way you talk to us, not what you say, that we will remember. We know the feeling, but dont know the plot. Your smile, your laugh and your touch are what we will connect with. Empathy heals. Just love us as we are. Were still here, in emotion and spirit, if only you could find us.
Christine Bryden, Dancing with Dementia, 2005 p138)
Lawlor, B (2002) Managing behavioural and psychological symptoms in dementia The British Journal of Psychiatry 181: 463-465.
Lowenstein, D and Acevedo, A The relationship between Instrumental Activities of Daily Living and Neuropsychological Performance. In Thomas, D and Grant, I (eds) (2010) Neuropsychology of Everyday Functioning Guildford Press. London. U.K. Snowdon, D, A., Kemper, S, J., Mortimor, J, A., Greiner, L, H., Wekestein, D, R., and Markesbery, W, R. (1996) Linguistic ability in early life and cognitive function, and Alzheimers disease in later life: Findings from the Nun study. Journal of the American Medical Association 275, 7, 528-532. Wisconsin DOH (2003) Progressive Declines of Alzheimers Disease & Related Dementia: Physical Changes That Effect Perception of the Environment. Bureau of Aging & Long Term Care Resources, Wisconsin. USA.
References/resources
Wenborn et al (2008) Assessing the validity and reliability of the PAL Checklist. Aging & Mental Health, in press. Stoddart (1998) Dementia Care: Supporting a plea for personhood. Scottish Journal of Healthcare Chaplaincy 1: 9-11. Everybodys business: integrated mental health service for older adults: a service development guide. Department of Health (2005) www.dh.gov.uk The National Institute for Clinical Excellence (2006): dementia. www.nice.org.uk Pool (2007) The Pool Activity Level (PAL) Instrument for Occupational Profiling: A Practical Resource for Carers of People with Cognitive Impairment. Bradford Dementia Group Good Practice Guides. Jessica Kingsley Publishers; 3Rev Ed edition.