1. Cognitive Rehabilitation Reversing the symptoms of dementia Jackie Pool Dementia Lead Affinity Training

2. GREAT
Goal-oriented cognitive Rehabilitation in Early-stage Alzheimer’s disease: multi-centre single-blind randomised controlled Trial
great.bangor.ac.uk

3. Review the underpinning skills and knowledge required to plan and implement goal oriented therapeutic interventions with patients
Have a framework for planning cognitive rehabilitation interventions and improving occupational performance
Be able to use a range of therapeutic strategies:
Compensatory rehabilitation
Restorative rehabilitation
Anxiety management
Understand the importance of therapeutic relationship with the participant and carer

4. What do we mean by ‘dementia’?
away from
the mind
a condition DE
MENT IA

5. The Disability of Dementia
Neurological Impairment
Interaction with others
Person’s situation

6. What can we achieve with CR?
To do again, repeat
the mind
a condition RE
MENT IA

7. The Role of the Therapist
To create a “just right” environment so that the person with memory impairment is not disabled
Consider your role as a Care Worker…..
Assessor?
Therapy provider?
Activity Provider?
Facilitator?
Enabler?
Educator?
Resource?
Discharge planner?
It is possible that you have several roles, but all of them involve helping the individuals in your care setting to live meaningful and fulfilling lives.
Jackie Pool Associates Ltd ©

8. Cognitive rehabilitation
Recognising objects
Getting started with an activity (initiation)
Understanding
writing
Planning
what to do
Finding items

9. Compensatory strategies: environmental adaptations

10. Compensatory strategies: environmental adaptations

11. Restorative strategies: errorless learning
Semantic Memory
Visualisation
Mnemonics
Activity Grading
Positioning:
Self
Objects
Communication:
Speech
Body Language
Pace
Working Memory
Expanded Rehearsal
Effortful Processing
Procedural Memory
Tapping into old patterns of movement
Learning new patterns

12. Using semantic imagery finding the potato masher in ‘that’ drawer
Tip:
Think blue
(Visual semantic memory)

13. Visual mnemonics

14. Restorative strategies: The just right challenge for activity grading
Ability of the individual
Demand of the Activity

15. A person displays function when he is able to choose, organize, and perform occupations that are personally meaningful
Volition
Source of motivation
Habituation
Patterns and routines
Performance
Cognitive and physical abilities

16. The Model of Information Processing
Attention captured
Intact
Input
Throughput
Information Processing
Output
Impaired

17. The Pool Activity Levels of Ability
PLANNED
EXPLORATORY
SENSORY
REFLEX
PLANNED – orientated to obvious goals
EXPLORATORY – more concerned with the process of an activity than the goal
SENSORY – concerned with the impact on own senses
REFLEX – Sub- conscious responses to direct stimulation
Using the PAL Checklist on p. 12 and 13, think of a person with dementia with whom you work and who you know well. Complete the checklist based on their performance over the last few weeks.
Total the score for each level at the end.
What is the persons Activity level?

18. The Pool Activity Levels
Method of engagement
Reflex
Sensory
Exploratory
Planned
Sensory cues
Subliminal
Proprioceptive/
Tactile
Tactile/Visible
Related
Motor actions
Automatic
Postural
Goal-directed
Process
Effect on body
Several actions for effect on environment
Overt trial
and error
Purpose
Arousal
Comfort/Movement
Interest
Touching
Self-control
Reasoning
Perceptibility
of media
Penetrate
Subliminal state
Own body
Colour
Shape
Space and depth
Related intervention
Setting of media
Internal
Arms reach
Visual field
Task environment
Tool use
Stimulated body
Part
Spontaneous
use of body part
Chance use of
found objects
Hand tools as a
means to an end
Verbal directions
Pronouns, Names of body parts Verbs
Verbs, Names of
material objects
Adjectives
Adverbs
Prepositions
Explanations
Demonstrated directions
Physical contact
Guided movements
Action on an object
Each step in a series
Each step &
precautions for errors
Adapted from: Allen CK, Earhart CA, Blue T (1992) Occupational Therapy Treatment Goals for the Physically and Cognitively Disabled
The American Occupational Therapy Association, Inc. Rockville, MD

19. The easy-to-complete PAL© Checklist works out the level of cognitive and functional ability of the individual

20. Cognitive Rehabilitation
GOAL:
Complete daily chores without being distracted
Compensatory Intervention:
White boardI
Create ‘workstations’ with all objects needed placed in the visual field.
RESTORATIVE:
GRADED ACTIVITY
Write a ‘method’ in stages for each task and place at the workstation.
Use expanded rehearsal and gradually withdraw written cues
Anxiety and stress management:
Existing strategy of deep breathing reinforced and refined to include slow out-breath
Pacing of chores
Cognitive Rehabilitation
ATTENTION AND concentration:
Focused on divided attention:
Plan tasks for when wife at day care
Take control when unable to give full attention e.g. ring back, rearrange appointments.

21. Cognitive Rehabilitation
GOAL:
Independently use the en suite toilet
RESTORATIVE:
GRADED ACTIVITY
Establish a new pattern of moving from bed to toilet using expanded rehearsal
Compensatory Intervention:
Toilet sign on door
Plain flooring
Anxiety and stress management:
None needed
Cognitive Rehabilitation
ATTENTION AND concentration:
Colour contrast toilet seat and toilet paper
Have a fun reminder notice opposite the toilet for readjusting clothing

23. www.affinity-training.com jackie@affinitycm.co.uk