Week 4 Flashcards
name the 4 types of dementia.
- alzheimer’s
- vascular dementia
- lewy body dementia (LBD)
- frontotemporal dementia
- cognitive screening tool
- examines orientation (time and place), immediate and delayed recall, attention and calculation, language and visuospatial ability
- useful for quantitively estimating the severity of cognitive impairment and documenting cognitive changes
- sensitive and specific
mini-mental status exam
- quick screening tool for probable dementia (2-4 minutes)
- combines word recall with clock draw
- sensitivity and specificity are strong
- performance on test is not influenced by education level or language skills
mini-cog
- a rapid screening for mild cognitive impairment
- assesses attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation
montreal cognitive assessment (MOCA)
- a functional measure that examines level of cognitive support required by a person with dementia to complete a cooking task.
- client asked to prepare a box of pudding with set up, instructions for stove use, directions for locating items, large print instructions available.
- cueing provided as needed (verbal and physical)
- initiation, organization, performance of all steps, sequencing, judgment, safety and task completion noted
kitchen task assessment (KTA)
what does the KTA provide information about?
provides info regarding assistance level needed
- provides information that reveals a client’s ability to deal with safety hazards
- clients are asked to identify and correct 8 safety hazards in the kitchen
- avoid cueing the client, note number of times instructions have to be repeated.
- use ambulation device as needed
- do not enter kitchen unless client can state instructions
- note order hazards are found and safely corrected, how the environment is scanned, balance and coordination.
- safety with corrections depends on mobility status.
- non-standardized but useful for discharge planning
robnett home safety screening
name the 4 main intervention approaches for individuals with dementia/cognitive impairment.
- task-specific training
- COPE
- theory-based activities for behavioral symptoms
- TAP
- used for individuals with mild to moderate dementia
- determine client’s valued roles and associated tasks
- constant practice using graded cues
- incorporate external memory strategies
- visual feedback and verbal praise
- practice without error
- verbal or physical assistance to perform task correctly
task-specific training
what does COPE stand for?
care of persons with dementia in their environment
- designed for clients with middle to late stage dementia
- clients exhibit functional dependence and behavioral symptoms
- caregiver distress noted
COPE
name the 5 COPE principles.
- client-centered and client-directed
- customized and tailored
- culturally relevant
- problem-solving
- active engagement - learn by doing
- multi-component intervention
- home-based intervention
- requires training
COPE
what is the goal of COPE?
to reduce environmental stressors and improve caregiver skills
which types of visits does COPE consist of?
2 NP visits and 10 OT visits
describe phase 1 of COPE OT visits.
2 visits for assessment
describe phase 2 of COPE OT visits.
treatment, including provision of COPE prescriptions over 6 sessions
describe phase 3 of COPE OT visits.
promote generalization of strategies, 2 visits
describe 4 roles of the OT for the COPE intervention.
- interview caregiver to determine patient routines, previous and current roles, interests and habits.
- assess cognitive skills - attention, initiation, perseveration, memory
- provide caregiver training regarding home modification, adapting activities, communication strategies, use of problem-solving
- provide written action plan for each targeted concern
name 4 COPE strategies.
- communicate effectively
- modify the home
- reduce the complexity of the task (simplify the activity)
- enhance activity participation
name 3 outcomes of COPE intervention.
- improves caregiver well-being
- decreases functional dependence
- improves engagement
which type of care setting are theory-based activities for behavioral symptoms most useful for?
long-term care setting
what are the MMSE scores that must be obtained to use theory-based activities for behavioral symptoms?
8-24
- based on need-drive dementia-compromised behavior model
- participation in activities adjusted for personality and functional level
theory-based activities for behavioral symptoms
what is the name of the questionnaire used to determine personality type for theory-based activities for behavioral symptoms?
NEO-PI-R
depression, anxiety, self-consciousness
neuroticism
gregariousness, assertiveness, activity, excitement seeking
extraversion
fantasy, feelings, ideas, aesthetics, actions
openness to experience
altruism, straightforwardness, tendermindedness
agreeableness
order, achievement striving, dutifulness
conscientiousness
name the 2 functional levels considered for theory-based activities for behavioral symptoms.
- cognitive skills
- physical function
name 4 activity examples for theory-based activities for behavioral symptoms.
- bicycle with front seat
- tether ball
- removing items for tackle box or purse
- feelings cube
name 3 outcomes for the theory-based activity program.
- improved engagement
- decreased passivity
- decreased agitation
- tailored towards interests and ability
- culturally relevant
- problem solving: collaborate with caregiver
- active engagement (practice the activity)
- client-centered (caregiver status)
tailored activity program (TAP)
name the 3 components of a TAP assessment.
- client: interests, roles, occupations, cognitive status, mobility, sensation
- environment
- caregiver
describe the 4 components of TAP activity prescription.
- 3 potential activities tailored to client capacities, environment, and caregiver
- training and practice (set up, cueing, monitoring)
- generalization: modifying the activities, practice communication, link strategies to everyday activity
- activity schedules
name 2 TAP outcomes.
- reduced frequency of problem behaviors, greater activity engagement
- caregivers had less time “on duty”, increased self-efficacy, and skill enhancement
describe 4 strategies for communicating with clients with dementia (mild stage).
- take time to listen to how the person is feeling
- give time to respond
- don’t interrupt or finish sentences
- explore which method of communication is most comfortable
describe 12 strategies for communicating with dementia (moderate stage).
- identify yourself, use the client’s name
- use short words and simple sentences
- one question at a time
- speak slowly
- repeat as needed after a pause
- give visual cues
- avoid quizzing
- ask yes/no questions
- use friendly facial expressions and tone of voice
- use positive phrases
- go along with what is said
- use distractions to redirect the client
name 3 strategies for communicating with clients with dementia (severe stage).
- approach the person from the front
- encourage non-verbal communication
- emotions expressed may be more important than what is being said
difficulty with memory, trouble with orientation to time and space, difficulty with new learning
early stage alzheimer’s disease
people become more repetitive - repeat themselves over and over again, have difficulty with familiar tasks, have difficulty recognizing people
middle stage alzheimer’s disease
people respond more globally (respond to their name with eyes moving, for ex.), issues around incontinence, swallowing problems
late stage alzheimer’s disease
which is the last type of memory to go?
procedural memory
- interruption to the blood supply to the brain
- could have a stepped progression where they are functioning at a certain level and then see a drop in function.
vascular dementia
issues with motor skills, issues with cognitive deficits as we see in other types of dementia, hallucinations, muscle rigidity, balance problems
lewy body dementia
number of different disorders that affect the frontal and temporal lobes - changes in personality, disinhibited, deficits in language skills - unable to communicate using language, muscle rigidity, impaired coordination
frontotemporal dementia
what are MMSE scores for mild dementia?
21-26
what are MMSE scores for moderate dementia?
11-20
what are MMSE scores for severe dementia?
0-10
mild cognitive impairment, not affecting your memory as much as other things - being able to find your way in space is a common issue
nonamnestic
describe scoring for the MOCA.
score of 26 or above - person is consider normal, lower scores = cognitive impairment
describe the pretest for the kitchen task assessment.
instruct pt. to go into the kitchen and wash their hands - if they can’t do that, you don’t continue with the assessment
is the KTA a static or dynamic assessment?
dynamic
describe scoring for the KTA.
0-18 - higher score indicating a higher level of impairment
is cueing involved in the Robnett home safety screening?
no
describe covert vs overt hazards.
overt are more obvious and covert are more hidden.
task-specific training capitalizes on what type of memory?
procedural memory
don’t let them make a mistake
practice without error
COPE is tailored towards which types of people?
people who have functional dependence (require a lot of assistance)
COPE engages the caregiver in what?
problem-solving and active engagement
which type of personality would like to participate in the bicycle with front seat activity?
openness to experience
which type of personality would like to engage in the tether ball activity?
extraversion
describe the difference between TAP and COPE.
TAP is just activity prescriptions and schedules but COPE goes beyond that and involves nursing, strategies, activity modification, communication strategies, environmental modifications
