Strategies and tasks for people with Dementia or Alzheimers

This is my next installment in the series of cognitive therapy task ideas taken in part from a student project by Janelle Barrett). Have you read my ideas for Orientation therapy tasks HERE, Left Attention and Left Neglect HERE, Memory HERE, and Attention HERE.

Without further ado, I give you all the dementia treatment ideas I could think of today:

• Make a personalized memory book
• Include information about the patient themselves, what they like, their age, etc.
• Include photos of the family, the home, etc.
• Example: 
• Page 1: My page
• Consider including name, address, birthday...
• Page 2: My parents
• Page 3: My wife
• Page 4-7?: My kids
• Page 8: My grandkids
• Page 9: My dogs
• Page 10: My house
• Page 11-14: My history
• Page 15: My hobbies

 *I should add here that one of my old students- Melissa Kirby from a few years ago, made me an AWESOME example memory book to show to patients and families and to help them create their own.  It's been really nice to have an example to show them isntead of just explaining it.  It usually helps them spark other ideas.  I try to have them start working on it right away and get it done early so we can use it in therapy before the patient discharges.  
 

• Reminiscence therapy
• Spaced Retreival
• Have patient write out steps for specific tasks (ie. taking medications)--place around patient’s room
• Place labels around the room where certain objects should be kept (ie toothbrush, keys, shoes, etc.).
• Family training for use of strategies
• Creating a daily schedule - teaching family how to assist patient with it daily.
• Create a daily log notebook or a journal.  Have patient and family contribute daily.
• Research shows that in patients with dementia, the brain is still capable of new learning, so cognitive tasks and cognitive stimulation continue to be beneficial.
• Place orientation information around the room
• A (large-print) calendar 
• Photos of family and even staff if appropriate
• A note on the mirror (or in a location that will be most helpful) to help with confusion in the morning, for example.
• This depends on the patient's needs, but could include something about who they are, where they are, where to find the information they need, etc. 

Other helpful tips:

• Familiar music can be comforting
• Staying active and going for walks is good too!
• Keeping a calm positive therapy atmosphere

 So what do you do for patients with dementia?  Many of you may have MUCH more experience with this population than I do!  

Tasks Ideas for Visual attention, Left Neglect/Inattention

Portions of Janelle Barrett's student project continued...

Visual Inattention or Visual Neglect are such a bizarre phenomenon.  I remember when I was a beginner clinician and saw my first patient with left neglect.  It was hard to wrap my head around the fact that it's not a VISUAL problem.  The patient absolutely could not see things on the left, only because they were "not looking."  Totally blew my mind as I watched the patient struggle to find my eyes, bang into the wall on the left, and eat only the food on the right side of his plate.  The patient was just as baffled as I was (I mean, I had learned about this in school, but seeing it in real life was so wacky!)  Of course, left neglect is most common, but despite those non-believers, I HAVE seen true right-sided inattention or neglect as well!

People seem to make relatively quick progress in this area if they work really hard on it.

There has been some argument about whether or not the word "neglect" is truly correct, versus inattention, etc.  Call it what you want- but how do you attack it.  Here are some ideas from a few SLPs and SLP students.  The high- and low-level are all mixed together.  What about your ideas?  Leave me a comment!

Image courtesy of: cognitiveneuro.wordpress.com

• Of course I always sit to the patient's neglected side, and try to ask them to look at me all throughout the session.  
• I also ask staff and family to always sit to the neglected side
• I have their TV put on the left, or shift the bed around if needed so that they are looking to the left
• A couple of my patients have loved looking out their window or out into the hallway, so I have had the bed switched around so those things are on the left. 
• I will literally hold the patient's head to the left in severe cases (where they cannot sustain a left sided turn of the head and they instantly "sprinkler" back to the right or non-nelgected side).
• I put all therapy tasks on the neglected side (if the patient can do it)
• Cancellation and cross out tasks 
• For really severe cases this can be as simple as having two pictures on a page and having the patient find the one on the left
• Letter cancellation tasks (large or small print, full or part-page)
• Symbol cancellation can be even tougher.
• I think it's important to make sure the patient goes line by line, left to right. No jumping around.  That will not help them with reading in the future.
• Reading tasks
• Newspapers, magazine articles, large print if needed
• Can use colored line on side of neglect or inattention if needed
• Can use colored index card to follow lines of writing
• I usually have them follow along with their finger
• Can also number the lines if needed 
• My co-worker has patient follow along as she reads
• Writing tasks
• Keyboarding/typing tasks
• Web navigation
• Google searches
• Email
• Reading and typing
• Apps: 
• Dr. Ben
• Doodle Pro
• Little Things
• Reading and typing tasks on iPad
• Games: 
• Memory or concentration 
• Cooking tasks: keep necessary items on side of neglect
• Visual search tasks 
• Find all the similar symbols
• Where's Waldo
• I Spy 
• Fruit Ninja
• "Oops, you missed that bomb. It must have been on the left side!"
• Going for a walk or an outing 
• I'll have them look for things on the neglected side
• Post-its or pictures on the wall
• Hidden clues 
• Ask about details in the pictures on the wall, etc.
• Sometimes we place obstacles on the neglected side
  

• Having the patient read and follow a map
• We have really liked some of the tasks and worksheets in the book Focus on Function (among many other great cog books) and have used everything from check writing, to maps, to filling out forms, to reading a TV guide from this book.  
• Hide things in the drawers of the room (on the left side of the drawer (e.g., Where's your chap-stick?).
• Some of the Lumosity games are great (we have a staff log-in we can all use which has worked well.
• Tic-tac-toe
• Mazes
• There is a task we like that is hard to describe- it has a poem at the top, and then the poem below with many similar and extraneous words throughout.  We have the patient circle the correct words as they read along.  In the end you have the poem in order once again.
• Kitchen tasks 
• Have the patient find the ingredients or utensils they will need
• Have them search for safety problems (my OT co-worker sets up an awesome room full of hazards, including cords ready to trip someone, running water, a burner left on, a knife placed precariously, etc.) 

 Happy Left-Scanning!

Kristin

Therapy Task Ideas for Orientation

This post is a continuation of the series of cognitive therapy ideas taken from a student project by Janelle Barrett (who is not a student anymore!). These are ideas gathered from several SLPs and students.  Comment and let us know what you do for orientation!

• O-Log worksheet.  Do this before showing them their calendar and memory aides. (This is a standardized little task with 10 questions.  They are worth up to 3 points per question for a total of 30 points.  Practice "calendaring"
• Have the pt. fill out a blank calendar (numbering the days, labeling the month)
• Have the pt. cross out days that have past
• Write all holidays and important upcoming family events and birthdays
• Write all significant hospital-related days (surgeries, accidents, date of admission to Rehab, discharge date, last day of therapies, etc.)
• Have the patient answer questions (e.g., "According to your calendar, how long have you been here in the hospital?  In Rehab?  How much longer will you be here?  How long until the next holiday?  How long will your total Rehab stay be?") 
• Jot down up-coming appointments or to-do's (e.g., Write a birthday note to Julie before Friday.)
• I like to use a small post-it sticky on "today's date" if the patient is struggling each day to find it.  Each morning we practice moving the sticky and crossing off the previous day.
• Discuss different ways to find orientation info (environmental cues, calendars, newspapers, etc.)
• Have the patient go on a walk and find ways to answer orientation questions (Where are we?  Where could you go to find the answer?)
• Have a daily log book
• Have them write down what the patient did each session, who was there, any other significant events, visitors, the patient's thoughts and feelings.
• Have the patient review past entries each day to remind them of what's going on and who has been around.  
• Practice day planner use, including to-dos, etc. 
• Or for tech-savvy patients and teens, we work on electronic planners, calendar apps, etc.
• Practice using alarms (cell phone alarm to remind them to take pills, etc.)
• I'll put an enormous poster-sized calendar or orientation poster at bedside if needed.  Sometimes I'll have the patient put it together with me as part of therapy.

What other comments do you have?  Leave me some fresh ideas in your comments!

MORE Memory Therapy Task Ideas

 Memory troubles are just the worst!

This post is a continuation of the series of cognitive therapy ideas taken from a student project by Janelle Barrett (who is not a student anymore!).  I know I have posted about memory task ideas here and here in the past.  This post just has more!  These are ideas gathered from several SLPs and students.  Comment and let us know what you do for memory!

(The cat realizes she left something in the oven.)

• Functional Strategies
• Associations
• Chunking
• Calendars
• Visual Memory/Mental Imagery
• Use of Alarms
• Writing things down in a planner or notebook
• Daily log
• Daily checklist
• Mnemonics
• Visual reminders
• Post-its
• Written instructions to-self
• Rehearsal
• Tasks
• 3 Facts
• Prospective memory: ask them to initiate telling them to you at a specified time.
• Have them make up a memory strategy to remember each
• Word list retention
• The Simon Game app (there are several variations/apps like this)
• Recalling 4 categories as they go through a 4x4 categorization matrix
• The “Help for Memory” book is great
• Study a picture 1-2 minutes, then recall all they can.  THEN think of a strategy to remember them better and practice again or change pictures
• Flick Flag app (First we study the flags under the instructions.  I have them come up with a good association strategy for remembering each flag- the more creative the better.  Great for learning to make memory tricks and associations.)
• Hide 3-4 objects around the room (good for non-verbal patients)
• Have them remember a hand shake combo (also good for non-verbal patients)
• Apps with “concentration” game
• Practice strategies for remembering faces or photo cards
• Practice strategies for memorizing state abbreviations
• Chunking word lists (Help for Memory p. 52)
• Using visualization to remember information (Help for Memory p. 101)
• Taking notes from material presented out loud (Help for Memory p. 103)
• Associate visual objects (The Source for Memory Exercises p. 81, 83)
• Mental Manipulation - read patient 3 words, have pt. say them back in alphabetical/chronological/reverse order (ie. “October, April, February” → “February, April, October”)
• Visual Memory: Have the patient use a chunking strategy to recall 12 pictures (The Source for Memory Exercises p. 152, 153)
• Identifying “key” information: Read sentence to patient, have patient identify key words to simplify encoding. (Help for Memory p. 21)
• Repeat list of 3-6 words, then ask pt. to identify which items have certain attributes (e.g., which are animals, which are the softest, etc.)
• Cog-log worksheet (more difficult than it's famous sister worksheet- the O-log)
• WALC 10 workbook is great.
• Practice using day planner or electronic day planner (calendar app)
• Alternating card task: I show them one word or picture card (e.g., fork) and then another (e.g., ball) and have them say the previous card (fork).  We continue until they get lost.  I have found that ~11 is typical for my non-impaired co-workers.  Some people can go an even longer time!
• Mental math with no writing things down
• Memory Rehabilitation: Integrating Theory and Practice" by Barbara Wilson - See more at: http://pathologicallyspeaking.blogspot.com/2013/05/email-slp-q.html#sthash.0EaYqvrC.dpuf
   Book: "Memory Rehabilitation: Integrating Theory and Practice" by Barbara Wilson.
  "Memory Rehabilitation: Integrating Theory and Practice" by Barbara Wilson - See more at: http://pathologicallyspeaking.blogspot.com/2013/05/email-slp-q.html#sthash.Ec7dO5e9.dpuf

Hope you got some new fodder for your sessions tomorrow.  :)   

Don't forget to comment- 

I need some fresh ideas!  

What do you use for working on memory deficits?

-Kristin