It is important to consider which model when working on intervention in dementia to ensure you are focusing on the person as a whole?
the WHO Model of Body structures/ functions, activates and participation
What are the objectives of intervention for individuals with dementia
- feel useful
- purposeful use of time
- give a sense of control
- use residual skills
- maintain current abilities
- promote verbal and non-verbal communication
- meet social needs
In general what are the two types of approaches to intervention in dementia?
direct/ internal strategies
indirect/ external strategies
Describe direct/ internal strategies
- work directly on memory system
- rely on active memory search to RECALL info
- requires conscious effort
- has to be introduced early in disease (while episodic memory still intact)
Describe indirect/external strategies
- based on automatic processing
- rely on RECOGNITION of info based on experience and practice
- external monitoring of info
- physically present in the environment
List some possible direct (internal strategies)
- mnemonic devices
- face-name association
- localization method
- imagery (sounds, sights, smells)
- memory games
- rehearsal
what are three types of rehearsal methods?
- repetition
- elaboration
- association
What are the two subtypes of repetition strategies?
- repeated exposure
- spaced retrieval
Describe spaced retrieval
- repeat same stimulus with increasing space between each exposure
- if patient fails to recall response, info is provided and pt repeats (error full)
- relies on non-declarative memory systems, which are thought to be spared in AD
What are the strengths of spaced retrieval?
- can be incorporated within other task in pt’s routine
- clinician can control the type of response being trained, duration of time intervals, overall # of recall trials, and activities taking place between recall trials
- highly flexible because response can fe verbal or nonverbal
What is errorless learning?
- ensures pt always responds correctly, involves the use of cues and prompts
- i.e. vanishing cues, and forced choice
How can errorless learning apply to dementia
- learning new info
- relearning forgotten info
- face and name associations
- biographical info
- using calendar and electronic memory aid
What are the strengths of errorless learning?
- actively engages participant in learning process
- participants experience success through the learning process
- can be combined with other strategies such as spaced retrieval
- reduces or removes errors
Results from an errorless learning study in class show what?
- sig improvement in performance on trained items
- maintenance at 6 months follow up
- better results for cued recall
Indirect intervention, external memory aids can either be _________ or ________
high tech
low tech
What are some examples of high tech memory aids?
Watch reminders, clock radios and timers, automatic medication dispenser, amplified photograph telephone, electronic diary, neuro pager, pill organizer etc.
What are some examples of low tech memory aids
Calendars, notes, information boards, schedules, labels, pictures, strategic object placement, memory book/wallet, etc.
Memory aids are objects that are utilized to decrease cognitive load and assist with deficits in which three areas?
- Memory (recording, retrieval and recall)
- Executive funciton (planning, organization, execution, verification)
- Language (semantics, pragmatics, syntax, phonology)
What should be included in memory books/wallets?
- biographical info
- collection of pictures and artifacts
- descriptions of events
- provide recognition cues, through visually accessible topics that facilitate and support communication
Who benefit from memory books?
- mild, middle, and late stages of AD
- individuals with language deficits
Why should we use memory books?
- increases positive verbal behaviour and decreases non productive verbal behaviour
- provides thematic structure and increases # of ideas produced
- enriches convo
- portable and easily modified
What is one problem with memory books and AD?
some people will refuse to use them as they believe they don’t need them
What scientific evidence has been found supporting the use of memory books
- increase in factual statements and fewer ambiguous utterances
- improvements in quality of info content
- decreased unintelligible and perseverative utterances, and increased efficacy of cueing strategies
What are some limitations of memory books?
- often forget to include desirable content
- requires: organization skills and commitment, visuospatial skills, fine motor skills, memory and reading skills
