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TRANSCRIPT
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Cognitive Stimulation Therapy: Making a Difference for People with Dementia
Disclosure StatementWe have no relevant financial relationships to disclose
PresentersJanice LundyBSW, MA, MHADirector of Social Work and Geriatric Case ManagementPerry County Memorial [email protected]
Debbie Hayden RN, BSN, OTR/LDirector of Occupational TherapyPerry County Memorial [email protected]
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PresentersSue TebbPhD, MSW, RYT-500Professor School of Social WorkSaint Louis [email protected]
Julia Henderson-KalbMS OTR/L Instructor Department of Occupational Science and Occupational TherapySaint Louis [email protected]
AcknowledgementsMax ZubatskyPhD, LMFTAssistant ProfessorDepartment of Family and Community MedicineMedical Family Therapy ProgramPhone: 314-977-2496 [email protected]
Developing and Implementing a CST Group
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What is Cognitive Stimulation Therapy?
An evidence based Psychosocial treatment for individuals with mild to moderate dementia
Focuses on the improvement and strengthening of cognitive functions
Maintenance of social and interaction skills
Potential to improve mood and quality of life
Development of CST
CST developed by Dr. Aimee Spector under the direction of Dr. Martin Orrell and his
team at University College London (UCL).
Introduction
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Outline of CST Train the Trainer Toolkit/Session
How to use the manual Evaluating culturally appropriate material How to set up sessions/classes Planning and facilitating groups (recruiting, marketing,
transportation, time of day, space) Co-leading groups Managing behaviors in group Maintenance of groups short-term/long-term
Outline of CST Train the Trainer Toolkit/Session (cont)
Forms used in CST groups Billing of group activities-how it is coded Offering CST on an individual basis Exercise option Caregiver support, understanding CST and use of CST
between sessions FAQ
Key Principles of CST1. Mental stimulation 2. New ideas, thoughts and
associations3. Using orientation, both
sensitively and implicitly4. Opinions rather than facts5. Using reminiscence as an aid to
the here-and-now6. Providing triggers to aid recall7. Continuity and consistency
between sessions8. Implicit (rather than explicit)
learning
9. Stimulating language10.Stimulating executive
functioning11. Person-centeredness12. Respect13. Involvement14. Inclusion15. Choice16. Fun17. Maximizing potential18. Building / strengthening
relationships
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Session Structure Introduction
Welcome every member individually Group name Soft ball toss ( warm up and orientation of members) Reference to day, weather, season (always on board as cue). Any discussion of important events in their lives since last session.
Theme Song Current Affairs ( Local and national). Main Activity Suggested activities for home (may include in take home
handout). Closure (discuss time, day, and activity for next session-get
opinions).
Videos on CSTShort version: 21/2 min
https://www.youtube.com/watch?v=ohM8WGo2gO4
Medium version:11 min.https://www.youtube.com/watch?v=kh3XqDEqVN4
Key Features of CST Program
14 CST sessions, usually twice a week 45 minutes to an hour, with exercise component will be longer. Ideally 5-8 participants in a group, run by two
therapists/facilitators. Each session has a choice of activities, to cater for interests
and abilities of group. Group members should ideally be at similar stages of
dementia, so activities can be pitched accordingly. Attention should be paid to gender mix.
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Who is appropriate for CST?Meet
criteria for dementia,
SLUMS greater
than 10?
Can s/he
have a “meaningful” conversation?
Can s/he hear well
enough to participate in a small
group discussion?
Is her/his vision good
enough to see most pictures?
Is s/helikely to
remain in a group
for 45 minutes?
YES
YES
YES
YES
YES
THIS PERSON MIGHT BE
INCLUDED IN THE GROUP
THIS PERSON SHOULD NOT BE INCLUDED IN THE GROUP
NO
NO
NO
NO
NO
Assessment of participants SLUMS
http://medschool.slu.edu/agingsuccessfully/pdfsurveys/slumsexam_05.pdf QOL-AD
http://www.dementia-assessment.com.au/quality/qol_handout_guidelines_scale.pdf Cornell Scale for Depression in Dementia
http://www.amda.com/resources/2005_updates_ltc_teaching_kits/dementia.pdf TUGS
http://www.cdc.gov/homeandrecreationalsafety/pdf/steadi/timed_up_and_go_test.pdf http://www.rehabmeasures.org/PDF%2520Library/Timed%2520Up%2520and%2520Go%2520Test%2
520Instr.. Short Blessed
http://geriatrictoolkit.missouri.edu/cog/bomc.pdf Trailmaking A and B
http://doa.alaska.gov/dmv/akol/pdfs/uiowa_trailmaking.pdf AM-PAC mobility and daily activity
http://www.bu.edu/bostonroc/files/2013/10/AM-PAC-Short-Form-Manual_10.24.2013-SAMPLE.pdf
Strengths, sensitive areas, interests, literacy, hearing, etc.
Preparation to Begin Groups
Marketing/Recruitment Medical community, web sites, senior centers, LTC/RES
communities, churches, caregiver support groups, etc.
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Preparation to Begin Groups
Explaining nature and purpose of CST groups to participant and caregiver.
Organizing transportation, room, therapists/facilitators. Deciding on time of day (mornings if possible). Preparing material for each session (Being well prepared
is essential). Preparing send home information for each session.
ROLE PLAYING ACTIVITY
Co-Leading Groups
Essential that therapists/facilitators are a good match. Choose co-leaders carefully. good understanding of dementia symptoms and behaviors patience and ability to manage and redirect ability to emotionally connect with group members (group
members see you as leader but also part of the group) define roles prior to beginning groups
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Managing Groups Varying of cognitive abilities Attempt if possible to group according to cognitive abilities-not
always possible Attention to members not participating (draw them back in to
discussion) Attention to each members feelings at all times Attention to members who monopolize
o sometimes can be due to anxiety ( helping them feel at ease)o recognize their contribution and gently move discussion to
another member. Physical needs (toileting, ambulation, mobility)
Assure patients’ physical needs are met (co-facilitator)
Managing Groups
Examples for discussion of common issues that occur
1. It is very difficult to get some members to come to sessions, although once they are there they really seems to enjoy it. What could you do to encourage them?
2. When the caregiver is a spouse they sometimes can resent the closeness of the group. What can be done to help them feel a sense of inclusion?
3. Often you will have one or two members who will take over and repeat the same lengthy stories over and over again. Other members begin to notice and are becoming bored. How can you manage this?
Maintenance CST Groups
Community vs facility. Deciding on time. Incorporating new members into the group. Group name and song (can become confusing if adding
new members to an existing group) Managing size of the group and similar cognition How to handle when a member is no longer appropriate
for group. How to keep it interesting and from becoming stagnate
over time.
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Maintenance CST Groups
Monitoring progress Keeping records of progress Outcome measures, including:
SLUMS- measures cognitive changeQOL-AD- measures quality of lifeDepression screen
Feedback from group and caregivers Regular support and supervision is essential
Incorporating Exercise into CST Groups
Exercise Can Benefit Those With DementiaMeta-analysis found exercise helps in most domains 40 studies used broadly defined exercise interventions-
including flexibility, strength, balance, and aerobic activity
It assessed a range of outcomes including, cognition, behavior, function, endurance, balance, strength, flexibility
Found exercise helps people with dementia in most every physical and functional aspect-jury still out on cognition
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Guidelines for Exercise in Older Adults Aerobic Exercise
Moderate Intensity; 30 minutes/day; 5 days/week Vigorous Intensity; 20 minutes/day; 3 days/week
Resistance Exercise At least 2 nonconsecutive days/week Eight to ten exercises
Flexibility Exercise At least 2 days/week for at least 10 minutes
Balance ExerciseAmerican College of Sports Medicine and the American Heart Association
Types of Exercise
CDC Exercises for Older Adults
CDC Strength Training for Older Adults
Part I: strengthens the body slowly and gently, using only the person’s own body weigh
Part II: introduces dumbbells and ankle weights to increase strength
Part III: adds variety with new ways to boost strength even more.
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Providing Support for CST Participants’ Care Partners
Working with Caregivers of Dementia I. Exploring the Experiences and Journey of the Diagnosis
II. Determining the Individual’s Style of Caregiving
III. Assessing Resources and Support Systems
Exploring the Journey of the DiagnosisImportant areas to consider when exploring the lived experiences and narratives of new caregivers and support members: How was the diagnosis communicated to you? What meaning have you tried to make of the
diagnosis? Who was involved in your care team during the
initial stage of the diagnosis? How have you and your family handled the
caregiving responsibilities? (open to outside help or choosing to handle needs within the family system)
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Determining the Individual’s Style of Caregiving
In caregiving, there is truly no “one size fits all” approach. Individuals offer care to their loved ones in a variety of ways and have a unique routine that works in sync with the diagnosed member.
Caregivers must also balance the tasks of their personal family, work and social obligations with the increasing demands of caring for their loved one.
Providing encouragement and validating the strengths of caregivers in their roles is an important aspect in the early stages of caregiving.
Assessing Resources and Support System Many first time caregivers feel the need to solely
take on all caregiving tasks and assume full responsibility for their loved one.
It is important not only for caregivers to get a break from the caring role, but to also receive comfort and support in their own lives.
Alzheimer’s Disease is truly a systemic disease, one where changes in the physiology in one person, affects the physical, psychological and social aspects of others members within the family unit.
Questions?
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References Aguirre E, Spector A, Streater A, Hoe J, Woods B and Orrell M (2011). Making a Difference 2.
Hawker Publications: UK. Chapman, S. B., Aslan, S., Spence, J.S., DeFina, L. F., Keebler, M.W., Didehbani, N., Hanzhang, L.
(2013). Shorter term aerobic exercise improves brain, cognition, and cardiovascular fitness in aging. Frontiers in Aging Neuroscience, 12.
Heyn, P., Abreu, B.C., & Ottenbacher, K.J. (2004). The effects of exercise training on elderly persons with cognitive impairment and dementia: A meta-analysis. Archives of Physical and Medicine Rehabilitation, 84(10), 1694-1704.
Khoo, Y.J., Schaik, P. & McKenna, J. (2014). The Happy Antics programme: Holistic exercise for people with dementia. Journal of Bodywork and Movement Therapies, doi: http://dx.doi.org/10.1016/j.jbmt.2014.02.008
Mozes, A. (June 5, 2014). Yoga, meditation may help dementia patients and caregivers alike. Consumer Health News. http://bi.galegroup.com.ezp.slu.edu/essentials/article/GALE/A370354293
Nelson, M. E., Rejeski, W. J., Blair, S.N., Duncan, P.W., Judge, J.O., King, A.C., Macera, C.A., Castaneda-Sceppa, C., (2007). Physical activity and public health in older adults: Recommendation From the american college of sports medicine and the american heart association. Circulation, 116 (9),1094-1105.
Spector A, Thorgrimsen L, Woods B and Orrell M (2006). Making a difference: An evidence-based group programme to offer Cognitive Stimulation therapy (CST) to people with dementia. Hawker Publications: UK
Images retrieved from Google Images or taken during CST group at Perry County Hospital, Perryville MO