Abilities Based Approaches to Assessment and Treatment of Persons with Dementia

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1. I think it depends on the stage of dementia. I think that spaced retrieval can do much more for us, as clinicians, than we realize. It just takes time, appropriate intervention, and focus. Individuals can make significant strides with spaced retrieval. In the end stages, errorless learning is key. These are areas that we will tap into more next week, but they are both equally beneficial. I do not really have a favorite. I think it depends on where the person is in their disease process.

2. As therapists, things that seem very simplistic to us are not always simplistic to other caregivers. When training staff, I recommend using a multiple phase training process. First, they need to verbally express that they understand the way that you need them to perform the dressing, bathing, toileting, or eating task. They then need to return demonstrate. I always make sure that they know it is a two-step process. They may be able to explain to you how they need to dress that patient, but do not just have them explain, have them show you.

3. Yes. Nursing is typically thrilled when we tie in spaced retrieval because they are typically the ones that are getting those repeated questions. This is a good area to use this technique. Talk with nursing and see if there something that they continually ask for. For example, "When is dinner?, What are the activities for the day? What is my room number?" This is always a good test area. 

4. The answer is no. When you looked at the content and the way it was divided up today, the compensation portion, the visual signage, and verbal-auditory rehearsal would be for moderate or end stages. Dual tasking and spaced retrieval would typically only be recommended for early stages. I am not going to say never because we have all seen the dementia patients that surprise us, but typically you are going to see the most success in the early stages.

5. You hit the nail right on the head. If you are adding visual contrast in a SNF, you have to have facility buy-in to do that. Typically where I see facilities going this route is by moving to restraint free environments, and wanting individuals to have freedom to move throughout the facility. How can we start with adding visual cues? Signage on doors or even using shadow boxes is an easy buy-in. Gait is a complex task, but gait is procedural memory. If we allow folks to move throughout their environment freely, even to end stages, they can. Adding little strips of tape across the hand guards that you see in the hallway to increase visual contrast of where someone needs to grab, or where the wall is, is another way of adding visual cues into the environment.