Killick, J. and Allan, K. (2001) Communication and the care of people with dementia. Remembering What You Hear . A more structured approach to communicating with people with advanced dementia is one called ‘Intensive Interaction’. She was also able to take communicative turns, initiate interactions and imitate her communication partner (who was Maggie), signalling her willingness to interact with another person through her behaviour. Remembering Appointments . Speech and language therapists work in a variety of setting supporting those with dementia, including specialist memory services, older people’s later life community mental health teams, acute hospital wards, care homes, community services, learning disability services, and forensic services. What we need to remember is that the person will be trying to communicate in other ways, as the need to communicate remains to the end. What can you talk about with a person who appears to have little or no verbal communication? ‘Coma work’: can it help people with advanced dementia? Therapists can play a role in caring for those with Alzheimer’s disease and other forms of dementia, however, says Carmen Vitton, MS, CCC-SLP. I just need a few things to get you going. Dementia speech therapy materials created by Medical SLPs. Even if you believe your loved one now has a limited ability to learn new things, occupational therapy treatment can be helpful. Both a physical and occupational therapist may assist you in changing and enhancing your loved one's environment to improve function and safety. Hi! It can help them stay independent and feel better in themselves. Get personalized guidance from a dedicated local advisor. (1983) ‘Newborn infants imitate facial gestures’, Child Development, vol 54, no 3, pp 702–09. Remember to structure the conversation in a simple way, and not to expect the person to try to answer questions (other than perhaps just with a simple nod) or explain things. Let’s consider a few simple points about non-verbal communication first, as it plays such a big part in communicating with people with advanced dementia. This imitation forms the basis of early interactions between babies and parents and provides the foundation for future communication (Tomasello 1992). This is sometimes written as ADRT - advance decision to refuse treatment - and used to be known as a living will or advance directive. I recently lost my mother who lived with dementia for the last 8 or more years. However, an experienced speech pathologist can tailor a treatment plan that improves the patient’s outlook on all fronts. For care staff, this sort of communication is only possible if the care team have a clear picture of the person’s life history, and have things to draw on that are close by – for example, photographs, important pieces of memorabilia or other items that are meaningful for that person. I realized that there are a couple of purposes to cognitive therapy for those with dementia. Skip to the front of the line by calling (888) 887-4593. Ellis, M.P. Cognitive stimulation therapy (CST) is a structured program for groups of people with mild to moderate dementia. Identifying pain in people with dementia If we can uncover and focus on these alternative methods of interaction, we have a better chance of reaching the person. In the early stages, rehabilitation services can help your loved one be as functional as possible for as long as possible. We have all experienced how difficult it can be to understand the tone of a text message or an email because we can’t see the facial expression and body language of the person when they send it. Objective: To describe the circumstances under which SLPs recommend oral nutritional intake for these patients. Remember that the expression on your face will convey more than the content of your words. I can help you compare costs & services for FREE! and Moore K.M. 1092778 This point was echoed by Tom Kitwood who said that, ‘In the course of dementia a person will try to use whatever (communicative) resources he or she still has available. It appears to have great potential for improving communication between people with very advanced dementia and those who care for them. Physical therapy can assess one's ability to walk safely, the risk of falls, and other functional tasks. I'm a senior care specialist trained to match you with the care option that is best for you. Introduction. Young, T.J., Manthorp, C. and Howells, D. (2010) Communication and dementia: New perspectives, new approaches. To investigate the potential of Intensive Interaction for improving communication between people with advanced dementia and their caregivers, Arlene Astell and Maggie Ellis conducted a study in a nursing home (Ellis and Astell 2008). Find out more about Dementia Gold, the training programme on the use of Intensive Interaction with people with advanced dementia, Alzheimer’s Society The Role of SLP in Dementia Michelle DuBre, M.S.CCC-SLP Clinical Specialist, Genesis Rehab Services Master Clinician, Dementia. What we need to remember is that the person will be trying to communicate in other ways, as the need to communicate remains to the end. Speech therapy is a great way for patients to maintain a level of independence for longer. The key message here, however, is that meaningful emotional exchanges are possible between people with advanced dementia and their caregivers without the need to use speech. Some creative work has been tried in relation to applying the ideas of ‘coma work’ (an approach to working with people in withdrawn states, such as a coma) to working with people with dementia. All rights reserved, Communication in the later stages of dementia, Each person is different – so get to know me, Using ‘Talking Mats’ to help people with dementia to communicate, Dementia Communication Difficulties Scale (DCDS), The progression of Alzheimer's disease and other dementias, Identifying pain in people with dementia, Oxleas Advanced Dementia Service: Supporting carers and building resilience, Supporting people in the advanced stages of dementia. healthtalk.org People with Alzheimer's or dementia are at greater risk of falls and mobility problems due to muscular weakness, history of falls, gait, balance deficits and cognitive impairment. Speech-language pathologists (or speech therapists) are often consulted to determine whether a patient can safely continue eating and drinking by mouth … How can a person with Alzheimer's disease or dementia benefit from functional rehabilitation when they don't even recognize family or places that should be familiar to them? Each time I visited with her, we sang the same hymn together. In advanced dementia, the challenge is how to facilitate communication when the person has little or no speech and may only make sounds or repeat isolated words or movements. Source: Speech and Language Therapy - Community Services Reference No: 6551-1 Issue date: 4/10/19 Review date: 4/10/22 Page 1 of 5 s Advice on eating, drinking and swallowing in dementia Before you refer to Speech and Language Therapy Dysphagia (a difficulty swallowing) is common in people with dementia. What happens when they want surgery they don't really need? TALK OUTLINE heck Your Memory… Memory Loss Myths vs. Facts… Memory Processes & the rain…. Question re: Therapy when insurance has paid out the max and no other funds? For example, those persistent body movements mentioned above (such as tapping a finger or pulling at a piece of fabric) could be used as a basis of communication between people with advanced dementia and their caregivers. institute for excellence. Some researchers have studied the links between how we learn to communicate as infants and how this might relate to communication with people with advanced dementia. Dementia affects a variety of cognitive functions, including memory, attention, and visual perception. In the early stages, rehabilitation services can help your loved one be as functional as possible for as long as possible. This neurological disorder causes deterioration of cognition, memory, language, emotion and behaviour and can lead to swallowing problems in elderly people. Advance care planning is a cornerstone of the care of patients with advanced dementia. An SLP can test speech, language, and thinking skills. Occupational therapists can provide instruction on how to manage these daily tasks safely and with as minimal stress as possible. Another approach to communicating with people with limited verbal skills in advanced dementia relies on using a resource called Talking Mats, which was developed by speech and language therapists at the University of Stirling. Speech and language pathologists also offer individualized therapy specific to those with Alzheimer’s disease. Early speech therapy intervention can make a huge difference to quality of life for dementia sufferers. Melanie Sponholz is a Physical Therapist with a Board Certification in Geriatrics (GCS). These imitative behaviours suggest that babies are born ready and willing to interact with others. How Can Speech Pathology Help? Hand book of counselling and psychotherapy with older adults, New York: Wiley. and Astell, A.J. This allows the infant to communicate with their parent in a way that is meaningful to both of them, without the need to use speech (Papousek 1995 cited in Duffy 1999). 2 Objectives • Define Dementia • Understand Staging using The Global Deterioration Scale • Strategies for SLP intervention • Assessment Tools • Swallowing/Dysphagia • Locate Tools & Resources . Edie could not speak and was no longer mobile. The focus of physical therapy (PT) with dementia care is to improve balance, muscle strength and mobility, and provide pain management. Speech-language pathologists have a primary role in the assessment, diagnosis and treatment of swallowing disorders associated with dementia. Supporting people in the advanced stages of dementia Speech-language pathologists can play a pivotal role in the engagement of residents with dementia in a community. Watson House54 Baker StreetLondon W1U 7EX, © Social Care Institute for Excellence. Newson, J. Researchers Maggie Ellis and Arlene Astell have pioneered the use of Intensive Interaction with people with advanced dementia and have developed a programme which teaches caregivers how to engage in this type of communication with those they care for. 4289790 Another goal of PT treatment is fall prevention. Some people with advanced dementia may do certain things over and over, involving the stimulation of their own bodies: rubbing their leg, chewing their fingers, pulling at items of their clothing or patting either themselves or objects with their hands. I'm matching you with one of our specialists who will be calling you in the next few minutes. Talk to them about things of interest (for example, how the family are and what the grandchildren are doing). JESSIE HANGER. DEMENTIA MYTH vs. Buckingham: Open University Press. Ellis, M.P. By acting ‘as if’ they understand their baby’s communicative attempts, a parent encourages the infant to become self-aware (Newson 1978). (Neuroscience), B.A. ognitive Tests… Memory Tools… Remembering Names . Continued. The key purposes that stuck out to me were to help patients maintain their current level of function, reduce behavioral outbursts, and promote independence within their environment. The material of this web site is provided for informational purposes only. and Astell, A.J. A person does not need to remember having engaged in an exercise program to reap the benefits of exercise – they just have to participate. If some of the more sophisticated means of action have dwindled away, it may be necessary to fall back on ways that are more basic, and more deeply learned; some of these were learned in early childhood’ (Kitwood1997). As dementia takes a hold on an increasingly ageing population the Speech and Language Therapist has a key role to play in the care of a person with this disease. For many, family caregiving becomes the most practical and cost-effective solution, at least for a time. Intensive Interaction involves the caregiver becoming familiar with the person they want to communicate with and their non-verbal behaviours, such as sounds or movements. Company Reg. Physical therapy, occupational therapy and speech-language pathology services can be beneficial to the person with dementia as well as their family and caregivers at various stages of Alzheimer's or dementia. Rehabilitation services have much to offer at all stages of dementia to maximize function, manage day-to-day activities, reduce caregiver stress and improve the quality of life for all. The Speech Therapy Group . Speech therapy activities, worksheets, evaluations, and handouts. Struggles in the early stage may include but are not limited to denial; depression; short-term memory loss; paranoia; repetitive question asking; and … A number of researchers have shown that people with advanced dementia still have many identifiable communication skills (Orange and Purves 1996) and still want to communicate and interact with others (Ellis and Astell 2008). In speech-language therapy, exercises often target dysphagia (swallowing problems), cognition, and communication. She is an alumnus of Columbia University where she received a Master of Science Degree in Physical Therapy. These specialists also can assess a person's cognitive and communication abilities and recommend strategies to help manage difficulties. Orange, J. and Purves, B. After initial diagnosis, a speech-language pathologist (SLP) must first obtain a detailed, heightened awareness of the daily challenges against which the individual with early stage dementia is battling. (2008) ‘A case study of Adaptive Interaction: a new approach to communicating with people with advanced dementia’, in Zeedyk, M.S. (2011) ‘Adaptive Interaction: a new approach to communication’, Journal of Dementia Care vol 19, no 3, pp 24–26. Vitton is chief operating officer of Rehab Synergies. NAPP developed a range of resources to support the campaign, including 10 videos, a booklet for care staff, a booklet for family carers, a poster, and a report of a major survey of care homes on the issue of pain in people living with dementia. How to begin interacting with a person who may seem distant and unable to communicate? His or her initial loss of independence can be overwhelming. social care Hearing loss may also put a person at risk for dementia. All SCIE resources are free to download, however to access the following download you will need a free MySCIE account: Caldwell, P. (2005) Finding you finding me: Using Intensive Interaction to get in touch with people whose severe learning disabilities are combined with autistic spectrum disorder. The healthtalk website contains stories from 31 carers of people with dementia, some presented in videos, some in audio recordings. This accumulation of symptoms often leads to impaired judgment, disorientation, and even depression. We often convey the underlying meaning of a conversation through non-verbal forms of communication, for example we pay great attention to non-verbal signs such bodily movement, touch and facial expressions when we communicate with each other. This 2013 resource from The King’s Fund describes how health and social care services in one local area are working together to support people living with advanced dementia in the community. Dementia is a syndrome caused by a number of progressive disorders that affect memory, thinking, behavior, and the ability to perform activities of daily living (World Alzheimer Report, 2010).Alzheimer’s disease (AD) and other dementias currently affect more than 5 million Americans (Fargo and Bleiler 2014) and 747 thousand Canadians (Alzheimer Society of Canada, 2012), and the incidence is expected to exceed 7.1 milli… (1996) ‘Conversational discourse and cognitive impairment: Implications for Alzheimer’s disease’, Journal of Speech-Language Pathology and Audiology, vol 20, pp 139–150. The SLP can also look at eating and swallowing functions, if those become a problem. Get an easy-to-understand breakdown of services and fees. By responding in ways that are familiar and meaningful to a person without speech, initially imitating and then developing non-verbal communication into a shared ‘language’, it is possible to build and sustain close relationships (Caldwell 2005). 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