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Abilities Based Approaches to Assessment and Treatment of Persons with Dementia

Renee Kinder, MS, CCC-SLP, RAC-CT

September 1, 2017

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Question

1. What is your favorite teaching method that you use? 

2. What have you found that works well in transitioning task steps to staff?

3. As far as the spaced retrieval, have you used it in skilled nursing? How does nursing respond to that? Do they follow through pretty well with that?

4. Do you use spaced retrieval at all levels of dementia?

5. Do you have any ideas on how to add visual contrast in a skilled nursing setting, where it may be harder to modify the environment?

Answer

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. 


renee kinder

Renee Kinder, MS, CCC-SLP, RAC-CT

Renee currently serves as Director of Clinical Education for Encore Rehabilitation where she provides education for interdisciplinary team members related to clinical programming, Medicare regulations, documentation requirements, and evidenced based practice patterns. She maintains certification as a resident assessment coordinator (RAC-CT) from the American Association of Nurse Assessment Coordination (AANAC). She is an active member of the American Speech Language Hearing Association currently serving as Editor of Perspectives on Gerontology and acting as a member of ASHA’s Healthcare and Economics Committee. Additionally, she is a member of community faculty for the University of Kentucky College of Medicine, serves as an Ambassador for the Alzheimer’s Association of America, and acts as Vice President of Healthcare for the Kentucky Speech Language Hearing Association.


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