Transcript Reminiscing Therapy and Remotivation Therapy

Interventions: Elderly
KNR 253
Interventions
• Reminiscence
– Austin, 2009
– Dattilo & McKenney,
2011
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Reality Orientation
Validation Therapy
Sensory Stimulation
Remotivation
– Austin, 2009
Interventions
• Montessori Technique
Theoretic Foundations
• Role theory
– How well one adjusts to aging depends on
how well the role changes of later life are
accepted
• Rosow, 1976
• Disengagement theory
– Older adults have a natural tendency to
withdraw from society and become more
introspective
• Cumming & Henry, 1961
Theoretic Foundations
• Activity theory
– People who are active will be more satisfied and
better adjusted than those who are less active
• Havinghurst, 1968
• Continuity theory
– As we age we become more of what we already
were in our youth. We deliberately continue
familiar patterns
– Could be positive or less positive patterns
• Atchley, 1993
Reminiscence
Dattilo & McKenney (2011) calls it
Therapeutic Reminiscence
Population
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Dementia/Alzheimer’s
Depression
Older adults
People in transition or life crisis
• People who
– Have mild to moderate cognitive functioning
– And have at least a 5 minute attention span
Definitions of Memory
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Memory
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Recording of feelings and emotions
Knowledge about self, world, & experiences
Many are involuntary
– Sensory
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Comes through sense of smell, touch, taste,
hearing and seeing
Imprints quickly
– Smell word burning & think of campfire
– Smell lavender perfume & think of Grandma
Definitions of Memory
• Short term memory (immediate)
– Working memory
– Lasts for a few seconds or minutes
– Can only keep 6-7 items at once in STM
– If retain longer, must be rehearsed &
connected to other memories
• Look up phone number
• Follow directions to a room
Definitions of Memory
• Long term memory
– Information that has been rehearsed & connected
• Could be recent (what had for lunch)
• Could be distant (first dog’s name)
– 4 parts to transfer from STM to LTM
• Registration: Information perceived
• Encoding: Attach new memory to previously stored
memories
• Storage: Collection of what retained
• Retrieval: Recall information previously registered,
encoded, and stored
Reminiscence
• Excursion into one’s memory of the past
– Weiss, 1989
• Act of relating personally significant past
experiences
– Koffman, 2000
• Activity in which the leader assists and guides
a person to recall previous life experiences
and facilitates the affirmation of the value of
these experiences
– Could be individual or group
– Could be written or recorded
Reminiscence
2 types of life experience recollection:
1. Simple/informative/story-telling
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Recollection of previous life experiences
Remembered for pure pleasure of
experiencing occasions and to pass
information on to others
2. Life review
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Focused on analyzing, evaluating and coming
to terms with unpleasant or unhappy previous
life experiences
Reminiscence
Process:
– Quiet, comfortable room free of
distractions, table
– Same times and day of week, 2x week is
best, 30-60 min
• Enough time for all to share
– For groups, s/b under 10-12 members.
With some groups may be 5-6.
Reminiscence Topics
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Vacations
Favorite games
First playmate
First pet
School days
Olympics
Floods
Engagements
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Seasons
Holidays
Seasons
Childhood
Adolescence
Music
Dance
Others
Reminiscence Topics
Current Events: Now & Then
• Engagements
– Here is a picture of a man who rented a
billboard to ask his girl friend to marry him
– How did you (your husband) propose?
– Did you give (get) a ring?
– What did your parents say?
– How long had you known each other?
– How long were you engaged?
» Dattilo, 2000, p. 320
Reminiscence Guidelines
(See sample)
• Intro – welcome, introduce topic
– Mr., Mrs., Dr., unless permission for first name
• Initial cue – present an item associated with theme
(make cues multi-sensory, present one at a time, use verbal and nonverbal cues)
• Prop/artifact #1 – focus on past experiences
• Prop/artifact #2 – focus on current experiences
• Related activity (time permitting) – slides, movies,
cooking, etc.
• Closure – thank yous, time for social interactions
between participants
Outcomes
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Increase self esteem as review history of competence
Increase life satisfaction
Reaffirm sense of identity
Bring pleasure from sharing the past with others
Increase socialization
Stimulate cognitive processes
Provide feelings of competence as person relates LT memories
Allow for expressing of feelings
Come to terms with old disappointments
Discover similarities with others
Decrease loneliness
Increase self awareness about leisure
Others
Outcomes
• Decrease depression &
confusion
• Decrease boredom
• Increase self-esteem
• Increase well-being
• Enjoyable
• Develop friendships
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Engage in conversation
Maintain family contacts
Teach & inform
Identify & solve
problems
• Prepare for end of life
• Increase socialization
• Maintain cognitive
functioning
Activities
• Grab Bag
– Therapeutic Recreation Directory
• Leisure Lifeline
• Scrapbook
Reality Orientation (RO)
Population & Settings
• Population
– Older adults
– Moderate to severe disorientation &
confusion
• Settings
– Nursing homes
– Geriatric units in psychiatric hospitals
Purpose
• Prevent cognitive decline
• Reverse cognitive decline
• Maintain cognitive functioning
Definition
• Involves a technique of regular
repetition of basic facts
– Time, place, names, events of day, things
in environment, etc.
• The technique is used to help overcome
symptoms of confusion and
disorientation
Types of RO
• 24 hour a day RO
– Everyone who comes in contact with the person
– Asks questions like:
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What is your name?
What is the name of this facility?
What city are we in?
What is your hometown?
How is the weather today?
– Clues in environment
• Signs
• Clocks
• Calendars, activity calendar
Types of RO
• Daily RO Classes
– 4-6 residents
– 15-30 minutes
– Same time each day
– Quiet well-lighted area
– Uses RO board
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Location
Date
Time
Weather
Types of RO
• Daily RO Classes Routine
– Greet residents
• Would you like to tell the group your name?
• What is your name?
– If correct answer “good,” if incorrect probe or tell
– Introduce ourselves
• Tell leader’s name. May ask to repeat
– Read the reality orientation board
• Ask each patient to read
– Perhaps another activity
• Write menu & have residents help spell words
• Have pictures of food & ask residents to identify
• Flash cards
– Remind about time of next meeting
Types of RO
• Incorporate in TR programs
– Repeat your name at beginning of groups
– Tell what you do
– Review programs did in past
– Work time in introductions
– Talk about seasonal events
– Highlight upcoming activities
– Review monthly activity calendar
– Austin, 2004
Validation Therapy
Naomi Feil
Population
• Same as RO
• Alzheimer’s
• Old-old clients who need help resolving
pasts
• Not for people who have:
– Chronic mental illness
– Intellectual disabilities
– Alcoholism
Rationale
• Developed because some folks reacted
negatively to RO
– Agitation
– Withdrawal
• Basic premise is that reality underlies the
behavior of even very disoriented clients
– Resolve past relationships
– Resolve unfinished life tasks
– Express suppressed feelings
Process
• Accept people as they are and be empathetic
toward them
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Maintain eye contact
Rephrase
Speak with caring tone of voice
Use appropriate touch
Avoid “why” questions
Communicate that what they said was heard and
respected
– Agree but steer without them knowing they are
being redirected
• Austin also describes phases for groups
• Chuck: "I have to find my car keys."
Me: "Your car keys..." ( I don't tell him he doesn't have a car and
he hasn't driven for years)
Chuck: "Yes, I need to get home - lot's of work to do, you know!"
Me: "You are busy today?" (I don't tell him he is at adult day
care and isn't going home for hours)
Chuck: "Hell, yes. I'm busy every day, girlee."
Me: "You like being busy?" (I'm trying to find a topic of
conversation that he might accept discussing)
Chuck: "What planet do you live on? I didn't say I LIKED it. I just
have to work - like most of the rest of the world, ya know?" (He's
getting a little frustrated, but seems to have forgotten the keys.)
Me: "I know about work, Chuck. I do some of that myself. In fact,
I'm getting ready to fix some lunch for us. Care to join me?"
Chuck: "Lunch, huh? What are you having?"
» http://www.ec-online.net/community/Activists/difficultbehaviors.htm
Sensory Training
Sensory Stimulation
Sensory Training
• Originally developed for work with
children with perceptual motor problems
(sensory integration)
– Autism
• Frequently used with regressed &
disoriented older persons
– Psychiatric facilities
– Nursing homes
– Long term care facilities
Sensory Training
• Goal is to improve perception &
alertness in responding to the
environment
• Attempt to maintain or improve
functioning of regressed patients
• Stimulate all senses each session
Sensory Training
• Kinesthetic awareness exercises
– Flex & extend parts of body while sitting
• Tactile stimulation activities
– Feel objects (e.g., balls, sponges, wood, etc.)
– Answer questions about sensations, preferences,
and feelings
• Smelling activities
– Smell sharp or distinct substance
– Answer questions about feelings & uses of
substances
Sensory Training
• Listening activities
– Sounds through media like records,
clapping, songs, etc.
• Tasting activities
– Taste contrasting foods like candy &
pickles
• Visual activities
– Mirrors, colorful objects
Sensory Stimulation
• Used as treatment for patients with TBI who
are in prolonged comas
• 2 types
– Multimodal
• All senses every session
– Unimodal
• Treating single sense in a session
• Observe to determine what stimulates
consistent responses like hand or head
movement or eye gaze
• I have more frequently heard sensory
stimulation for both clients who are
disoriented or are in comas
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Backrubs
Facials
Brush hair
Lotion
Music
Aromatherapy
Pets
Remotivation
Population
• Moderately confused elderly residents
• Often used with folks who have
successfully completed RO
• Purpose: to promote discussions of
topics that may bring participants closer
in touch with the world outside the
institution
Remotivation
Process:
– Group (8-15) interaction for 45-60 min
– Conducted by a trained staff – sometimes
an aid (remotivator)
– Attempt to renew interest in environment
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Remotivation
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Planning conversations that stress simple,
objective features of everyday life not
related to their emotional difficulties (e.g.
gardening, baseball—avoid controversial
subjects such as sex, politics)
Establish warm, accepting atmosphere
Deal with well parts of client
Encourage rediscovery of interests
Begin to establish control over leisure
selection
Remotivation
• 5 phase process (each 10 min)
1.Climate of acceptance
2.Bridge to reality
3.Sharing the world we live in
4.Appreciation of the work of the world
5.Climate of appreciation
Climate of Acceptance
• Greet each participant by name
• Shake hands
• Made some comment about
participant’s appearance
• Purpose is to create a warm, supportive
environment
Bridge to Reality
• Develop group discussion around a
theme
• Start by reading a poem, story or article
related to theme
• Ask questions to encourage participants
to recall and share ideas related to topic
– When you were little did you have a train set?
– What were the cars like?
– Read poem “Freight Cars”
Sharing the World We Live In
• Visual aids and questions used to
encourage clients to share personal
stories
• Attempt to move focus to world as it
currently is
– What are some uses of freight cars?
– What other cars are in a train?
– Show a picture of a train
Appreciation of the Work of
the World
• Get participants to think about pros and cons
of the topic
• Help relate the topic to other things in the
world
• Encourage to rediscover past hobbies or
occupations
• Projections to the future are encouraged
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Who is the boss of the train?
What are the other jobs on the train?
What jobs are in the freight yard?
Which of these jobs would you like?
Climate of Appreciation
• Review what has been said
• Comment about how each person
participated
• Than the people for attending
• Tell about plans for next session
Therapeutic Recreation
Directory
• Has some activities for
– Reminiscence
– Remotivation
– Sensory stimulation
Montessori Technique
• Relatively new
• Originally with children
• Now hybrid version for people with
Alzheimer’s
• Strength based philosophy
• Engages person in meaningful activities
• Bypasses deficits
• Provides feedback on success to foster selfesteem
• Done 1-1
Concept
• The longer people practice strengths,
the longer the skills last
• Theory of first in, last out
• Uses procedural memory vs. declarative
– Declarative = episodic memory of past events & autobiographical
information
– Semantic memory world knowledge, vocabulary
Procedural Memory
• Preserved abilities in dementia
– Habits/skills (reading)
– Location learning/environmental cueing
– Motor learning
– Classical conditioning
– Repetition priming
• The ability to improve performance after initial
exposure to information
• Montessori-based activities use
procedural memory
Program Presentation
• Use cues and templates
• Materials should be set up left to right,
top to bottom
• Always demonstrate what needs to be
done
• Use as little verbalization as possible
• Use reading skills often
– 48-font, plain words in written cues
Program Presentation
• Leader’s movements are slow
• Don’t overstimulate
– Fidgeting, looking away, not interested
• Category sorts
– Sort cards by suite, color with template
– Dice with cue cards…can you roll the same
number? How many 5’s can you roll?
• No wrong answers
• Success is completion, not accuracy