3 Things to Know About Severe Cognitive Impairment Therapy
By Susan Saldibar
First, a true story, as relayed by Angela Edney, Occupational Therapist and National Clinical Director for Aegis Therapies, a Senior Housing Forum partner:
Almost every day an 85-year-old husband would visit his wife in a local memory care community. She was suffering from severe cognitive disability due to Alzheimer’s disease. One day an Aegis therapist asked him, “What did she used to enjoy in the old days?”
He answered “She loved her rose garden. And I used to bring her roses here, but she never responds to them, so I gave up trying.”
The therapist suggested, “Bring roses tomorrow. Let’s try again.”
So he brought the roses and the Aegis therapist sat down with his wife and him. He held the roses up in front of her. No visible reaction. “See? She doesn’t even notice them,” he said.
“Put them right up to her face, just a couple inches away,” said the therapist. He felt silly, but he did so. After a few minutes, her eyes began to flutter and her expression softened. “Now, take her fingers and let her feel the petals while talking to her,” instructed the therapist. He did so. “Don’t stop. Don’t give up,” said the therapist. He held her fingers to the petals. It was awkward and he almost gave up. But within minutes she began to slowly stroke them. A few minutes later tears came to her eyes and a smile to her face. Soon she, and her husband were quietly crying tears of happiness.
The husband responded, “She knows that I am here”. The husband was instructed by the therapist to do this daily and this became part of her program.
“It was the combination of seeing, smelling and feeling those roses that broke through,” says Angela. “And one more critical element — giving her the time she needed to make that connection.”
Angela, along with Susan Almon-Matangos, Speech-Language Pathologist and National Clinical Director, are working to educate facility staff and families to help make more of these kinds of breakthrough moments happen.
I spoke with both Susan and Angela about how senior care providers can work more effectively together with their residents, therapists and family members to re-engineer the way they assess and work with severely cognitively impaired individuals. They identified three basic building blocks.
Better education and knowledge building:
While most senior care providers know that educating the families of cognitively disabled residents is crucial; many, in fact, aren’t really “educating.” Most only scratch the surface. “Understanding the complexity of challenges experienced by residents who have dementia and Alzheimer’s is the key to building bridges between the residents and their families,” says Angela. “This can’t be done in seminars, brochures or short sessions alone; it requires time, patience and lots of Q&A,” she adds.
Hit the re-set button on expectations:
A scenario we are all familiar with is when a family member attempts to push memories back into the heads of residents — “Don’t you remember Mike? He’s your nephew!”
“That sort of ‘quizzing’ can actually cause damage to the cognitive process as well as to the emotional wellbeing of family members,” says Angela. “We work with family members to understand that the old rules of engagement will no longer get the results they are seeking,” she adds. That means doing things that could not be imagined when the resident was operating at full functionality. As an example, actions such as gently moving a bright colored ball within inches of a resident’s face can help activate the brain and open up a pathway for communication.
Change the definition of “success”:
For individuals with severe cognitive impairment, success should be measured in millimeters, not miles. “Often people don’t notice a reaction from a resident because they are seeking a complete sentence or full participation in an activity,” says Angela. “In fact, a word, a smile or even an almost inaudible grunt or tiny movement of the neck can be an indication of success,” she adds.
And, success should be adjusted to the individual’s changing cognitive levels, Susan points out. “As an example, in an earlier phase we might ask, ‘What would you like to wear today?’ which, in time, we may adjust to ‘Which shirt do you prefer?’ and then to ‘How about this shirt?’ and so on.”
Above all, never, never, never give up.
The bottom line, as Angela and Susan point out, is that there is no cognitive level low enough not to warrant caring interaction. Even for residents who may be near-comatose, they recommend range of motion therapy, massages and speaking to them “as if they understand.”
Aegis Therapies conducts ongoing research and has accumulated years of working with cognitively impaired patients. Their failure-free programs use the Allen Cognitive Disability model and have been highly effective in building a sense of empowerment for residents and all those who interact with them. For more information about their services and work, visit the Aegis Therapies website.