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ALZHEIMER'S & OCCUPATIONAL THERAPY.
Term Paper ID:24449
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Essay Subject:
Examines disease's victims' treatment needs, therapy goals & protocols, equipment, caregiving team.... More...
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10 Pages / 2250 Words
14 sources, 21 Citations,
APA Format
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Paper Abstract:
Examines disease's victims' treatment needs, therapy goals & protocols, equipment, caregiving team.
Paper Introduction:
OCCUPATIONAL THERAPY & ALZHEIMER'S
Introduction
This paper presents occupational therapy for Alzheimer's disease. Occupational therapy trains individuals with cognitive, emotional, and physical impairments to be as self-sufficient as capabilities allow. Meaningful activity is needed to prevent debilitating effects of inactivity and promote well-being. Alzheimer's disease and other dementias, chronic and irreversible, are accompanied by progressive loss of cognitive and motor ability resulting in incapacity. Occupational therapy for patients with dementing illnesses, includes continuous modification and adaptation of daily tasks within physical and social environments. Occupational therapy helps people use abilities and retain as much control over their lives as possible
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As procedures improve,verbal cues and supervision would be decreased. Range of motion, coordination, equilibrium, muscle tone, gait,posture, and movement speed and rhythm evaluation are used to assess motorfunction. A. Evaluation of apatient assess the levels of cognitive and motor functions; tests ofperceptual and cognitive abilities are administered. Pedretti, L. American Journal ofOccupational Therapy, 48(1), 38-45. A complete understanding of the patient's history,and the needs of all involved (family, caregivers) is necessary fortreatment of this population. Assessment ascertainsthe person's ability to initiate, sustain, and complete tasks. Head trauma may also be a risk factor.Some state that the disease is a disorder stemming from damage to the brainthat is subclinical for decades, making those affected particularly proneto the consequences of neuronal attrition. Normal objects are also used as cues. Theoccupational therapist is responsible for the accurate record keeping fordocumentation of the patient's evaluation results, identified problems,treatment goals and plans, and patient progress toward established plans.Documentation is needed for administrative tasks, reimbursement,communication, quality assurance, educational, and legal intentions. N. The therapist needs to emphasizegratifications from caregiving such as those resulting from anticipatorycare. (1995). M., Kole, S. (1994). Brumback, R. Sensorimotor functioningcan be assessed by observation, testing, and interview (functionalstrength, physical endurance, muscle tone, hand function, coordination,involuntary movement, sensation, visual perception, visual acuity).Cognitive functioning such as judgement, safety awareness, motivation, andintellectual functions, are assessed by observation and interviewing.Psychosocial functioning is determined through observation and interviewing(disability adjustment, emotional stability, coping skills). J. This includes AD special careunits found in nursing homes and adult day care programs (AOTA, 1994). Performanceareas to assess include self-care (observe, interview), mobility (test,observe), home management (test, observe, interview), and leisure skills(test, observe, and interview) (Pedretti, 1996). Therapist & Caregivers Compromised abilities can lead to caregivers taking over, resultingin helplessness, inactivity, and depression for the patient. Research shows that occupational therapist focus on caregiver issuesand caregiver's goals results in more caregiver involvement than a focus ontechnical issues and therapist's goals. Wheelchair for mobilitywould be introduced as functions decline (Pedretti, 1996). M. Other Professionals Coordination of services is needed for the care of AD. Age of onset is a major feature considered in thedistinction between Type I and Type II Alzheimer's disease. Accurate written records of the service provided and client'sprogress toward objectives is essential for reimbursement of service. The occupational therapist has aresponsibility to understand and explain the caregiver's preferences forcertain management strategies. New York: Mosby. (1994).Statement: Occupational therapy services for persons with Alzheimer'sdisease and other dementias. Thefundamental data collection method used is observation. W., Buckwalter, G., Bowman, J. Long-term goals include improving functionalcapacity, promoting participation in activities, and easing caregivingactivities. American Journal of Epidemiology, 142(5), 515-523.----------------------- 13 Typical Treatment A sample treatment plan includes description of the case, treatmentgoals and plans, reference to additional services, OT evaluation,evaluation summary, assets and problems lists. Examples of assets to list include good intelligence, family supportand relationships, comfortable living, good sensation, motivation, andrange of motion, and positive affect. W. Apathy, anxiety,disinhibition, overactivity, suspiciousness, irritability,argumentativeness, and belligerence are found. (1994). Caregivers need to use techniques effectively andflexibly for management of daily care. Componentparts of each task are determined to evaluate the person's ability forcontinued performance. Assistive devices may be used or normal objects act as cues. Tests for cognitive evaluation include the Mini-Mental StateExamination, Allen Cognitive Level Test, and the Cognitive PerformanceTest. N. The Assessment of Motor and Process Skills test and the KitchenTask Assessment, evaluate performance. Alzheimer's Disease Alzheimer's disease (AD) is believed to be the fourth leading causeof death in the United States, with approximately 4.5 million Alzheimer'sdisease victims. B., Gilman,S., & Beane, E. Caregivers express satisfaction if patient needs are correctlyguessed (Corcoran, 1994). The occupational therapist needs also to teach caregivers howto manage the progressive incapacities of the patient (Pedretti, 1996). Psychiatric symptoms vary.Frequency of hallucinations ranges from 3 percent to 49 percent; prevalenceof depression varies from percent to 87 percent. (1994). Alzheimer's disease and other dementias, chronicand irreversible, are accompanied by progressive loss of cognitive andmotor ability resulting in incapacity. Willard and Spackman'soccupational therapy, seventh edition. Treatment Protocols The OT process includes screening, referral, assessment and programplanning, implementation, reassessment, documentation, termination ofservice, standards of practice, legal/ethical concerns, and reimbursementmechanisms (Punwar, 1988). Occupational Therapy Goals Long term goals of occupational therapy intervention for Alzheimer'sdisease include the following: maintaining, restoring, or improvingfunctional capacity; promoting participation in activities optimizingphysical and mental health; and easing caregiving activities. Objectives,methods, and gradation are noted for each problem. Abathtub bench helps with safe transfer into and out of the bathtub, forthose with apraxia. Most cases occur after the age of 65 years and aresporadic rather than familial. For example, throw rugs,unstable chairs, knives, and stairways may be considered potential dangers(AOTA, 1994). Punwar, A. Occupational therapy assessment is initially directed toward taskswhere a decline is first noticed (work, home, driving, and safety).Progressive stages shift attention to functional mobility, communication,personal self-care, and leisure/recreation skills. Range of motion and muscle relaxant activities are used whenindicated (Hopkins & Smith, 1988). Telephone aids for emergencycommunication are used. Occupational therapy, principles andpractice. For example ashaver might remind a man to shave. Treatment Needs AD affects the primary caregiver, all family members, and thepatient. Increasing coordination of the Dementia servicedelivery network: planning for the community outreach education program.The Gerontologist, 34(5), 7 -7 6. J. Usual documentation includes brief, factualnotes on the client's progress, that compares present ability with initialstatus. AD has been found to be positively correlated withstarvation/malnutrition and negatively with analgesics; earlier-onset iscorrelated with physical underactivity and nervous breakdown (Henderson,Jorm, Korten, Creasey, McCusker, Broe, Longley, & Anthony, 1992). (1995).Occupations with exposure to electromagnetic fields: a possible risk factorfor Alzheimer's disease. Treatment Equipment Therapy intervention may include specialized devices and adaptiveequipment for those with cognitive impairments; the therapist trains theperson to use the device effectively. Theuse of verbal (brush teeth), visual (demonstration of brushing teeth), orphysical (put toothbrush in patient's hand and move hand for brushingaction) prompts are taught. (1993). (1992). For individuals unable to remember to takemedication, an electronic reminder signaling them would be beneficial. Spousal caregivers make decisions that reflect efforts to anticipatethe patient's needs, prevent harm, supervise actions, perform instrumentaltasks, and protect self-esteem. An exploratorystudy of how occupational therapists develop therapeutic relationships withfamily caregivers. Documentation procedures provide important information regardingpatient, treatment, and continual assessment; accurate notes are necessaryfor treatment assessment and reimbursement. (1996). Henderson, J. Clark, C. Treatment methods include activityprograms, environmental modification, activities of daily living,behavioral control, family education, and day care (Pedretti, 1996). American Journal of Occupational Therapy, 49(7), 681-685. Family and patientcounseling and financial arrangements assistance may be needed. Final stagesinclude the goals regarding basic life functions which include: managingfeeding and dysphagia (difficulty swallowing), positioning the bodycorrectly, and maintaining joint motion (AOTA, 1994). Baum, C., Edwards, D. D., & Lee, P. (1988). (1988). Occupational therapy, practice skills forphysical dysfunction, fourth edition. Family education, behaviormanagement, and support are also components of the occupational therapyprogram. Problems to list include ataxia,tremors, incoordination, low endurance, difficult mobility, poor safetyawareness, and loss of social, work, or leisure activities. Patient, family member, orcaregiver interviews provide additional data (Pedretti, 1996). A graded program of environmental modification and tasksimplification is needed. It is alsohelpful if the therapist directs interactions with instruction and advice(Clark, Corcoran, & Gitlin, 1995). D. Partnering interactions, based on a two-way communication andopen exchange of dialogue between therapist and caregiver are important.Informing interactions assist in strengthening the therapeutic relationshipbetween therapist and caregiver; these include those in which the therapistprovides, educates, and explains, or gathers information. MD: Williams & Wilkins. Gait training with the walker by a physical therapist would berequired. For example, forproblems with ataxia and mobility, a front-wheel walker might be theobjective. Sobel, E., Davanipour, Z., Sulkava, R., Erkinjuntti, T., Wikstrom,J., Henderson, V. Understanding of preferences provides abasis for further discussions. Longitudinalanalysis of a two-component model of the memory deficit in Alzheimer'sdisease. Thisdocumentation includes referral, evaluation data, initial evaluation,progress notes, interim reassessments, and discharge summary.Documentation is to be clear, concise, accurate, and organized with anagreed-upon system for record internal consistency (Pedretti, 1996). Caregivers would be educated as well. Occupational therapists need todemonstrate caring interactions such as an interest in the caregivers' well-being and that of the patient. Insome settings, client records are computerized (Punwar, 1988). The therapist must also teach the caregiverhow to correct hazards and promote safety. Becker, J. AD results in gradual, progressivedeterioration of cognitive functioning with memory loss usually the firstand most prominent feature. American Journal of Occupational Therapy, 49(7), 587-594. Identificationand measurement of productive behaviors in senile Dementia of the Alzheimertype. Emotional and behavioral changes occurring inAD are factors in its study and management. A., & Leech, R. Occupationaltherapy helps people use abilities and retain as much control over theirlives as possible (AOTA, 1994). Journal Okla State MedicalAssociation, 87, 1 3-111. OCCUPATIONAL THERAPY & ALZHEIMER'S Introduction This paper presents occupational therapy for Alzheimer's disease.Occupational therapy trains individuals with cognitive, emotional, andphysical impairments to be as self-sufficient as capabilities allow.Meaningful activity is needed to prevent debilitating effects of inactivityand promote well-being. The therapist determines modifications needed to improve functioning. Treatment must consider the needs of all involved. Performancemay be improved by modifying task requirements and adapting the environment(AOTA, 1994). References American Occupational Therapy Association (AOTA). W. Conclusion AD results in progressive intellectual deterioration and ischaracterized by loss of memory, cognitive impairment, speech and gaitdisturbances, disorientation, and changes in personality and behavior.Etiology is unclear. Supportive interactions build and maintainrapport and build trust; these include comments regarding a good job done.Friendliness contributes to rapport as well; this includes small talk andcompliments. Occupationaltherapists observe in naturalistic and clinical settings. Risk factors are confirmed as advanced age, family history ofdementia, and Down's syndrome. Behaviors found includeaggressiveness, outbursts, assaultiveness, wandering, disturbed sleep,incontinence, agitation, insecurity, less responsiveness, and cheerfulness,irritability, selfishness, and crudeness. (1994). In Type I(later-onset), environmental factors may pose a greater risk and familyhistory is less common. Seltzer, B., & Buswell, A. F., & Howell, N. Formatsfor progress reporting differ. The therapist needs a clear understanding of thepatient's history before beginning the evaluation process. Focus for this paper includes Alzheimer'sdisease etiology (age 5 plus), treatment needs, long term goals, treatmentprotocols, equipment, other professionals involved, typical treatment,therapist and caregivers, and documentation procedures. A., Corcoran, M., & Gitlin, L. Alzheimer's disease:pathophysiology and the hope for therapy. J., Holmes, S. T., Bajulaiye, O., & Smith, C. Theoccupational therapist role includes the responsibility to educatecaregivers regarding the structuring of the environment for the maintenanceof optimal functioning. Aging Magazine, 363-4, 24-28. L., Benedict, C. Corcoran, M. Occupationaltherapy with AD patients focuses on self-care, independent living skills,and assessment for employment potential. Productive behaviors vary andinclude areas of: work performance, concentration, social activities, andproblem-solving abilities. Antecedents may vary and include geneticfactors, factors related to aging, and environmental factors (Baum,Edwards, & Howell, 1993; Becker, Bajulaiye, & Smith, 1992; Brumback &Leech, 1994; Seltzer & Buswell, 1994; Sobel, Davanipour, Sulkava,Erkinjuntti, Wikstrom, Henderson, Buckwalter, Bowman, & Lee, 1995). Management decisions made by caregiverspouses of persons with Alzheimer's disease. The Gerontologist, 33(3), 4 3-4 8. Andiel, C., & Liu, Lili. Signs with words or pictures helplocate places and objects (AOTA, 1994). As AD progressed,evaluations asses self-care such as feeding, swallowing, dressing,toiletting, hair and nail care, bathing or shaving, and mobility. New York: Lippincott. L., & Smith, H. As treatment is progressing, changes need to be documented. (1995). Documentation Procedures OT documentation includes written records and reports containinginformation regarding patient status, progress, and performance. OTprovides a graded program of task simplification and environmentalmodification that keeps with the pace of the patient's decliningcapacities. The power of support. OT for dementia includes methods that reducetension and change the environment to a routine, familiar, and structuredsituation. Data-gatheringmethods such as self-report and standardized testing may have little valuefor persons with severe cognitive impairments. Support isalso needed from social workers, psychologists, and nursing staff. Equipment may be required to assist in treatment protocols.The OT practitioner has a responsibility to the caregiver as well as thepatient. Connell, C. Psychological Medicine, 22, 437-445. Assistive and adaptive equipment and orthotics are used whenneeded. For example if the person is not eating becausethey cannot use the utensil, finger foods may be recommended. Environmental damage compoundsthe effects of age-related neuronal losses; pathogenic exposures would bemore likely to be detected when neuronal changes of ageing are the greatestas in later-onset. OTpractitioners offer consultation and educational services to manyfacilities and programs serving AD patients. Occupational therapy for patientswith dementing illnesses, includes continuous modification and adaptationof daily tasks within physical and social environments. (1992). The occupational therapist teachescaregivers skills necessary to initiate, sustain, and complete tasks. American Journal of Occupational Therapy,48(1), 1 29-1 31. Hopkins, H. Psychiatric symptoms inAlzheimer's disease: mental status examination versus caregiver report.The Gerontologist, 34(1), 1 3-1 9. Interpersonalrelationships are determined by interview and observation. Data allows for selectingappropriate intervention strategy and/or support decisions regarding levelsof care, placement, and guardianship (AOTA, 1994). AD care includes medical management such as prescription ofmedication and maintenance of general health. A typical sample of OTevaluation might include performance components. Working memory and older adults:Occupational therapy. Over thecourse of this illness, many services are needed which include:comprehensive diagnosis and assessment, physical, occupational, or speechtherapy, respite care, caregiver education, support groups, legal services,home health aides, transportation, skilled nursing care, and autopsyservices (Connell, Kole, Benedict, Holmes, Gilman, & Beane, 1994).
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