Target activities that focus on strengths
Target activities that focus on strengths
Tool identifies abilities in Alzheimer's patients
Too many dementia care units and adult day care centers plan activities without evaluating which Alzheimer's patients have the interest or ability to participate. Now a new assessment tool developed by a New Jersey therapist identifies the remaining strengths in dementia patients and allows case managers to help select more appropriate activities and programs for their clients.
"In many cases, if dementia patients have no interest in an activity, they have difficulty expressing the desire not to participate. They may refuse to do the activity or become very confused or agitated," says Michelle S. Bourgeois, PhD, CCC/ SLP, associate scholar scientist with Florida State University in Tallahassee. "Many times, caregivers and providers assume that this means the patient is no longer able to participate in activities and exclude them from future programs. Simply because the patient had a negative reaction to one activity, he or she is excluded from others he or she might enjoy."
Look into patient's life story
Bourgeois has been involved with field testing of a new assessment tool developed by Eileen Eisner, MEd, CCC/SLP, director of Speech and Language Services of Westfield (NJ) and founder of Theragraphics, consultants on the care of cognitively impaired adults. "The tool, the Informal Geriatric Observation Inventory, helps therapists tailor programs to the interests of the individuals they serve. This greatly increases the likelihood that programming they do will be participated in and have a therapeutic affect."
In the home setting, the tool helps families focus on activities that are still of interest to the patients, she notes. "Many times, families are at their wit's end to know what to do and how to interact with dementia patients. They think they must try something totally new. In reality, it's most often activities the patient previously enjoyed that are most beneficial."
Eisner based her assessment tool on the work of Howard Gardner, PhD, who proposed in his 1983 book, Frames of Mind, that human intelligence encompasses these seven areas:
1. Verbal/linguistic. This involves both the written and spoken word. Individuals with strengths in this area may enjoy reading, writing, and telling stories.
2. Logical/mathematical. This includes problem solving, usually in the form of numbers, sequencing of events, and patterns. Individuals with strengths in this area may enjoy working with numbers and assembling puzzles.
3. Visual/spatial. This refers to visual perception of differences, similarities, and images of varying colors, shapes, and forms. Individuals with strengths in this area may enjoy drawing, watching movies, and viewing pictures and slides.
4. Bodily/kinesthetic. This involves the use of the body for self-expression, such as dance, exercise, and gestures. Individuals with strengths in this area may enjoy moving, touching, and activities such as sports and acting.
5. Musical/rhythmic. This refers to the auditory perception of pitch, tone, and rhythm. Individu als with strengths in this area may enjoy singing, humming, playing instruments, and listening to music.
6. Interpersonal. This refers to dealing with others and understanding their feelings. Individuals with strengths in this area may enjoy being in the company of others and attending social events.
7. Intrapersonal. This includes good self-knowledge and being in touch with one's feelings. Individuals with strengths in this area may enjoy working alone and pursuing their own interests.
The tool is a five-page checklist of activities with an interest rating scale separated into each of the seven areas of intelligence. It can be used by informal caregivers and professionals to assess the patient's past and remaining interest in each area. "Most dementia scales focus on level of impairment. This tool differs in that it gives caregivers and professionals a guide to understanding the individual with dementia and to see what he or she still has an interest and ability to do."
For example, included in the checklist for verbal/linguistic intelligence are:
· Patient responds to verbal instructions.
· Patient talks with other residents.
· Patient initiates conversation with children.
· Patient uses automatic discourse, such as saying "hi" to passersby.
· Patient appears to read newspapers and magazines.
If an assessment indicates a dementia patient has no bodily or kinesthetic aptitude or interests, that doesn't mean the patient should be left behind if the dance therapist is coming, notes Eisner. "However, it may mean that the patient enjoys sitting in a corner of the room looking at pictures and listening to the music rather than participating in the dance therapy."
The theoretical model of multiple intelligence helps organize activities for cognitively impaired adults into usable and workable categories, Bourgeois explains. "It's a more practical tool for planning meaningful activities than other tools in the field."
Eisner continues to fine-tune the Informal Geriatric Observation Inventory. What the tool doesn't yet do effectively is assess a hierarchy of remaining skill levels, Bourgeois says. "The next step guides clinicians more clearly as to the various cognitive levels within each of the seven areas of intelligence so that activities and programs could be planned and modified to best fit the individual's needs, from most complex to least complex."
For example, perhaps a dementia patient was an avid reader. "Now, with the dementia, it's not possible for him or her to read an entire novel, but perhaps, we can take that interest in reading and couple it with another former interest, such as travel," Bourgeois says. "We can take these two interests and create a memory book titled, "My Favorite Vacations." The book could be created using minimal text such as one or two sentences on each page and a combination of personal photographs, mementos, and pictures cut from magazines. This type of book is very useful for initiating conversation in dementia patients."
[Editor's note: Eisner's book, Creating Programs for Adults with Dementia: A Practical Resource for Assessing and Prescribing Strength-Based Activities, will be published in late 1999 by Pro-ed Publishers in Austin, TX. The Informal Geriatric Observation Scale will be included in the book.
Case managers interested in participating in a field study using Eisner's assessment tool may contact her directly at (908) 233-6602.]
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