Home Based Memory - Memory rehabilitation Rehabilitation Programme - PDF document

Outline • Cognitive Rehabilitation Home Based Memory - Memory rehabilitation Rehabilitation Programme • Home Based Memory Rehabilitation Programme - Brief outline of the programme - Outcomes of rehab with people with dementia An occupational therapy early - Case study intervention for dementia • Questions Email : Dumf-uhb.OTreferrals-mentalhealth@nhs.net Twitter: @OTMH_DG NHS Dumfries and Galloway Mental Health Occupational Therapy Service NHS Dumfries and Galloway Mental Health Occupational Therapy Service Cognitive Rehabilitation Cognitive Rehabilitation • Cognitive rehab was originally developed through work with • Person with dementia and their families work together with younger people with a brain injury; however has been found healthcare professional to identify personally relevant goals to be equally appropriate for progressive conditions such as and devise strategies for addressing these. early stage Alzheimer’s Disease (Clare et al, 2000) (Wilson, 2002) • Individualised approach, which focuses on improving functioning in everyday life/activities • Memory rehabilitation taps into a ‘partially intact learning capacity’ (Bird, 2001) NHS Dumfries and Galloway Mental Health Occupational Therapy Service NHS Dumfries and Galloway Mental Health Occupational Therapy Service Home Based Memory Rehabilitation Memory Rehabilitation Programme Key is to compensate for memory difficulties • Evidence based OT early intervention via: programme for people with dementia 1) Environmental Adaptation • First established in Belfast City hospital in 2007 (McGrath & Passmore, 2009) 2) Use of external memory aids Contact: Mary.McGrath@belfasttrust.hscni.net 3) Use of internal memory strategies • COT OT Evidence Factsheet for dementia NHS Dumfries and Galloway Mental Health Occupational Therapy Service NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Home Based Memory Rehabilitation Criteria for Programme Programme • Diagnosis of mild dementia or mild cognitive • Programme aims to help people with dementia compensate for memory difficulties affecting everyday functioning impairment • Structure and Repetition: • Non age specific encourages new learned behaviours in early stages of • ACE III >60/100 MMSE >20/30 (guideline) dementia • Family/friend/carer support : preferable • Habits and Routines : • Insight / awareness of everyday memory more likely to be remembered as memory loss difficulties continues • All Memory Clinic referrals screened • Early intervention, post-diagnostic support, living well with dementia NHS Dumfries and Galloway Mental Health Occupational Therapy Service NHS Dumfries and Galloway Mental Health Occupational Therapy Service Session 1 Remembering Your Assessments Priorities • Large Allen Cognitive Level Screen (LACLS) • Memory book • Checklist of Everyday Memory Problems • Medication checklist • Modified Carer Strain Index (MCSI) • Remembering where you’ve put things (Thornton, M & Travis, S.S, 2003) • Tip sheets • Activities of Daily Living : dependency scale • Practice • Assessment of Motor and Process Skills (AMPS) NHS Dumfries and Galloway Mental Health Occupational Therapy Service NHS Dumfries and Galloway Mental Health Occupational Therapy Service Session 2 Remembering What People Session 3 Remembering Something Have Told You You Have To Do • Review previous week and practice progress • Review previous weeks and practice progress • Pocket Notebook • Permanent reminders, checklists • Telephone use: prompt card, notebook • Calendars, memory boards • Reminder notes, techniques, tips • Practice • Practice NHS Dumfries and Galloway Mental Health Occupational Therapy Service NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Session 4 Coping in Social Situations Session 5 Keeping Your Brain Healthy • Review previous weeks and practice progress • Review previous weeks and practice progress • Keeping track in conversations • General advice about active brains • Remembering people’s names • Breathing exercises • Techniques and Tips • Local and online resources • Practice • Practice NHS Dumfries and Galloway Mental Health Occupational Therapy Service NHS Dumfries and Galloway Mental Health Occupational Therapy Service Session 6 Remember Your Bearings & Reassessment Driving • Review previous weeks and practice progress • 3 months post programme completion • Tips on driving • 1 year • Tips for on foot bearings • 2 years • Revision of all previous sessions • Repeat assessment package • Revision of strategies in place • Monitor memory strategy use • Practice NHS Dumfries and Galloway Mental Health Occupational Therapy Service NHS Dumfries and Galloway Mental Health Occupational Therapy Service Outcomes : Pilot Data Outcomes : ongoing data • Number of memory strategies in use • Number of memory strategies in use • Checklist of everyday memory problems • Checklist of everyday memory problems NHS Dumfries and Galloway Mental Health Occupational Therapy Service NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Ongoing data Emotional Touchpoints (Bate and Robert 2007) • Large Allen Cognitive Level Screen • Carried out on completion of the HBMR Programme • ADL Dependency Scale • Modified Caregiver Strain Index NHS Dumfries and Galloway Mental Health Occupational Therapy Service NHS Dumfries and Galloway Mental Health Occupational Therapy Service Emotional Touchpoints Case Study Mrs G Mrs G is a 79 year old lady who was diagnosed with Alzheimer’s dementia. • ACE III: 65/100 At time of referral, main difficulties identified: • • “I find the strategies helpful.... I am looking for something to - remembering where she has put things help with the blank bits – I found these [strategies] helped.” - remembering what she has to do e.g. appointments/meeting friends/working in local community shop - remembering what she has done each day • “HBMR - Realising I still have skills and I’m hopeful this will continue for some time. I know I can still be responsible for - sequencing more complex tasks such as cooking - general organisation of day to day activities myself. If you think of the effect of all of these, Mrs G functions well within ADL’s and lives independently then you’re going to be happy” with support from her daughter. HBMR completed NHS Dumfries and Galloway Mental Health Occupational Therapy Service NHS Dumfries and Galloway Mental Health Occupational Therapy Service HBMR with Mrs G HBMR with Mrs G Mrs G completed the HBMR programme and took on the following • Mrs G stated she found HBMR “very useful” and as a result feels more • strategies “organised within day to day activities”. - memory book Daughter “simple but effective strategies”. - telephone prompt card and notebook beside phone - pocket notebook Repeat testing: • - safety checklist - EDMP and ADL scoring remained the same - use of post-it notes - LACLS on initial assessment = 4.8 - going out prompt card LACLS on 3 month review = 4.6 - calendar - timer - all tip sheets within HBMR folder which Mrs G looks over regularly NHS Dumfries and Galloway Mental Health Occupational Therapy Service NHS Dumfries and Galloway Mental Health Occupational Therapy Service