Dementia care
Dementia: the benefits of cognitive rehabilitation
A new cognitive rehabilitation programme has been developed that enables people living with dementia to function at their best level possible, remain engaged, and manage everyday activities. Jackie Pool, dementia care champion at social care consultancy QCS, explains all
Cognitive rehabilitation (CR) therapy has been used for many years to improve and restore cognitive function after a serious brain injury such as a traumatic brain injury (TBI) or a stroke. Now, after years of clinical research and a recently completed large-scale trial, a new type of CR intervention has been proven to benefit people with early-stage dementia. Great Cognitive Rehabilitation (GREAT CR) came out of a University of Exeter project and has been endorsed by NICE guidelines and the Royal College of Psychiatrists.1, 2
What is GREAT CR? GREAT CR provides an individual problem- solving approach to enable people with mild to moderate dementia to regain lost abilities or to learn new ones in order function in everyday activities. It uses rehabilitation strategies to address the impact of cognitive impairments in the areas they want to manage better.
An evidence-based method,
the therapy helps people with mild to moderate dementia to remain active, manage everyday activities and keep doing the things they want to do. The Goal-oriented cognitive Rehabilitation
in Early-stage Alzheimer’s and related dementias: multicentre single-blind randomised controlled Trial (GREAT) involved 475 people with dementia and their care partners. It demonstrated the positive effects of the therapy.
It focuses on what is important to each individual, so the starting point is always identifying meaningful personal goals – things the person wants to be able to do, or improve on, or learn, such as using a mobile phone or recalling grandchildren’s names. Then the person, and their carers and/ or family members work with a trained practitioner to plan how to achieve these goals.
The practitioner will identify any difficulties in carrying out activities or learning new skills and then use this understanding to tailor strategies to overcome obstacles and enable the person to achieve their desired goals.
How does it work? GREAT CR therapy addresses cognitive difficulties by looking at how they impact the person’s ability to do something, for example using a mobile device, and then teaching them to do it in a different way. This will then lay down a new nerve pathway in the brain and teach the person new ‘muscle memory’. There are two types of approaches used: compensatory techniques are the simplest, although they also need some new learning to make best use of them. These remove the need to rely on the impaired ability and would include simplifying the activity by, for example, having the person use memory aids such as notes and memos that cue them into information, compensating for lost ability. The other type of approach is ‘new learning’ or ‘relearning’ and uses a range of specific methods:
Effortful processing A technique called ‘effortful processing’ is helpful when a person is learning to do something new, such as using a microwave. The practitioner would not just provide a verbal explanation of how the oven works but also demonstrate it while breaking it down into small steps. The individual would write down the different steps, read them out aloud, and then go through each step as they completed the activity, while talking through what they are doing. In this way the brain is working harder, using different areas that synchronise during the activity.
Expanding rehearsal Another technique used in the approach is expanding rehearsal. This is when the individual practices the activity repeatedly, increasing the length of time between each session. The first interval is 30 seconds,
22
www.thecarehomeenvironment.com April 2022
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48
