Dementia care
then one minute, then two minutes, four minutes and so on up until 20 minutes. If the individual can successfully complete the activity after this time, they will have stored it in their brain – and would then practice the activity daily in order to maintain the new skill.
Errorless learning
Errorless learning is something all carers should practice when using CR. This is making sure they do not set the person up to fail. By breaking down the activity into small components, the individual has less chance of making an error. And if they do make a mistake, it is important to highlight what they should be doing rather than what they should not. So instead of saying ‘you shouldn’t have
turned left’, they should say ‘remember, here’s where you turn right.’ Everyone needs to use this approach, as one person can undermine achievements made previously, and the person is likely to remember the error made rather than the correction.
Great into practice During the ‘GREAT into Practice’ initiative, a pilot study was run in four care homes from one group. Staff including occupational therapists, activity co-ordinators and senior care assistants were trained in the programme, and they then worked with a total of 30 residents who each had twice- weekly, one-hour CR sessions for ten weeks. Following the pilot, all the participants
wanted to carry on. They all had a variety of goals – from remembering relatives’ names and relationships to learning how to use a mobile device, a popular activity. Two interesting case studies from the pilot highlight how beneficial the therapy can be. One individual in a care home with multiple floors and a lift was always extremely anxious about not finding her way back to her room and getting lost. When she came down to the lounge, she was unable to settle, and she would repeatedly ask the other residents where her room was, which was trying for all concerned. The carers devised a system for her to
find her own way back starting with the lift. The first step was to press the right button – so a small red sticker was placed next to her floor number, and she was encouraged to ‘reach for the red.’ When she exited the lift, she was told to head for the painting on the wall on the right – which took her in the correct direction.
April 2022
www.thecarehomeenvironment.com
As she was a cat lover, the carers placed a picture in the basket of her walking frame of a cat, and then placed the same image on the door to her room. She not only found her way back easily, she also became much less anxious and became much more sociable too. Once she knew the way, the red decal in the lift was taken away but the first step was embedded into muscle memory so she still knew which button to press. In another case, a man with moderate dementia moved into the care home but still wanted to go into town on his own. Following risk assessments, he was given the green light and together with his carers developed a system to ensure he did not get lost. He created an aide-memoire in order to catch the right bus, and he wrote down all the landmarks on his route and memorised them. He had a written version as back up in his pocket, and a mobile phone to call home if he got stuck. By using GREAT CR, he became more confident and independent and was able to go out on his own regularly. GREAT CR is not currently being used in
Cognitive rehabilitation 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
many front-line care services as it has only recently been evidenced, and the training course, which was delayed by Covid, needs to be completed in order to deliver the full GREAT CR Programme that systematically uses a goal setting and attainment instrument for planning and measuring outcomes. The GREAT CR online course is due out in this spring. It will be available on the NHS eLearning hub, so professional health and social care workers who have access to the site will be able to take the training. When the e-learning goes live, it will be announced on the Exeter University site. However, as part of the GREAT study, the research team collaborated with some people who are living with dementia to develop an online booklet of basic cognitive rehabilitation tips and techniques. This Alzheimer’s Society publication, My Life My Goals,3
provides people with a sense of hopefulness that it is possible to achieve some of their goals, using some cognitive rehabilitation approaches. For care givers who cannot access the eLearning course, the publication will also be helpful guidance to provide rehabilitation approaches to those who use their services
How does cognitive rehabilitation work? The first step is to support the person to identify a goal that is SMART (specific, measurable, achievable, realistic and timely) and important to the person. An example would be: ‘I will be going for a walk for 20 minutes to the newsagents each day’. The care giver or activity provider would then use a collaborative, problem-solving
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