Dementia care
approach to find out where there is a mismatch between what the person can do and what the goal requires, and where and why things go wrong. They would address the goal by using rehabilitative methods such as new learning, relearning, compensatory strategies, assistive technology and combined with a person- centred approach that addresses their emotional and social needs too
The five steps of the CR process The following steps are a guide to good practice for practitioners, whose job it is to enable rehabilitation.
1. Establish the person’s current level of functioning
Talk to the person with dementia, family, care and activity colleagues about the abilities and difficulties of the person with dementia.
Understand what the person can do currently, or what they could potentially do. Discuss the areas of everyday life where the person would like to see improvements. Get a clear idea of what exactly causes difficulty in these areas.
2. Define a goal with clear therapy objectives
Together with the person with dementia and family/care supporters (if available) agree a goal for the cognitive rehabilitation. Using the SMART criteria (Specific, Measurable, Attainable, Relevant, Time- limited) when formulating goals will help pin down all the necessary details, like the exact outcomes and timeline of the work. This exercise is very motivating for the person and can be helpful to share with
colleagues and close others so that everyone is supportive
3. Develop a personal therapy plan To develop a plan, understand the person’s current level of ability, and what makes a particular activity difficult. Then decide which CR methods might be most suitable to assist the person in achieving the goal. The QCS PAL Guides can support this understanding and the development of the personal therapy plan. The QCS PAL instrument4
was utilised
by many of the GREAT CR practitioners in the study in order to understand overall level of ability and those at a planned or exploratory level were felt to be most likely to benefit from CR. In addition, the resulting PAL Guides were also used to support family members and other care givers to provide the most enabling form of care beyond the specific cognitive rehabilitation. Key areas to consider are: n Are there any problems that need attention before you can focus on the goal, e.g. physical health, emotional needs?
n What activities are involved in achieving the goal?
n What exactly makes the goal-related activities difficult?
n Can the CR plan build on the person’s usual ways of coping?
n Could family/care supporters help in applying the CR plan?
n What CR methods could help in achieving the goal? These might include:
Compensatory n De-clutter the environment. n Remove distractions, e.g. turn off TV or
radio, ensure a quiet relaxing area. n Use notes and lists to follow.
Relearning or new learning n Break down the activity or the information into smaller steps.
n Show the person how to do each step of the activity.
n Encourage them to have a go, one step at a time.
n Have the person write down the steps, read them out loud and do them.
n Encourage the person to add meaning to information using visual images or word play.
n Support the person to practice the steps, several times in an hour session, with increasing time gaps between.
n Practice the activity daily and progress to add more steps as each one is achieved.
4. Carrying out the plan Support the person with dementia in working on the goal in line with the plan. Share their successes with them and show them how they are faring in relation to their overall goal.
5. Evaluation and re-assessment Review progress and adapt the plan if the chosen strategies are not working well. When the end of the agreed time for
working on the goal is reached, see how much progress has been achieved and possibly identify additional goals.
Who is cognitive rehabilitation suitable for? CR has been validated for people in mild to moderate stages of dementia. However, the principles of GREAT CR can also be applied to support people living with more severe cognitive decline, with specific objectives and techniques adapted to their needs and abilities. For example, maintaining the ability to dress oneself, enabling participation in an enjoyable activity. As dementia progresses, family members or other carers are likely to play a more active role in selecting goals.
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www.thecarehomeenvironment.com April 2022
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