140: Meaningful Dementia Therapy with Michelle Bourgeois, Ph.D., CCC-SLP ASHA Fellow, GSA Fellow, AAAS Fellow and Sarah Baar, M.A., CCC-SLP
Meaningful speech therapy for dementia is possible! Using a person-centered philosophy is supported by research. Let’s chat about assessment, goals, and treatment with this approach.
Topics covered:
Dementia Assessment
Functional Goals in Dementia
Latest evidence on treatment in dementia (montessori, Spaced Retrieval, Memory books)
the Discussion Guide
Download your free Discussion Guide to unpack the information covered in the episode at a deeper level. The Discussion Guide can be used in a group setting or on your own.
Resources
Life Participation in Dementia
Bourgeois, M., Brush, J., Douglas, N., Khayum, R., & Rogalski, E. (2016). Will you still need me when I’m 64, or 84, or 104? The importance of Speech-Language Pathologists in promoting the quality of life of aging adults in the United States into the future. Seminars in Speech and Language, 37, 185-200.
Functional Assessment in Dementia
Bourgeois, M., Camp, C., Antenucci, V., & Fox, K. (2016). VoiceMyChoice™: Facilitating Understanding of Preferences of Residents with Dementia. Advances in Aging Research, 5, 131-141.
Montessori Approach
Bourgeois, M., Brush, J., Elliot, G., & Kelly, A. (2015). Join the Revolution: How Montessori for Aging and Dementia can change long-term care culture. Seminars in Speech & Language, 36(3), 209-214.
Brush, J., Douglas, N.F., Bourgeois, M. (2018). Implementation of the Montessori philosophy in assisted living: positive outcomes and challenges. The Journal of Nursing Home Research Sciences, 4, 64-70.
Douglas, N.F., Brush, J., Bourgeois, M. (2018). Person-centered, skilled services using a Montessori approach for persons with dementia. Seminars in Speech and Language, 39(3), 223-230.
Video of Montessori approach: https://www.youtube.com/watch?v=1LCRrcxlrXE
Functional Goal-Setting Examples in Dementia
Frank: Mild Cognitive Impairment dx; lives at home
Overall Goals:
Enjoy his Retirement!
Attend Senior Academy to keep his mind alert
Improve memory
Word-finding issues
for Appointments
Volunteer at Veteran’s hospital
Continue playing tennis with friends
Socialize with friends
Memory Strategy Training
Long term goal
Client will utilize memory strategies on a daily basis in the home to maintain independent functioning
Short term objectives
Client will use calendar daily with minimal prompts
Client will complete weekly home activity with minimal assistance
Client will maintain participation and engagement in activities using memory aid with minimal assistance
Client will use memory aid to retrieve words during conversation 4/5 times with minimal assistance
Hazel: PPA dx; in short-term rehab
Overall Goals:
Go home!
Meets PT ambulation goals
Independent for Meds
Live independently
take care of herself (ADLs; food prep, laundry)
Dog care (feeding, walking)
Maintain social & church activities
Quilt group
Bible study group
Intervention approaches:
Early/Mild Stages of PPA
Self-cueing strategies
Semantic circumlocution, phonemic self-cueing, written cues, gestures, visualization
Motor sequencing strategies
Fading cues hierarchy to increase pronunciation of multisyllabic words
Communication wallet/written aids
Portable system of important words/information to support conversation
Rehearsal of personally relevant words
Home program for practicing retrieval and production of frequently used words in conversation
Later Moderate/Severe Stages of PPA
Script training:
Scripts for speaking on the telephone, tell stories or jokes, order food at a restaurant, say prayers, etc. (Youmans et al, 2005)
Facilitating auditory comprehension:
training caregiver to use strategies to simplify sentence structure, slow rate of speech, use nonverbal cue
Use Communication books (low-tech AAC)
Consider High-tech AAC (computer, TV remote, cell phone, iPad apps (Holland et al, 2012))
Marge: Moderate dementia dx; lives in SNF
Overall Goals:
Basic needs to be met
Food, shelter, friends
Meaningful activities
Reading group, music, gardening
Role in the community
Homemaking skills
Marge will maintain her weight by selecting and eating desired foods with moderate visual cues.
Marge will find her room independently with moderate visual cues.
Marge will participate in a reading group by reading text aloud with moderate visual cues.
Marge will participate in the community by making flower arrangements for the dining room tables on a daily basis with moderate visual cues.
Patient-reported outcome ideas
PROMIS: Patient-reported outcomes measurement information system
Amtmann, D., Cook, K., Johnson, K., & Cella, D. (2011). The PROMIS Initiative: Involvement of Rehabilitation Stakeholders in Development and Examples of Application in Rehabilitation Research. Arch Phys Med Rehabil, Vol 92, Suppl 1, S12-S19.
NIH Toolbox Cognition Battery: This battery, recommended for ages 7+, consists of tests to assess Executive Function, Attention, Episodic Memory, Language, Processing Speed and Working Memory.
Neuro - QOL: Quality of Life in Neurological Disorders.
Quality of Life-Cognition Battery: Applied Cognition-General Concerns, Applied Cognition- Executive Function, Communication
Intervention / Strategies for Dementia and Mild Cognitive Impairment:
Benigas, J. E. & Bourgeois, M. (2016). Using Spaced Retrieval with External Aids to Improve Use of Compensatory Strategies During Eating for Persons with Dementia. Am J Speech Lang Pathol, 25(3), 321-334. doi: 10.1044/2015_AJSLP-14-0176.
Bourgeois, M. (2013). Therapy techniques for Mild Cognitive Impairment. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 23(1), 23-34.
Lanzi, A., Burshnic, V., & Bourgeois, M. S. (2017). Person-centered memory and communication strategies for adults with dementia. Topics in Language Disorders, 37(4), 361–374.
Caregiver Education:
Bourgeois, M. (2019). Caregiving for Persons with Dementia: Evidence-based resources for SLPs. Topics in Language Disorders, 39(1), 89-103.
Websites to Explore:
Center for Applied Research in Dementia: https://www.cen4ard.com
Cognitive Concierge: https://mycognitiveconcierge.com/
Dementiability: Education and Resources for Professionals and Caregivers https://dementiability.com
Thanks for these amazing resources, Sarah & Michelle!
Michelle S. Bourgeois, Ph.D., CCC-SLP, ASHA Fellow, is a retired Professor in the Department of Communication Sciences and Disorders, University of South Florida. She has received numerous grants to evaluate memory aids and interventions for persons with dementia, aphasia, and traumatic brain injury, to develop interventions for spousal and nursing home caregivers designed to improve the quality and quantity of communicative interactions with residents with dementia, and to develop training programs for institutional caregivers.
Sarah Baar is a private practice speech-language pathologist in Grand Rapids, MI. She’s had the opportunity to work in many settings across the continuum including acute care, acute rehab, home & community, and outpatient therapy. In 2016, she started the Honeycomb Speech Therapy website as a way to promote person-centered and functional therapy ideas and materials for adult rehab. Those who attend her presentations enjoy the practical way she explains evidence in a way that is efficient and manageable while supporting a functional therapy approach.
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