“Dementia is a syndrome that results in decline of memory and at least one other cognitive ability, significant enough to interfere with daily living tasks.”
I read a systematic review looking at 43 research studies of cognitive intervention for individuals with dementia. The studies included the following most common interventions, which I will describe by using the example of training individuals to safely sequence walker or wheelchair use or ambulation.
Errorless Learning: This is an intervention focused on variable cues to reduce the risk of individuals’ mistakes during trials. Rather than correcting errors, cues would be provided to decrease or eliminate errors. Example: Rather than waiting for a patient to make an error in hand placement, I would say, “And then you put your hands…” to let them fill in the blank correctly.
Vanishing Cues: With this strategy cues or prompts are gradually faded as someone learns a task. Rather than providing the same level of cueing, you adjust the level of cue provided by the success someone is having. Example: When someone remembers to lock their walker brakes, I stop cueing for that step to be completed.
Spaced Retrieval: When using spaced retrieval the therapist asks the individual to recall information (such as steps for transitioning to and from a walker) at increasing intervals. Example: After explaining the steps to transfer from wheelchair to walker, I ask a patient to repeat the steps for me. First it may be immediately, then we may work up to 10 minutes or more.
Systematic reviews are interesting because you are trying to find the average among many studies. This systematic review resulted in mixed results. Sometimes the intervention strategies work, sometimes they don’t. However, the studies looked at participants across the dementia spectrum. I think that intervention strategies should be chosen based on the severity of dementia and the specific client/therapist relationship.
For my mild through moderate dementia clients I use a combination of all three interventions. I am a big fan of errorless learning. I have done training with occupational therapy and physical therapy staff to help them use errorless learning with great success. In combining the three interventions I find that it gives patients a greater opportunity for success. Patients that understand when they have done something correctly need that. Nobody wants to be corrected all the time. I like to set clients up for success.
An Evidence-Based Systematic Review on Cognitive Interventions for Individuals with Dementia. American Journal of Speech-Language Pathology, Vol. 22, (February 2013), pp. 126-145, doi: 10.1044/1058-0360 by Tammy Hopper, Michelle Bourgeois, Jane Pimentel, et al.
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