Fig. 29.1
Theraband exercise for strength training
The following contents are examples of physical interventions:
Strength training: exercise is mainly used, resistive bands, and focused on upper and lower major muscle groups
Balance and flexibility training: exercises including shifting center of gravity, forward and backward walks, and chair sit to stands
Aerobic fitness: brisk walking was the primary activity (Steinberg et al. 2009)
The Snoezelen therapy (multisensory behavior therapy; Staal et al. 2007; e.g., see Fig. 29.2) is a multisensory environmental approach leading participants to various sensory such as vision, hearing, tactile sense, vestibular sense, proprioceptive sense, olfactory sense, and taste. The structured activities consisted of programs, including physical stimulation such as massage; sensorimotor stimulation such as pressure and squat; visual stimulation such as color, light, and shade discriminations. The practice is of total 24 sessions of 2 sessions per week. Protocols are for 25–30 min per session, and individuals are guided by an OT (Ro et al. 2011; Pagliano 1999).
Fig. 29.2
Snoezelen therapy for sensory stimulation
Music therapy is the intervention used where individualized music that was related to special memories of each participant for positive emotions such as pleasure or joy. The participants listened to the selected music via a CD player . The music is offered to participants for 1 week and then practical training was conducted for 5 days (Sakamoto et al. 2013).
The Snoezelen and music therapy (Sakamoto et al. 2013) are interventions applied to reduce the behavioral and emotional problems.
Since caregivers too have stress due to high dependency on the patient, OTs need to provide an educational program for caregivers, including practical advice strategies to manage effectively person with severe dementia (Nobili et al. 2004). Educational interventions for caregivers consisted of discussions provided by OTs for 90 min and one separate home visit. Especially educational interventions provided by OT include strategies to prevent and manage behavioral problems, to maintain and improve the patient’s residual functional abilities, to modify home environments, and to limit dangerous situations such as fall (Kim et al. 2012a). OTs also can be provided with an information manual about managing the elderly with severe dementia.
According to the international guideline, it is recommended to use occupational therapy intervention for elderly people with severe dementia (Korczak et al. 2013).
The Role of the OT
OTs evaluate individuals with dementia to identify their strengths, impairments, and performance areas needing intervention (Schaber 2010). OTs provide therapeutic activities, including crafts, physical exercise, cognitive training, and sensory activities, to improve physical and cognitive functions of participants on their own occupations. Moreover, an important role of OTs is to provide education to caregivers, especially in the late stage of dementia.
Evidence-Based Practice
A study by Steinberg et al. (2009) demonstrated that the home-based exercise program, including aerobic fitness, strength training, and balance and flexibility training, for person with severe dementia had positive effect on hand function and lower extremity strength. These findings of evidence-based practice can assist to guide management with severe dementia patients. The Snoezelen therapy may reduce behavioral problems and additionally improve activities of daily living in hospitalized people with severe dementia (Staal et al. 2007). Among Snoezelen equipment, participants had a high preference for familiar sensory such as a bubble tube and projector, but negative response for unfamiliar sensory such as aroma diffuser and optic fibers (Kim et al. 2011). Music therapy showed positive effects on emotional state of people with severe dementia (Sakamoto et al. 2013). The educational interventions for caregivers improved stress management skills while caring for person with severe dementia (Nobili et al. 2004).
Finally, based on a systematic review (9 studies including 751 people), Kim et al. (2012b) concluded that OT interventions based on sensory stimulation was an effective intervention to improve behavioral problems.
Discussion
This chapter demonstrates that occupational therapy services enable the person with severe dementia and caregivers to improve the quality of life . Especially, among these services, physical training and Snoezelen sensory stimulation therapy have positive effects on physical and emotional aspects for the clients. In conclusion, occupational therapy services were essential to the people with severe dementia.
The Case Study: Effects of Occupational Therapy Intervention with Mr. Kim
Keywords
Occupational therapy, severe dementia, quality of life
Introduction
The theme of this case study concerns intervention effects of occupational therapy for a person with severe dementia.
The student’s tasks include the following:
Finding information about condition and progression of severe dementia
Making intervention plan for assessments and activities applied with severe dementia patient
Synthesizing the information into a report
As a starting point, the students should use the following references to gather background information:
Boller F, Verny M, Hugonot-Diener L, Saxton J (2002) Clinical features and assessment of severe dementia. A review1. Eur J Neurol 9(2):125–136
Burge E, Kuhne N, Berchtold A, Maupetit C, von Gunten A (2012) Impact of physical activity on activity of daily living in moderate to severe dementia: a critical review. Eur Rev Aging Physical Activity 9(1):27–39
Chang E (2006) Palliative care dementia interface: enhancing community capacity project (Doctoral dissertation, University of Western Sydney)
Folstein MF, Folstein SE, Mc Hugh PR (1975) Mini-mental state: a practical method for grading the cognitive state of patients and for the clinician. J Psychiatric Res 12(3):189–198
Herrmann N, Gauthier S, Lysy PG (2007) Clinical practice guidelines for severe Alzheimer’s disease. Alzheimer Dementia 3(4):385–397
Kim SY, Yoo EY, Jung MY, Park SH, Park JH (2012) A systematic review of the effects of occupational therapy for persons with dementia: a meta-analysis of randomized controlled trials. NeuroRehabilitation 31:107–115
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