REHABILITATION AND

DEMENTIA

Professor Mary Marshall

Definitions of Rehabilitation

• “A process aiming to restore personal

autonomy in those aspects of daily living

considered most relevant by patients and

service users, and their family carers”

• “Rehabilitation is concerned with enabling

those with any short or long-term disability

to obtain the maximum psychological or

physical independence possible”

Definitions

• “Rehabilitation is about enabling people

who are disabled by injury or disease to

achieve their optimum physical,

psychological, social and vocational well-

being”

Rehabilitation and dementia

• An unlikely pairing?

• A way of presenting an optimistic

approach to dementia care

• Could provide a useful structure for

dementia care itself

Four kinds of rehabilitation

• Rehabilitation following an acute physical

episode

• Rehabilitation following a dementia-related

episode

• Cognitive rehabilitation

• Rehabilitation as an approach to dementia

care

Rehabilitation following an acute

physical episode

• Some issues for the acute health sector

– Low expectations

– Role of nurses

– Training gap

– Pain

– Delayed discharge

– Moving between wards

Rehabilitation following an acute

physical episode

• Some general issues:

– Communication skills

– Lateral thinking

– Doing with not doing for

Rehabilitation following a dementia-

related episode

• Reviewing medication

• Detective work

• Revising the care plan

• Changing the social and the built

environment

Cognitive rehabilitation

• Aims to enable clients or patients, and

their families, to live with, manage, by-

pass, reduce or come to terms with deficits

precipitated by injury to the brain

– Professor Clare will explain how

Rehabilitation as an approach to

dementia care

• We need to look at the characteristics of

rehabilitation

Characteristics of rehabilitation

• Teamwork

• Working with families and supporters

• Prosthetics

• Removing causes of excess

(unnecessary) disability

• Learning and motivation

• A focus

Teamwork

• Has to be a joint effort

• Every profession has a role

• Consistency is crucial

Working with the family and other

supporters

• Families and friends can contribute crucial

information and understanding

• Families and friends may need training

and support

Prosthetics

• Design

• Signage

• Adaptations

• Equipment

Skilled assessment is essential

Removing causes of excess

(unnecessary) disability

• Almost any aspect of the person’s social

and built environment can be sub-optimal.

For example:

– Interactions which undermine confidence and

self-esteem

– Care plans not based on personal

preferences

– Under-nutrition and dehydration

– Lack of activities

Learning and motivation

• Easy to underestimate the capacity to

learn of people with dementia

• Motivation is linked to self-esteem and

confidence

• Need for lateral thinking

A focus

• Could be short term, for example,

restoring confidence in cooking or

restoring continence

• Could be long term, for example,

maintaining exercise or social skills

The sub-theme

• Optimism

– Because

• Fear has to be acknowledged

• Dementia is not entirely a negative experience

• We have increasing evidence about what works

Fear has to be acknowledged(Stephen Post)

• “In our hyper-cognitive culture and

society… nothing is as fearful as AD

because it violates the spirit of self-control,

independence, economic productivity, and

cognitive enhancement that defines our

dominant image of human fulfilment….the

hyper-cognitive societies..can neglect the

emotional, relational, aesthetic and

spiritual aspects of well-being.”

Dementia is not an entirely

negative experience• We need to listen to people with dementia

• “Personally, I would not like to go back to not

having dementia. I’m in love with dementia and

fascinated with the condition. I now understand

how a kaleidoscope works, Shake me and find

out!”

• We need to focus on the emotional,

relational, aesthetic and spiritual aspects

We have increasing evidence

about what works• In psychosocial interventions, for example:

– Singing

– Activities

– Training and support for carers

– Design features

Three questions:

• Can we be invigorated by increasing

optimism about dementia care?

• Can we improve rehabilitation for people

with dementia?

• Is this a useful way to describe dementia

care?

Sources

• Thanks to all the contributors to: Marshall, M (ed.) (2005) Perspectives on

rehabilitation and dementia. London, Jessica Kingsley Publishers

• Other references:

• Brodarty, H., Green, A., and Koschera, A. (2003) ‘Meta-Analysis of Psychosocial

Interventions for Caregivers of People with Dementia’, Journal of the American

Geriatric Society 51: pp 657 -664

• Brown,S.,Gotell,E. and Ekman,S (2001) “Singing as a therapeutic intervention in

dementia care” in Journal of Dementia Care. July/August

• Fleming,R., Crookes,P., Sum,S. (2009) Design for dementia. A review of the

empirical literature on the design of physical environments for people with dementia.

Stirling, Dementia Services development Centre

• Huusko T.M.,Karppi,P.,Avikainen,V., Kautiainen,K., Sulkava,R. (2000) “Randomised,

clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture:

subgroup analysis of patients with dementia” BMJ 2000;321:1107-1111

( 4 November )

Sources cont.

• Stephen G Post (2000): The Concept of Alzheimer Disease in a Hypercognitive

Society in Whitehouse P. J, Maurer K and Ballenger J F: Concepts of Alzheimer

Disease. Biological, clinical and cultural perspectives. The Johns Hopkins University

Press

• Spector,A.,Thorgrimsen,L.,Woods,B.,Royan,L.,Davies,S.,Butterworth, M.,Orrell, M.

(2003) Efficacy of an Evidence-Based Cognitive Stimulation Therapy Programme for

People with Dementia: Randomised Controlled Trial, British Journal of

Psychiatry,183, pp 248 –254.