Allied health professional Enhancing Daily Living: Home base memory rehabilitation #OTHBMR – An update

On Wednesday there was a workshop with over 40 occupational therapy staff from across Scotland to talking about home based memory rehabilitation. Home based memory rehabilitation was originally developed by Mary McGrath (2013) and is an evidence-based, occupational therapist-led, six week intervention. It takes place in the person’s own home with a family member, where possible and is based on principles of cognitive rehabilitation. It aims to teach the person to compensate for their memory deficits and includes minor adaptations to the home environment to support these strategies. There are also four key principles that Mary shared in Dementia in Scotland (2016:23) that can help all of us cope a bit better with dementia:

  1. Don’t multi-task. Focus on one thing at a time. Whether that’s what you’d planned to make for dinner or trying to recall the name of a school friend from a photograph, putting all of your attention on the task at hand puts less strain on your memory.
  2. Don’t guess. If you don’t know, you don’t know and that’s fine. For a person with dementia, the process of making a guess can store that information in their mind, whether that information is right or wrong. For example, if somebody asks what day it is, don’t urge them to work it out for themselves, tell them and then reinforce the answer by encouraging them to repeat it and write it down.
  3. Dementia doesn’t define you. It’s very easy to start defining someone (or yourself) by their dementia. However, you must remember that there is more to someone than their dementia. Loss of self-confidence can have a big impact on a person with dementia’s trust in their own ability to remember things or carry out tasks. 
  1. Don’t over care. For many family members and carers it is a natural instinct to want to support the person with dementia as much as they can. This over caring can mean that even tasks and responsibilities that the person in still capable of achieving are taken away and that can contribute to further decline. Where it is safe to do so, people should be encouraged to continue being involved in familiar activities.

Home based memory rehabilitation has been successfully implemented in Scotland by the occupational therapy team in NHS Dumfries and Galloway. You can hear from four people who have been involved on the positive impact of the approach to their daily lives in the video below.

We are now collaborating in Scotland to test home based rehabilitation in 12 areas of Scotland and you can see from our photo album below who is involved.

National team supporting the work

NHS Dumfries and Galloway, Queen Margaret University & Alzheimer Scotland.

Keep in touch:

We will continue to share with you our progress on home based memory rehabilitation through this blog and on our community of practice http://www.knowledge.scot.nhs.uk/ahpcommunity/ailip-priority-workstreams/dementia.aspx

You can also follow #OTHBMR to find our more or post us a question on this blog

Thank you

McGrath M P 2013 Promoting safety in the home: The home-based Memory Rehabilitation Programme for persons with mild Alzheimer’s disease and other dementias.

Techniques and strategies for improving memory 2016 Dementia in Scotland issue 90 page 23

5 things I learned in Japan

Alzheimer Disease International holds a conference every year and it is a unique opportunity to bring together everyone with an interest in dementia – staff and volunteers of Alzheimer’s Associations, people living with dementia, family members, clinicians, researchers, care professionals and scientists – to share and learn from one another.

I was lucky enough to represent Alzheimer Scotland at the Alzheimer Disease International Conference in Kyoto, Japan in April, sharing our work in post diagnostic support. As I was going all that way for a conference I wanted to see the best of dementia care and support Japan has to offer so set up some visits to services that I’d heard were well respected. Here’s some of the headlines:

  1. Scotland is seen by the dementia community in Japan as world leading and way ahead of anywhere else. Our Human Rights approach; 5 and 8 Pillar models; our activism on dementia such as the Scottish Dementia Working Group. The few people from Scotland who were at the conference felt like minor celebrities-it was very humbling.
  2. In Japan dementia care is funded through a long term care state run insurance that everyone over 40 pays for. It has created a mixed market so, whilst the quality is mixed, there is a wide range of support available and lots of innovation is evident.
  3. Group homes of up to 9 people are a popular option for people with dementia who can no longer live at home. Daily life centres around an open plan kitchen and living space and people with dementia are supported to maintain their skills and abilities, including shopping for food and contributing to cooking meals, from chopping vegetables to stirring pots or laying out the chopsticks.
  4. Cognercise, used in some primary schools here, is growing as a therapeutic intervention in Japan. At a day centre in Tokyo, I joined in the body & brain exercise that energised everyone mid-afternoon.
  5. Dementia care, like everything, sits in a cultural context. Dementia care in Japan is thoughtful, kind, intricate and considered, with Hokkoi, roughly translated as a deep sense of wellbeing and contentment, the ultimate goal of dementia care.

Kyoto preparing lunch

Making a friend in the park

Room sign, Katerei no ie

On Reflection

How much do cultural values and norms influence our dementia care in Scotland? And how aware are we of this?

Occupational Therapy Lead Memory Management Group: a practice example

For over ten years occupational therapists in Lanarkshire have been running memory management groups. These groups are for people who have a problem with their memory and wish to do something themselves to improve this. It aims to enable people to be as independent as possible in their daily lives.

The groups are suitable for those with mild memory difficulties who feel it is impacting on their daily life. It is essential that the person is aware of their memory problem and actively wants to manage this effectively. People are referred to our groups via their consultant psychiatrist or GP. Everyone is visited at home by the occupational therapists prior to the group starting to talk through how the group could help and if they would like to take part.

The informal structure of the group allows people to gain support from others in a similar situation as themselves. Occupational therapist staff facilitate discussion, whilst working through a programme and offer practical advice related to their concerns regarding their memory.

Through discussion we assist people to work out solutions to the difficulties they are experiencing with memory problems. This is done by suggesting techniques and strategies to assist their memory in order to manage their day to day lives more effectively. The groups are generally small for approximately 4-6 people, taking place over four to five with each session lasting 90 minutes.

Some of the topics included in the group are:

  • Remembering names
  • Staying safe at home
  • Getting out and about
  • Tips and strategies
  • Enhancing well-being
  • Keeping the brain active
  • Leisure

We have practical materials we demonstrate in the group and provide what we can after each session as from experience individuals are more likely to use the strategies suggested if they have the required material rather than having to go and get the item themselves.

 

To evaluate the group we use “Emotional Touchpoints” which has been an effective way for those attending to share how they have found their group experience. For those unfamiliar with this method, ‘Emotional Touchpoints is a powerful means of helping people to share the aspects of experiences that are important to them – rather than the things service providers think are important.’ (Scottish Health Council, 2016). Below are a few examples of what people have said about this group.

“I now feel hopeful but I didn’t before I came here. I used to isolate myself and do things alone as I was embarrassed if I got things wrong. I now willingly go out with others and say yes to invites. I feel I’ve changed. I feel more positive and see a difference in myself since coming to this group. I’m relieved as I used to think about my memory all the time but I’m now at the stage I go with the flow and I’m enjoying myself.”

“I’m happy I’ve been involved with others with the same problem and feel I can now handle stuff I couldn’t have before. I’ve valued the hints and tips shared in the group and hopeful that what I’ve learned will stay with me and allow me to enjoy myself.”

“I’ve felt welcome here right from the start and quickly felt involved. I’m relieved to know I’m not the only one going through this. I’m hopeful; by using what I’ve got from here that I will be able to manage what is ahead of me.”

“I was really anxious about my memory at the start but now feel inspired and more hopeful and confident in myself and about my memory. I’m using techniques eg in the pub yesterday I was listening for someone’s name being said as I knew him from years ago and was talking to him but couldn’t remember his name. Being supported here has made this a great group and I will miss coming.”

Thank you for reading our blog post. we would love to hear what you think and if you have experience of working with occupational therapy

 

Gill Gowran, Specialist Occupational Therapist, NHSL

@MHOTGill (Twitter)

#valueofOT

 

 

 

Maximising Psychological Wellbeing – Music Therapy Reflections: On a positive note…

 

In my last Blog post, I asked our Art Psychotherapy Student, Shirelle Young about the best of her Alzheimer Scotland placement experience. Here, the conversation is with Ed Muirhead who has just finished his Music Therapy placement, asking him about what worked well during his time spent in one of our Dementia Resource Centres.

Environment

Question: Reflecting on the therapeutic environment, what really mattered?

Answer: “The room was very important as part of the secure space, and maintaining this space was a key building block of the therapeutic process.

Music

Question: Concentrating on the process of music making, what worked well?

Answer: “Singing was the most frequent form of music-making, people seemed most familiar and comfortable with this. We would sing known songs according to peoples’ preference – everyone has their own particular songs they like to sing. These would be accompanied with piano or guitar, and we would occasionally improvise words in the moment to known tunes. Other instruments such as glockenspiel, shakers, drums and tambourines were also used, though not so often as singing.”

 

Relationships

Question: Focussing on the therapeutic relationships that developed, what made a difference?

Answer: “There was evidence of developing relationships with people throughout the 22 weeks of the music therapy practice placement. Particularly after the Christmas break, I noticed a deepening of relationship, a closer proximity, both physically and emotionally, and heightened eye-contact and engagement. At this point, so close to the work, it’s hard to pinpoint exactly what made a difference, perhaps the continuity of the work, being there every week at the same time in the same place and holding on to memory on behalf of people.”

Reflection

Question: Thinking about your own reflective processes, what was helpful?

Answer: “Reflection has been important along the way, and will continue in the coming weeks as I write up my professional project. I’ve chosen a clinical project that focuses on personal reflection while carrying out the placement – including a service evaluation element. Process notes along the way were helpful, as were video recordings of sessions (with informed consent by people coming to Alzheimer Scotland).”

Approach

Question: Looking at how you have adapted your approach to meet the needs of people with dementia and their families within Alzheimer Scotland what has been important?

Answer: “Learning repertoire to suit each person has been important, as has learning chord sequences that suit music from their era. General knowledge of the music of the 1940s, 1950s and 1960s in particular has been useful. My own approach relies on listening, which has been vital in hearing what people have to say or sing, though sometimes musical prompting has been required.”

Dementia

Question: In working towards becoming a dementia skilled practitioner, what has been useful?

Answer: “My practice educator provided valuable documentation about working with dementia (NHS/NES manual, articles), also I’ve read Kitwood and other person-centred literature. Working alongside colleagues in Alzheimer Scotland has had the most practical benefit, seeing them with people living with dementia, watching how they are and learning from them.”

Celebration

Question: Looking back at your placement at Alzheimer Scotland, what are you really proud of?

Answer: “It has been a wonderful experience to use music therapy with people who seem to have benefited so much from the experience. Questionnaire feedback from people living with dementia, families and staff has been very positive, and I’ve learned a lot about the unique power of music for each person involved.”

Over to you

Having shared some of Ed’s thoughts, we would be interested to hear about your experiences of being creative and the impact on your health and wellbeing… What has made a difference for you?

 

The Best of Today: Informing Art Psychotherapy Dementia Practice Education

In our Building Bridges AHP Practice Education Programme, we are committed to finding out what is working well today to work out how to best move forward tomorrow. The students on placement are really our placement experts so it is really important that we can listen to their perspective. In this blog, I ask Shirelle Young, student Art Psychotherapist about her recent placement at Alzheimer Scotland.

Environment

Question: Reflecting on the therapeutic environment, what really mattered?

Answer: “It was very important to have a space that was private and quiet and easily adapted or use as an art room in a short space of time. It was important that it was recognised as a confidential exclusive place whilst the art therapy session was in progress, and free from interruption.”

Materials

Question: Concentrating on the process of art making, what worked well?

Answer: “I think it worked well to have several materials available for use. At first I had quite a lot of materials on show but I learned to limit this but still have them available if required. Once I got to know people, I was better able to gauge what materials the clients may want to experiment with in the future and suggest options for them when appropriate.”

 

Relationships

Question: Focussing on the therapeutic relationships that developed, what made a difference?

Answer: “Talking to participants as a person first, without letting dementia over-shadow their self. Giving my people the time and space to express themselves without pressure to talk was vital. Given the sensitive nature of dementia I feel that time is needed to let people build trust and their self-esteem in order to feel comfortable enough to express themselves both creatively and verbally.”

Reflection

Question: Thinking about your own reflective processes, what was helpful?

Answer: “It was helpful to look at myself and realise that when I become emotional about issues relating to clients that this is not a fault, it is normal. If I can recognise it as empathy and work with it then I can become a more productive practitioner. I should take credit for my strengths and accept compliments graciously.”

Approach

Question: Looking at how you have adapted your approach to meet the needs of people with dementia and their carers within Alzheimer Scotland what has been important?

Answer: “I think patience is very important, to slow down and work at their pace. To enjoy the process alongside them and take pleasure in their accomplishments. To try and become a better listener and learn to respond rather than react to things you experience with your clients.”

Dementia

Question: In working towards becoming a dementia skilled practitioner, what has been useful?

Answer: “It has been useful to work closely with people living with dementia and this includes the carers who sometimes have different challenges but no less relevant. It is good to read all the books, articles and pamphlets but the experiential learning that takes place within a placement is invaluable. It is only through relating to and building the therapeutic relationship with a person living with dementia that we can learn to become an informed and empathetic therapist”.

Celebration

Question: Looking back at your placement at Alzheimer Scotland, what are you really proud of?

Answer: “I am proud of how people used the art therapy sessions to explore their own feelings, to experiment with art materials and to be supportive of me in my work with them at a time when they are dealing with their own personal challenges living with dementia. I am proud that I motivated and inspired some people to take their art and display it in a public exhibition. I am proud of how I dealt with working autonomously during the organisational changes taking place within Alzheimer Scotland. I am proud of the staff that supported me during my placement, even though they were under their own work pressure.”

Over to you

Having shared some of Shirelle’s thoughts, we would be interested to hear about your experiences of being creative and the impact on your health and wellbeing… What has made a difference for you?

About the author:

Adrienne McDermid-Thomas
Allied Health Professional Practice Education Facilitator

A Skilled AHP workforce :

When many people think of physiotherapy they think of that person who runs onto the pitch when a player is injured gets their magic sponge out and within a few rubs all is well again. So what role CAN physiotherapy play in dementia and why does it matter?

This was the question that struck me when I learned that I was going to be the first physiotherapy student from Glasgow Caledonian University to go on placement at Alzheimer Scotland. I had met people with dementia before on other placements and my experience was of frail old ladies and gents in their 90’s and it didn’t take long before I was scouring the web looking to discover more information to get to grips with this daunting new placement and role. Soon I had ideas whizzing around my head about what I would be doing on placement and the types of people I would be seeing.  These ideas all started to change on my first day on placement, receiving dementia friends training made me think twice about my misconceptions.

 

Then a trip to a Dementia café where I met the real people with dementia that Alzheimer Scotland help completely turned my ideas on their head. The people there weren’t wee old ladies nor were they by any means frail. There were people here younger than my own parents who looked and were, fit and healthy. So my whole idea of what I was here for was out the window.

Luckily I wasn’t alone I had great support in the form of Lorna a dementia advisor who knew every one of the people at the café personally. She was able to introduce me to the individuals who she felt would most benefit from my knowledge and ability. It was after this I knew that going back to basics was the best thing I could do. For physiotherapists basics mean providing exercise for therapeutic purposes. In other words I would set up and run exercise classes to improve the general fitness of the participants. The overall aim would be to introduce them to activity and eventually get them to independently engage with the resources in their area to continue being active individuals living well with their diagnosis. This would be my remit for the placement getting people to engage with their own health and take action to make a lifestyle change to increase their activity levels.

The thread that runs through all physiotherapy services from musculoskeletal services to pulmonary rehabilitation or even care of the elderly is that we aim to maximise a person’s ability to be active and independent. We try to promote healthy lifestyles, especially the minimum activity amount of 150 minutes a week that all adults should be achieving. It sounds easy enough when you break it down to 30 minutes a day but getting into the routine can be difficult and for some the mere mention of exercise brings on cold sweats. Though there is no need to fear activity, a brisk stroll through the park, washing the car, doing the housework all of these things count towards our 30 minutes of daily activity. Building a routine that encompasses our household chores is a great way to keep ourselves fit, active and maybe even save some money!

I discovered during my placement that there are plenty of options to keep active out there in Lanarkshire. Paths for All is a great organisation that provides you the opportunity to go out on organised walks all over Lanarkshire and meet new people. Both North and South Lanarkshire leisure offer specialist classes for all including age specific exercise classes called Active Health, swimming as well as other sporting opportunities. If you are lucky enough to qualify you can get access to South Lanarkshire leisure facilities for as little as £1.10 per week!!!

For those who experience dementia it can be a terrifying condition where you feel you are stripped of your independence and perhaps even your dignity. Alzheimer Scotland offer support and guidance to everyone involved and are able to put you in contact with local activities. As I have experienced over my short period with Alzheimer Scotland, they are a supportive well informed group of caring individuals who I owe a very big thank you for all their help and making a positive impact to my future career as a physiotherapist.

Questions…..

What physical activities would you like to take part in within your local area??

Getting Ready for Dementia Awareness Week #DAW2017 29 May–4 June

Today 93,000 people in Scotland are living with dementia, and that figure is set to rise. Receiving a diagnosis of dementia can be a devastating and frightening time both for the person with dementia and for their families and friends.  Sadly, many people with dementia tell us that friends and even family drift away after their diagnosis. People can find it difficult to know how to react when they hear the news that a friend has dementia.

This Dementia Awareness Week, lets help people understand why friendship and kindness are more important than ever when you have dementia. Join us sharing information on what we can all do to support friends, family and people in our communities who are living with dementia.

You can help by hosting a tea & blether or share a friendship story or joins us at our Alzheimer Scotland annual conference on the 2 June 2017, Edinburgh International conference Centre, Edinburgh.  This year’s conference will explore big issues, from the impact of Brexit on research and collaboration, to challenging and trying to understand the often contradictory risk reduction headlines in the media about nutrition, food and drink. Plenary sessions will also ask pertinent questions of Government, the health and care sector, research and our own role, including ‘What’s next for Scotland?’ and query ‘Where is my new drug?’.

5 reasons to come to the Alzheimer Scotland annual conference

  1. Great choice

With nine parallel sessions on offer, delegates have the ultimate flexibility to tailor the conference programme in order to suit their specific interests. Parallel sessions will include:

  • Connecting people, connecting support led by our allied health professionals
  • Caring by design – function vs aesthetics
  • Nutrition, food and drink
  • Make it equal – all of our roles in equalities and dementia
  • Innovations in practice – music, film, dementia dogs and language
  • Designing services for younger people with dementia
  • Enabling technologies: technology and digital innovation
  • Advanced illness, end of life and palliative care
  • Capturing person centeredness – sex, diversity and hope
  1. Diverse networks

The conference will see over 500 delegates come together under one roof to share their insights and experiences, and to discover new ways that we can all work together to improve the lives of people living with dementia. Delegates will include people with dementia, their carers, health and care professionals, as well as those with an academic, policy or business interest. These include the pharmaceutical industry and representatives from the finance, legal, property, technology and innovation sectors. The conference will be a wonderful melting pot of ideas and inspiration.

  1. Big questions

Do you wonder what impact Brexit will have on dementia research and the Scottish research community? Are you frustrated with the lack of any new drugs? Can you make sense of the near daily newspaper headlines about dementia? Do you wonder what’s next for people living with dementia in Scotland? Join Alzheimer Scotland as we ask our speakers these vital questions.

  1. Vibrant exhibition

From product demonstrations, to poster-board presentations, from showand-tells, to videos – you name it; we will have it all in the exhibition area for 2017. Please view the website for a list of this year’s exhibitors. If you are interested in exhibiting, contact daw@alzscot.org for further details.

  1. Real stories

Members from both the Scottish Dementia Working Group (SDWG) and the National Dementia Carers Action Network (NDCAN) will be participating in key presentations throughout the day, providing unique insight into their opinions on the progress made to date, as well as hosting extended displays within the main exhibition area. Both groups encourage everyone to engage with them; to find out what the groups have on the horizon and to chat about how you could work with them in the future

You can find out more about how to support dementia awareness week here.

Or how to join us at our annual conference here.