420 Exam 2

Non-pharmacological Interventions

prevents, treats, or manages health conditions and improve quality of life without the use of medications or chemicals

De-Escalation

a combination of strategies, techniques, and methods intended to reduce a patient’s agitation and aggression

Behaviroal Disturbances

persistent patterns of disruptive, challenging, or inappropriate actions that interfere with a person’s daily functioning, relationships, and ability to cope with normal environmental demands

Traumatic Brain Injury (TBI)

damage to the brain caused by an external physical force, such as a bump, blow, jolt, or penetrating head wound

Post-Traumatic Amnesia (PTA)

state of confusion, disorientation, and memory loss that happens immediately after a truamatic brain injury

Dementia

umbrella term for a decline in mental ability severe enough to interfere with daily life

All behaviors is….

communication

TBI Behaviors

agitation, irritability, aggression, impulsivity, disinhibition, emotional liability, reduced self-awareness

Dementia Behaviors

agitation, aggression, disinhibition,wandering, purposeless activity, sleep disorders, vocalizing

Impact of Behavioral Disturbances

interferes with care, sleep, and nutrition

increase fall risk, puts clients and staff at risk

decrease quality of life

Cause of Behavioral Disturbances

cognitive impairment, confusion, fatigue, boredom, physical stressors, environmental stimuli

Managing Behavioral DIsturbances

doll therapy, sensory interventions, music & memory, sensorimotor activities, reality orientation, De-escalation techniques

Doll Therapy

can be dolls, blanket, stuffed animal

Outcome:

need for attachment, sense of purpose/role

reduced agitation, aggression, wandering

increased interaction/communication, transfer emotions to doll

Concerns: seen as patronizing & demeaning

Sensory Interventions

Aromatherapy: initial research shows decrease in disturbing behaviors

Sensory Integration: targeted sights, sounds, textures, and smells for the brain to process environmental input when cognitive function declines

Music & Memory

provides training for developing and utilizing personalized music playlists for individuals with dementia and other cognitive impairments, tap into deep memories & support activities of daily living and transitions

Benefits:

improved nutrition/hydration, sleep, mood, social interactions

reduced agitation, anxiety, chronic pain relief

Sensorimotor Activities

help decrease agitated behaviors by enriching environment with readily accessible sensorimotor items such as: activity apron, wandering cart, latch box, sensory vest, activity tablecloth, fishing/tackle box

Wandering Cart

designed for clients who like to push wheelchairs, medication carts, etc

designed for meal tray that can sit on top for clients who cannot sit long enough to eat

Activity Aprons & Sensory Vests

fill pockets with safe “treasures” such as: small picture books, junk mail, greeting cards, scarves, change purse, wallet

helps with repetitive sensory movements; craving things to pick up & touch, rummaging

Latch Box

provides cognitive stimulation and redirects motor agitation

residents sit/stand while opening/closing doors

each door has a picture of a leisure activity under it

Reality Orientation

used for people who have symptoms of disorientation to person, place, time, and/or situation

seen as an alternative for physical restrain, no specific protocol or standardized approach, start by assessing the client’s orientation levels

Reality Orientation Implementation

structured 1:1 or group sessions, unstructured individual encounters, orientation materials in the environment

RT challenges client questions about orientation, place, time, and situation, must know the answers to the questions to prevent learning false information

Other Orientation Methods

developing & adhering to a daily routine for the client, organizing client’s personal environment

making/posting clear signage for specific locations, teach landmarks

Reality Orientation

Post-Traumatic Amnesia (PTA);

DO: provide client with information and orientation materials

DO NOT: continually ask questions and expect client to remember information

Benefits of De-Escalation

preventing violent behavior, avoid restraints, reduce patient anger/frustration,

maintain safety of staff and clients, improve connections,

enable clients to manage their own emotions and to regain personal control, help them develop feelings of hope, security, and self-acceptance

De-escalation Techniques

utilize verbal communication, non-confrontational, avoid medical terminology

non threatening body language, approach client with respect, be supportive of issues/problems

use risk assessment tools for early detection and intervention

respond to expressed problems/conditions, will create a sense of trust with healthcare professional

set clear limits to follow and implement environmental controls, such as minimizing lighting, noise, and loud conversation

Reminiscence

discussion of past activities, events, and experiences to promote socialization and cognitive stimulation

typically occurs in group settings, tangible prompts such as photographs, music, familiar items

Reminiscence Therapy

for early and mid-stage dementia

all older adults with and without illness and disability, especially when “institutionalized”

needing assistance with self esteem, social isolation, skills, & interactions, anxiety, depression, life satisfaction

Contraindications

individuals who have experienced previous traumatic life experiences, diagnosis of PTSD, unless conducted by counselor in psychotherapeutic setting

Outcome of reminiscence

increase self worth, sense of achievement, life satisfaction, communication, improve individual identity

alleviate depression, decrease social isolation, help older adults deal with loss and life transitions

Formal group

most commonly used

structured, regularly scheduled meeting times with a common theme

discussion is preplanned

Formal individual

same as formal group but implemented 1:1

Informal (intimate) individual

unstructured, unscheduled reminiscence

formal, casual conversation conducted while providing care

Informal ad hoc (groups and individual)

informal conversations between staff members and participants where memories are discussed

Reminiscence-related activities

reminiscence is not the main goal, but memory/experience sharing occurs

Stinson’s protocol for structured reminiscence (2009)

group meets for 60 min 2x/week for 6 weeks, each session a different theme

example: week 1: introductions, week 2: remembering the past, week 3: sharing photographs

Common themes

childhood, family, pets, hometown, vacations, wedding day, proudest moments, raising children, holidays/traditions, life lessons, work/career, military service

Reminiscence modalities

scrapbook, family tree, cookbook, life story game, healthy bingo, memory game, nostalgic radio tunes

Reminiscence kits

can purchase or make one

follows a theme

childhood games, transport/travel

Life review

more structured form of reminiscence

targets integration of both positive and negative memories by remembering, re-evaluating, and synthesizing to resolve conflicts

reduces behavioral problems, promote self-control, prevents further deterioration

Intent

gather feelings and experiences of participants across lifespan

Life review indications/contraindication

Alzheimer’s disease, dementia, older adults with emotional problems

addresses: frustration, depression, low self-esteem, well-being, satisfaction, etc

contraindication: clients with significant trauma, former military

Life review and experiencing form (LREF)

1:1 life review

8 sessions

1- childhood

2- adolescence & family/home

3&4- adulthood

5&6- summary/evaluation

termination session

Life review program (LRP)

group life review

1- infancy

2-early childhood

3- play age

4- school age

5- adolescence

6- young adulthood

7- adulthood

8- old age

Life review facilitation techniques

music, media, storytelling, skit

Exteroception Senses

access stimuli outside of the body

smell, taste, sight, touch, and sound

Interoception Senses

access stimuli inside of the body

proprioception (location of body in space)

vestibular (balance)

other (hunger, thirst)

Sensory Processing

way the nervous system receives messages & turns them into motor or behavioral responses

detection threshold: sense receptors are stimulated

recognition threshold: information travels to the brain where it is recognized

differential threshold: information compared/contrasted to previous experience to form meaning, thought, & action

Sensory Processing Disorder (SPD)

can have SPD without other conditions

group of conditions that affects how your brain processes information, person can’t process/act upon information received through the senses (touch, taste, sound, move, sight)

common comorbidity: autism, intellectual/developmental, dementia, ADHD, and other conditions

SPD Categories

Sensory Over-Responsivity (SOR): overly sensitive to sensory information

Sensory Under-Responsivity (SUR): you need more sensory information than usual for it to have an impact

Sensory Craving (SC): you need and seek out information for stimulation

Sensory Deprivation Causes

aging process, mental health conditions, sensory impairments

lack of stimuli, assistance, and meaningful experiences

Diagnoses that need Sensory Intervention

dementia, intellectual/developmental, autism, SPD, stroke, TBI

Use of Sensory Intervention

Behavior management, development of sensory-related cortical pathways

Protocol & Processes for Sensory

sensory stimulation, integration & processing, diet, environmental enrichment

Sensory Stimulation

stimulate one or more senses

used to: restore sensory functioning, improve associated losses, reduce negative behaviors

Rancho Los Amigos Level 1 - 3

• Level 1 (no resposne)

• Level 2 (Generalized response)

• Level 3 (Localized response)

Activities & Stimuli Characteristics

carefully chosen for therapeutic value, manipulated/experienced by the individual, reflective of the client’s personality, and meaningful

provides a non-directive approach, appropriate environment, varied setting (1:1 or group), daily and routinely

Sensory Integration & Processing

challenge sensory system by guiding client through structured, fun activities, teachiing appropriate responses, and generalized settings

activities MUST be: vestibular, tactile, proprioceptive

Sensory Integration & Processing Activities

maintain appropriate arousal levels and alertness

challenge motor control related to senses, independent organization of activities, make adaptive responses to changing environmental demands

be collaborative , tailor to allow flow state

Sensory Diet

regularly scheduled sensory activities throughout the day

meet client needs in appropriate manners

Beneficial for sensory seeking clients

can be: bulk of client’s day, used as breaks to promote positive function

Environmental Enrichment

Additional/implementation of sensory, cognitive, or motor stimuli in a client’s environment

can be actively facilitated or passively enriched , similar to sensory stimulation/integration

passive: aromatherapy lighting, carpeting vs. vinyl floors, colorful walls, physical movement during activities

Aromatherapy

use of essential oils to promote the calming/stimulation of the senses

administration: diffusers, topical application, accessories, aromasticks, aroma dough

RT can become Certified Aromatherapist

Aromatherapy Precautions

some essential oils are toxic to animals, residents should not ingest oils, monitor skin reactions & rashes, staff need to be trained

Cedar wood & Lavender (sleep), Lemon (stimulate memory), Rosemary (decrease depression), Eucalyptus (invigorating/clears head), Grapefruit & Frankincense (appetite stimulant)

Multi Sensory Environment

snoezelen is a product, often rooms/carts in long term care and parks & rec

Sensory Activities

slime, beads, sand, squishy, needohs, fidget toys, etc

Deep Pressure Sensory Items

pool, rollers, bean bag, weighted stuffed animals

Snoezelen Training

2 levels of training for its rooms and products (basic & Advanced)

Aromatherapy certification

Aryes Sensory Integration (ASI) Certificate

• offered through the collaborative for Leadership in ASI (CLASI)

• currently available to OT, PT, SLP, Psychology, & Medicine

Stress

natural feeling that can turn into a problem, becomes excessive or unmanaged

often accepted as being out of one’s control, many experiences/sources

Eustress

Good stress

provides break from negative stressors, opportunity for creative problem-solving, fosters mastery, self-control, self0efficacy, and optimism

demand is placed on person, however the person is in control, desire to meet demand, and ability to view demand as important

Acute Stress

stress that lasts minutes to hours, specific stressor doesn’t matter, the “Fight or Flight” response is triggered

symptoms on those with health impairments, once stressor is removed the body system return to normal functioning

Chronic Stress

when a person experiences stress over a long period of time, from several hours to days/weeks/months

body prep to deal with stress by producing cortisol, bodily functions are suppressed to maximize physical energy needed to deal with stressor

emotional response to stress have negative effects on health

Potential outcome of chronic stress

weakening/dysregulation of immune/reproductive/digestive system, tissue repair and growth, and the inflammatory system

Cognition Change: poor attention, concentration, & judgment

Physical Change: weight, muscle tension, fatigue, BP, reduced metabolism, and increased headaches

feelings of emptiness, hopelessness, loss of direction, anxiety, anger, depression, irritability, and hositlity towards others

Source of Stress

emotional/psychological: feelings of oneself, sources that need emotional needs/awareness, can lead to stress

environment: noise, crowding, lighting, signs, odors, colors, litter, etc

finances: not making/having enough money, can cause conflict

health: can be good in health, issues with potential health problems, or constant health conditions

life crisis: good/bad life changes can cause stress

relationships, time, work

Contributors to Stress

substance use/abuse

body weight, inadequate diet, lack of exercise, lack of sleep/impaired quality, phones other devices, and work ethic

Coping

a capacity to respond and recover to something stressful

techniques to cope can be conscious, unconcious, or learned behavior

Managing

the implication that a person does not need to cope because they have the tools, knowledge, and resources to control a situation, stressor, threat, or conflict

interventions are indicated when a client expresses feelings of distress that negatively impact functioning

contraindications are modality specific

Stress Management

ability to emotionally, cognitively, and physically counteract the effects of stressors, may include a variety of stress management techniques

Step 1 Clinical Approach (Stress Management)

identify stressors and strengths

• sources of stress

• perceived stress scale, stress & wellness inventory

Step 2 Clinical Approach (Stress Management)

measure response to stress

• physical (elevated HR/BP), cognitive (distorted thoughts), behaviroal (eating, drinking)

Step 3 Clinical Approach (Stress Management)

provide education

• consequences to negative responses to stress

Step 4 Clinical Approach (Stress Management)

implement modalities

Step 5 Clinical Approach (Stress Management)

reevaluate

TR Modalities & Techniques (Stress Management)

• Bibliotherapy

• wellness

• bingo

• yoga/tai chi

• coping skills

• support groups

Expressive Writing (Stress Management)

journaling, written passages that document life events and thoughts, feelings, reaction to the events

increase insight into stressors, facilitate healthier reactions (coping) to stressors

Guided Imagery (Stress Management)

mental imagery/visualization, directed day dreaming, create a deeply immersive mind-state

RT follows a script, creation of images/scenes, by engaging imagination of the sights, sounds, sensations of the image

can have immediate results on mood and anxiety

Progressive Muscle Relaxation (Stress Management)

systematically contract and relax each muscle group, RT initially directs/teaches the process, used extensively with anxiety and chronic pain

PMR Technique: stater with upper/lower extremities, same muscle groups on both sides of the body should be contracted simultaneously

contract muscles for 5-10 seconds and relax for 30-45 seconds

Staff Training (Stress Management)

training needed for some interventions (yoga/tai chi)

RT must learn how to facilitate mind-body interventions, must practice leading; guided imagery, progressive muscle relaxation

Risk Management (Stress Management)

need medical clearance for physical activity (exercise/yoga/tai chi)

Mind-Body Interventions

focus on the interactions among the brain, mind, body, and behavior, with the intent to use the mind to affect physical functioning and promote health

Who benefits from mind-body interventions

most individuals regardless of diagnosis or ability level

individuals experiencing: depression, anxiety, schizophrenia, substance abuse, insomnia, chronic disease, etc

Contraindications of mind-body interventions

dependent on the modality (ex: schizophrenia on no meds can hallucinate)

potential physical injury, receive clearance for participation

Mind-body modalities

meditation, yoga, tai chi

mind-body RT staff

need to have the proper trainings, qualifications, and experience

• lower injury risk

• provides most effective treatment

different modalities have varying qualifications and trainings

Meditation

mental practice that trains your mind to focus, redirect thoughts, and achieve a state of calm and clarity

requires a quiet location, comfortable posture, focusing of attention, & an open attitude

mindfulness

a focus on being present

zazen

seated meditation, requires little instruction

transcendental

seated, repeating a mantra

kundalini

focus on breath through energy centers

Qi gong

focus on breath and circulating energy

Guided visualization

mental imagery of an event or environment

heart rhythm

focuses on breath and heartbeat

Concentrative meditation

good for improving attention span, reducing mental chatter, inner calm

can feel difficult/frustrating for beginners

focuses attention on a single stimulus

attention is narrow, pointed, & highly selective

when the mind wanders, work to gently bring focus back to stimulus