Last month we asked Regional Clinical Manager Jolene Denn, SLP to share how her team approaches dementia and her OT’s role. Jolene is an expert on dementia and has presented a CEU course on the subject to RehabVisions therapists. This month she is sharing specific treatment techniques to consider when treating patients with a dementia diagnosis.

1. First, find out about the patient’s likes and dislikes, routines and habits. This knowledge makes designing treatment interventions easier, personal and more successful.
2. Know the stage of dementia. Each stage comes with different behavioral markers and changes in functioning.
3. Consider vision. As dementia progresses, a loss of peripheral vision also occurs. Where do we usually stand when ambulating a patient in therapy? To the side…where they can’t see us! Also, as dementia progresses the visual gaze decreases. For instance, someone in mid-stage 6 generally has a visual gaze of 32-33″ from the floor. Think about where to display cueing signs.
4. Medication should be the last resort, not the first solution. If you’re encountering behavior issues with your patient, identify the cause of the behavior and avoid it. Consider asking yourself these questions:
   • What was I doing when the behavior occurred?
   • Has this behavior happened before?
   • Was I “present” or preoccupied?
   • Was I too rough? Going too quickly? Talking too fast?
   • Was I respectful of the person’s space?
   • Are they in pain?
   • Did I explain what I was going to do before I started doing it?
5. Communication is key. Keep the following strategies in mind:
   • Present one idea at a time.
   • Speak slowly and simply.
   • Avoid asking questions.
   • If you need to repeat something, repeat the message exactly as you said it the first time.
   • Approach dementia patients from the front, never from behind.
   • Use gestures or visual aids.
   • Remember processing delays (ex: patient may take up to 90 seconds to process a simple verbal command).
6. Finally, don’t forget the family/caregivers. Watching a loved one go through the stages of dementia can be scary, confusing and heart-wrenching. Get the family involved with activities and training:
   • Create memory books with family photos.
   • Train family with mobility devices.
   • Train family on transfers.
   • Instruct family on home exercise programs.

For more information on dementia and the role of occupational therapy, visit the AOTA website.