The occupational therapist of the AFA Alcalá center, Laura Caballero, explains the approach to neurodegenerative diseases via cognitive stimulation and occupational therapy workshops through NeuronUP.
Introduction
Who are we?
The Alzheimer’s and Parkinson’s Association of Alcalá de Henares was created in 1997 as a resource for and by family members of Alzheimer’s patients in order to support each other and achieve a better quality of life for the patient and their families. We are a regional NGO and our members are mostly relatives of people with age-related neurodegenerative diseases. Such as Parkinson’s, Alzheimer’s and other related dementias.
Our center, where the activities are developed, is located in Alcalá de Henares, which is the largest city in the area, but serves people from neighboring towns.
Interdisciplinary team
Our team is made up of professionals specialized in different areas, such as:
- Psychology
- Occupational therapy
- Art therapy
- Music therapy
- Speech therapy
- Physiotherapy
- Social work
From a transdisciplinary approach we achieve a holistic approach to both the person suffering from the disease and their family and social environment.
Neurodegenerative diseases we work on
The following is a concise description of the different pathologies that we treat in our center:
Parkinson
A chronic and progressive neurodegenerative disease characterized by extrapyramidal symptoms, due to the irreversible lesion of the dopamine-producing substantia nigra. The symptoms of Parkinson’s disease are:
- Bradykinesia: slowness of voluntary movements associated with decreased voluntary movements, with loss of automatic movements, hypophonic speech, absence of brachiation.
- Tremor at rest.
- Postural instability: loss of reflexes, forward leaning gait, increased base of support, gait disturbances.
- Stiffness.
In addition to these four fundamental symptoms for the diagnosis of Parkinson’s disease, there are neuropsychiatric alterations such as cognitive impairment, mood disorders, sleep disorders, delusions and hallucinations, bradypsychia, problems with chewing, speech and swallowing.
Cognitive Impairment
Cognitive impairment is the loss of cognitive functions, specifically in memory, attention and information processing speed (IPV), that occurs with normal aging.
This cognitive impairment of our brain depends on both physiological and environmental factors and is subject to great interindividual variability.
The difference between cognitive impairment and dementia must be kept in mind. When a person is not independent to meet basic needs it is considered dementia, but while it is true that a person may report some loss of memory or other cognitive functions, but remain independent in ordinary tasks, it is then called Mild Cognitive Impairment (MCI).
Several studies have shown that people with MCI are at risk of suffering dementia in the future. Cognitive impairment is classified as Mild, Moderate and Severe, from Moderate onwards, it starts to be considered as dementia.
Dementia
Dementia is a condition that is associated with age; as the age of the population increases, the frequency of the disease increases. Dementia is not a specific disease, it is a general term that describes a wide variety of symptoms related to the impairment of memory and other cognitive abilities, severe enough to interfere with the person’s activities of daily living.
There are several types of dementia, but only Alzheimer’s disease, diffuse Lewy body dementia and frontotemporal dementia will be described.
Alzheimer’s
Alzheimer’s disease is a progressive neurodegenerative disease characterized by degeneration of nerve cells in the brain and manifested by memory loss. First, short-term memory is lost, and finally, long-term memory. It also manifests with aphasia, apraxia and agnosia, as well as temporal, spatial and personal disorientation and intellectual impairment. Deficits are enough to interfere with social and occupational function representing a reclining of past function.
Lewy body dementia
Those with diffuse Lewy body dementia have lesions in protein forms in areas related to cognition. It manifests in dementia, fluctuating cognition and alertness, visual hallucinations that appear early in the disease and are very well structured, motor signs of parkinsonism, rigidity, slowness of movement, and to a lesser extent tremor.
Frontotemporal dementia
A progressive disease characterized by prominent behavioral disturbances and language changes. For example, primary aphasia, difficulty in naming, etc. It is also characterized by a number of physical signs such as: incontinence, rigidity, akinesia, tremor, frontal reflexes (glabellar, suck, palmomental) and behavioral deficits, social, judgment and disproportionate language due to memory defect.
Inclusion protocol: How is the approach to neurodegenerative diseases carried out in the center?
Interdisciplinary assessment
The entrance door to our association is through the social work department, where, through a guided interview, the most urgent needs are assessed. This first contact helps us to confirm if we are the right resource or, unfortunately, sometimes we act as intermediaries to other aids or institutions.
The next step towards the inclusion of workshops is the assessment by the transdisciplinary team. The overall functional, cognitive and physical assessment gives us an approximate idea of the state of the disease, as well as the impact it has on the patient’s immediate environment.
Intervention proposal and family orientation
Each professional of the team exposes in a weekly meeting the results of this assessment. All this information is used to offer the intervention plan that best suits the needs, taking into account: life history, personality and tastes, family support network, economic income, schooling level, significant activities and leisure time.
In a family orientation, the psychologist of the center talks about the disease and its evolution, management of possible behavioral alterations, doubts that may arise and finally offers them the proposal designed for their family member.
Inclusion in workshops: cognitive stimulation and occupational therapy in the treatment of neurodegenerative diseases with NeuronUP
Once the proposal is accepted by the family, the patient joins a stimulation group with a similar cognitive impairment. It is in these workshops where we work different cognitive areas affected, from different approaches and resources.
From the most conventional and functional for them as the pencil and the sheet to the application of new technologies and resources such as the tablet and NeuronUP.
We also resort to other non-pharmacological therapies such as expressive therapies. Specifically music therapy, drama therapy and art therapy, integrated into the daily life of the association.
What is worked on in the approach to neurodegenerative diseases with NeuronUP?
Activities of daily living
As occupational therapists, working in an out-of-home environment, it has always been very difficult for us to reproduce in the therapy room those activities of daily living and their therapeutic approach in order to retrain the patient in the lost skills. It is through NeuronUP that we were able to create a virtual environment where we could reproduce activities such as dressing, grooming, tidying up the kitchen, recycling, sequencing steps, etc.
Severe impairment
When the level of impairment and loss of abilities is very advanced, conventional resources are not enough. Therapists resort to different sensory resources as a way to reach an optimal level of stimulation for the person. In this aspect, NeuronUP provides us with sound and visual resources (movement, color, shape, low speed) adapted to low residual capacities.
Low literacy level
Even if the stimulation is done in a group, previous personal characteristics such as the level of schooling are taken into account. In cases where the person is illiterate or has attended few years of school, NeuronUP becomes a very valuable resource to be able to adapt the stimulation as much as possible.
The use of the program allows us to favor the autonomy of the person during the execution of the exercise, as well as to promote individualized attention.
The visual support (through pictograms and different images) and sound support (each exercise is explained verbally) in most of the exercises makes it intuitive to use.
Language impairment
We appreciate the large amount of resources related to this area that NeuronUP has. It allows us to work in the same field from different activities that make the approach motivating by not falling into repetition.
Impulse control
Perhaps, this is one of the areas in which we are focusing our attention in recent years. We observe the course of the diseases and how the symptomatology is changing, receiving at the present time numerous people diagnosed where this lack of impulse control makes their day to day life difficult.
The dynamics of the exercises allow us to work simultaneously on the affected areas as well as on different associated behavioral alterations, such as inhibition, social cognition, etc.
Conclusion
To conclude, it can be said that the therapists who carry out the cognitive stimulation workshops at the center for the treatment of neurodegenerative diseases have found NeuronUP to be a fundamental resource that helps us save time. As well as having a wide range of resources and also, reaching more patient profiles.
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