With more than 11 years of experience in the Association of Relatives and Alzheimer Patients of La Rioja, the occupational therapist Aitor Piñeiro Gago shares his experience applying cognitive stimulation in AFA Rioja with NeuronUP.

About AFA Rioja

The Association of Relatives and Alzheimer Patients of La Rioja (AFA Rioja) was created in 1993 with the purpose of offering a center with its own set of services, to which relatives of people with Alzheimer’s disease could have access in the absence of specialized resources in the social-health system. The objective is to offer a response to the needs of both family members and affected persons.

Throughout these years, AFA Rioja has been growing as shown by the annual data related to the number of professionals hired, the number of beneficiaries (approximately 180) and their families, as well as the diversification and specialization of the different programs included in its portfolio of services.

The objective of AFA Rioja

Among the objectives established by the Association, the aim is to achieve and maintain the highest level of quality of life (QOL) in the binomial person with Alzheimer’s disease and caregiver (in most cases, as in the literature, the spouse). All this, from an integral, individualized, cooperative, responsible and ethical perspective, in accordance with the values of the Association and our position with respect to society, families and individuals.

The vision of AFA Rioja

The vision plays a very important role in establishing the working methods, actions and proposals to be developed.

According to the existing publications, we can start from an approach of:

• Bottom-up, where the focus of the work is on the capacities affected by the disease.

• Top-down, where the focus is on meaningful activities and people’s life roles.

• Environment-first, where contextual factors are prioritized ahead of personal ones.

Translating these visions, often linked to professional preferences, service-centered planning, ideas pre-established years ago, and personal beliefs not based on current knowledge, is a challenge in order to coexist in the same work environment.

The AFA Rioja team

AFA Rioja’s interdisciplinary professional team currently includes:

• 3 social workers.

• 3 psychologists.

• 8 occupational therapists.

• 1 music therapist.

• 4 assistants.

Organized in two physical centers located in the city of Logroño, places where psychosocial interventions or non-pharmacological therapies (NPTs) are developed and where residents of the capital of La Rioja and other nearby municipalities attend.

NPTs in AFA Rioja

The first recorded experiences with NPTs in people with Alzheimer’s disease date from the 1950s-1960s, although the knowledge generated and acquired over the last few decades has grown exponentially. Studies, experiences, research and institutions endorse the efficacy and implicit results in a variety of areas through its administration, even at levels similar to pharmacological therapies.

The benefits of NPTs

Therefore, NPTs are considered as important as pharmacological treatment, where both, prescribed in a coordinated and appropriate manner, can multiply the benefits obtained for each person in aspects such as:

• QoL.

• Autonomous and independent performance in activities of daily living (ADLs).

• Volitional components.

• Emotional state.

• Promotion and maintenance of functional and healthy behaviors.

• Delay the decline linked to the disease.

• Reduce dependence on drugs, third parties and services.

• Reduce the economic cost of treatment.

• Postpone the moment of institutionalization in residential centers.

The results of NPTs

The reported results of NPT implantation are increasing year by year according to the numerous experiences and the growing interest in the subject. However, it is equally necessary to have the support of research to determine the results, level of effectiveness and possibilities of reapplicability in order to be able to reach degrees of recommendation.

Different NPTs for different needs

The Association is attended by people who, despite having the same medical diagnosis, have heterogeneous characteristics, in terms of the level of:

• Previous activity.

• Organization and satisfaction with routines.

• Identification of goals.

• Level of performance in ADLs.

• Level of function/dysfunction in individual abilities (sensory, cognitive, physical, communicative and interactive).

• Variety in social groups and supports.

• Maintenance or loss of significant roles.

• Emotional well-being.

• Presence of other pathologies.

In practice, this represents a set of needs to be covered by the different NPTs according to the object of their nature. Both those of a normative nature established by professionals, who indicate what results are expected and what services are necessary to achieve them, and the perceived or experienced needs, being those based on the perception of each person or group on a certain lack, based on a subjective appreciation (Bradshaw, 1972).

Development of opportunities

Creating and developing opportunities that cover as many of the resulting needs as possible, as well as guaranteeing the control of variables and measuring the effect of these on a set of individual factors, becomes a professional and organizational responsibility.

These opportunities must be coordinated, individualized, from a holistic perspective, they must be dynamic, flexible and with objectives that can be reviewed over time, these being some of the characteristics that this type of intervention must meet.

Hence, the proposals are as varied as life histories, interests, preferences, concerns and goals are identified in the population and individual analysis that must be carried out periodically.

Interventions such as magic, cooking, animals, art and culture, sports, music, books, life projects and occupational significance are just some of the interventions that complement the programs for the stimulation of individual capacities.

Interventions are developed taking into account the environments (professionalized, community, indoor, outdoor…); the number of people (individual, couples, small groups of 3 to 5 people, and groups of up to 9 people); their nature (self-care, life roles, or leisure and free time); expected results (according to perceived benefit, enjoyment and pleasure); and development methodology (self-managed, interactive, with professional support).

The objective

The priority objective is to achieve and maintain the highest level of quality of life possible according to individual characteristics and contextual factors. Therefore, the commitment and assignment of an individualized plan of life and supports by people and professionals, starts from an initial assessment process that lasts several months. It becomes almost imperceptible the moment when it ends to start a new one, being this cyclical, continuous and subject to appropriate changes to improve the experience, satisfaction and well-being of the person.

Collecting, dumping and interpreting the information obtained from the different sources available through quantitative and qualitative systems, from a multidisciplinary perspective, it is possible to shape the individualized therapeutic process appropriate to each person and each moment.

Cognitive stimulation

Historically, cognitive intervention has been postulated as one of the most widespread and accepted non-pharmacological treatments in the care of the person with Alzheimer’s disease.

There are multiple studies (it could be said that cognitive interventions are the set of NPTs that enjoy the largest number of publications and evidence) that support the benefits of their application, varying in level and magnitude depending on the methodology used and the clinical stage of the disease, as well as other associated individual factors (motivation, cognitive reserve, sensory limitation, level and type of previous activity, for example).

Changes in cognitive stimulation

Considering that the highest recommendation is obtained by multicomponent cognitive interventions, the variety of their application has become an exercise of creativity and innovation subject to emerging demands, new interests and concerns implicit in the beneficiary population.

In accordance with the vision, principles and foundations that guide professional practice and determine the type of interventions to be developed, the spectrum of methodological probabilities and formats in the design of eminently cognitive sessions has expanded.

Leaving behind the exclusive use of the well-known “paper and pencil” of which so much content has been generated in recent decades, to base cognitive interventions on people’s preferences and strengths, from an occupational perspective with a sense of new methodologies and work formats in the sessions. Any occupation has implicitly a series of cognitive abilities (among others) for its performance in an effective and functional way, so that the stimulation of one (or several) cognitive abilities in a direct way allows going beyond and linking it to the emotion and the sense that each person gives to the meaningful occupation.

Cognitive stimulation in AFA Rioja

The center prioritizes the preferences of people towards specific types of intervention, taking into account their individual abilities, not only in the cognitive area, but also from a social perspective, adapting the characteristics of the sessions and the contents to be developed according to the established objectives.

Cognitive stimulation in AFA Rioja with NeuronUP

For 8 years, NeuronUP has become a fundamental working tool for the design of cognitive interventions in the Association, which combined with other content allows us to obtain varied, innovative sessions of growing interest for the participating population.

The advantages of performing cognitive stimulation with NeuronUP

During this time, several advantages have been identified by the center’s professionals with respect to the NeuronUP platform, which, properly managed, have a direct impact on the achievement of individual therapeutic objectives.

From our experience, and without detracting from the other existing options, we name those that we consider most relevant (and that we use most frequently) in our work of design and implementation of sessions:

• Quantity and variety of content according to capabilities and occupational areas. Not to mention the amount of extra resources available, very useful for developing your own sessions or exercises in interventions with another work format.

• Available filters: age and type of exercises. It is important to present them according to the target population, making an attractive format as representative as possible of everyday life. In the same way, it allows the person to have access and approach to the world of new technologies from a playful and enjoyable variant that has a direct impact on the state of health.

• Adjustment of exercise parameters. Allowing to adjust the level of difficulty among a wide range, as well as the duration of the same in time and number of repetitions.

• Design of sessions in advance, avoids leaving the exercises, the search for new ones and their initiation. With the implicit damage that this would entail in the fluency and continuity of the same ones. It is very positive the possibility of editing the sessions according to the results obtained in order to optimize benefits and facilitate the preparation work of the therapists.

• The basal proposal of the exercises and sessions allows the therapist to adjust them to the characteristics of the person and the group, introducing dynamizing and derived management elements, allowing maximum individualization. For example, according to the level of participation of the people in the group: more energetic, more passive…, or with inhibition difficulties in exercises with turn-based responses. Thus achieving the highest degree of balance and benefit among all participants.

Conclusion

• Applying an NPT should not become a trivial issue within organizational routines that provide services with an impact on people’s overall health.

• Matching these therapies to individual needs should be the logical order of the process, and not waiting for the person to adapt to existing resources. And if they are not available, create them.

• We professionals must be coherent between what is done and what is said regarding the new paradigms and approaches to care and the services available in the centers. Taking into account (and sharing) ethical principles centered on people that guide the actions to be developed, reflecting this vision and philosophy in the type of programs and processes of evaluation, design and implementation of the same.

• NeuronUP allows to widen the range of working tools available to the service of the target people, complementing the existing ones, in order to guarantee these principles.

If you liked this post on cognitive stimulation at AFA Rioja with NeuronUP, you may be interested in these NeuronUP posts:

Anosognosia in Alzheimer’s disease

Cognitive intervention in people with Down syndrome

Online neuropsychological intervention in a case with developmental delay