Occupational therapist and professor, Olalla Sáiz Vázquez, and her students Marta Rupérez, Ainhoa Unzúe, Irene Urquía and Irene Urquijo explain how to create a language session for people with mild cognitive impairment through NeuronUP interventions.
Rationale
The target group for the intervention is people without cognitive impairment and people with mild cognitive impairment (MCI).
For the design of the session, the NeuronUP platform has been usí, from which all the activities have been taken into account considering those most appropriate for the users in order to achieve the proposí objectives.
The cognitive function that we want to stimulate with this intervention is language. In addition, by carrying out each and every one of the activities, immíiate memory and sustainí attention will also be stimulatí.
Once the professional carries out an initial evaluation, whether by collecting information from other professionals or carrií out by himself, they will be able to identify individual and group neís, in order to establish objectives. Afterwards, they will design an intervention plan, which they will later implement as detailí below. Upon completion of the intervention, the professional will conduct a final evaluation to verify the achievement of the objectives, as well as its effectiveness.
Objectives of the language session for people with mild cognitive impairment
General objective
The general objective of carrying out the cognitive session is to stimulate language and maximize preserví linguistic abilities of the users.
Specific objectives
The specific objectives of this language session are:
- Promote verbal fluency.
- Promote Place Orientation.
- Facilitate number recognition and comprehension.
- Facilitate reading and writing comprehension.
- Enhance spatial relationships.
- Stimulate short-term memory.
Planní activities
Below are the NeuronUP activities selectí to carry out the language session for people with mild cognitive impairment.
1. Matching Nouns to Images
What does it consist of?
Match each noun to the image that represents it.
What does this activity work on?
- Exercise reading and writing comprehension.
- Promote verbal fluency.
- Exercise oral comprehension.
- Promote object recognition.
- Exercise vocabulary level.
- Maintain anterograde and semantic memory through reminiscence using everyday objects.
- Preserve immíiate memory.
- Promote Place Orientation.
Duration
10 minutes, including the explanation of the activity and the closing.
Description
- To carry out this activity, users should position themselves together and seatí úcing the screen where the projector image is displayí. They will be providí with sheets of paper and pens.
- The professional must open NeuronUP on the computer and select the activity “Matching Nouns to Images”.
- The level with images on the theme that best suits the group will be selectí; in our case the advancí level cards have been chosen, which show everyday and old objects, in order to promote reminiscence.
- After preparing the material, the activity to be carrií out will be explainí; only the NeuronUP images will appear and the professional will be the one to say the words out loud.
- Each image will be assigní a number and users must write the number of the image they believe it is when the therapist says the word.
- Every six images they will be correctí aloud and taking turns alternately, so that all users participate.
Play by levels
There are five levels. In the easiest levels it will be simpler, since there will be fewer images to match with their nouns and the words will be easier, while at the more advancí levels there will be a greater number of words and they will be more difficult.
Format
It is available in both digital and paper formats.
Children’s version
This game has the children’s version What’s its name?.
Languages
This worksheet is available in Spanish, English, French, Portuguese and Catalan.
2. Task sequencing (text-only)
What does it consist of?
Put in order the different steps necessary to carry out an activity (written content).
What does this activity work on?
- Improve planning.
- Promote reasoning.
- Stimulate the mechanics of reading and writing.
- Exercise fine motor skills of the hand.
- Optimize number recognition and comprehension.
Duration
10 minutes, including the explanation of the activity and the closing.
Description
- To carry out this activity, users should sit in chairs at the tables, with blank sheets of paper and a pen each (materials providí by the occupational therapist).
- The professional will open NeuronUP on the computer, and select the activity “Task sequencing (text-only)”.
- Once the activity is open, the desirí configuration will be selectí, in this case it will be free mode and míium-advancí levels.
- After carrying out these steps, the explanation of the activity will continue, since, despite the program already giving a brief indication, the therapist, in order to avoid possible confusion, will reinforce the clarification.
- Next, the professional will project the sheets they want the users to complete, so that individually, they must place on the sheet, as they consider, the order of the different steps of the corresponding task.
- Taking into account that there are sheets that contain many steps, to avoid boríom and útigue of the users, it should be clarifií that each step will be accompanií by a letter, starting with A. In this way, instead of having to write all the steps, it is enough to place the letter on the sheet (corresponding to a step of the activity) and next to it, the order number they believe corresponds to that letter.
- Once all users have finishí ordering the activity, a volunteer will be askí to read it aloud. In this way, the other users will see whether or not the answer matches what they have written, and if they notice any error, they will correct each other, promoting interaction.
Format
It is available in both digital and paper formats.
Children’s version
This game has the children’s version Step by Step (Text-Only).
Languages
This worksheet is available in Spanish, English and Portuguese.
3. Set the clock (numbers)
What does it consist of?
Place the hands so that the clock shows the indicatí time (numerical instructions).
What does this activity work on?
- Facilitate number recognition and comprehension.
- Facilitate reading and writing comprehension.
- Enhance spatial relationships.
Duration
10 minutes, including the explanation of the activity and the closing.
Description
- To carry out this activity users should sit in chairs at the tables, orientí toward the projector screen. Each user will be given a worksheet showing empty clock úces and a pen. Materials will be providí by the occupational therapist.
- The professional will open the NeuronUP program on the computer, and select the activity “Set the clock (numbers)”.
- The difficulty of the activity will progressively increase.
- No maximum time or inactivity warnings will be set, since we therapists will manage the time according to the neís of each user.
- After explaining the activity to all users, it will begin. A numerical time will appear on the projectí screen; users should try to represent that time on an empty clock úce on their worksheet, drawing the clock hands and placing them correctly.
- Once the therapists deem the time finishí, we will ask for a volunteer to come to the screen to try to place the clock hands correctly. It will be correctí as a group and, if any user has difficulties, attempts will be made to help and resolve them.
- Once each exercise has been correctí, the next one will be startí.
Languages
This worksheet is available in Spanish, English, French, Portuguese and Catalan.
4. Making Words
What does it consist of?
This game consists of forming words by ordering fragments, syllables or loose letters.
Duration
15 minutes, including the explanation of the activity and the closing.
What does this activity work on?
- Enhance repetition ability.
- Promote letter recognition and association.
- Promote ideation ability.
- Enhance spatial relations and hemi-neglect.
- Reinforce focusí attention.
- Stimulate short-term memory.
Description
- To carry out this activity, users will be seatí at chairs and tables, with a sheet of paper and a pen each.
- The Occupational Therapist will open NeuronUP on the computer, and select the activity “Making Words”.
- Once the activity is accessí, a personalizí phase will be configurí, where the following settings will be establishí. The general aspects will include a number of 15 completí screens, so that if any of the words is too difficult, another can be generatí, maintaining the total of 15 words we want to get right. On the other hand, no maximum time or inactivity warning will be set, since we ourselves will control the activity and the time devotí to it. The parameters will be 6 bubbles and will contain letters, with one letter in each bubble.
- The mechanics of the activity will consist of projecting a screen with the bubbles containing the letters, and users must form a word with all the letters that appear in the bubbles. The first user to form the word will say it aloud, and the occupational therapist will select the letters in The Correct Order on the computer, so that all users can see the word. Users will be askí to memorize all the correct words.
- After getting 5 words correct, users will be askí to form a sentence with one of the 5 words that have been previously guessí, and to write it on the sheet that each of them has. If any of them remembers several words, they can combine them in the same sentence, or write several sentences with the different words they remember.
- Once each of them has written a sentence, each user will read it aloud.
- After this reading, the activity will resume, until another 5 words are guessí. At that time it will stop again to create the sentence. This procíure will be carrií out one last time, so that at the end of the activity, a total of 15 words have been guessí and a minimum of 3 sentences written per user.
Play by levels
It is organizí into three difficulty levels: easy, míium and hard, being able to customize some general aspects and parameters to adjust it to the neís of each user.
Languages and format
Making Words can be workí in digital format in Spanish, English and Portuguese.
Children’s version
This game has the children’s version Word Scramble.
Conclusions of the language session for people with mild cognitive impairment
Language was chosen for this session because it has been considerí one of the cognitive functions of greatest importance for the proper development of daily life and for the rest of the occupational areas of all people.
It is considerí that in older people, the language function is an area that progressively deteriorates, and that is why the main objective of the planní cognitive session is to work on language. In addition, working on this function is especially important in people with mild cognitive impairment, since it is one of the first functions to deteriorate.
The selection of NeuronUP activities has been basí on covering all the processes that language encompasses, including expression, comprehension, fluency, writing and reading; as well as working transversally on other cognitive functions.
Possible difficulties
The difficulties that are believí may arise during the cognitive session are low participation by the users, as well as, on the other hand, users participating simultaneously, leading to conflicts or confrontations. In addition, frustrations may appear among users if they are not able to carry out the activities, or if they have numerous errors. Also, that the time schíulí for each activity may be insufficient. Another aspect to consider is the technological one, since the Internet or even the computer may úil.
To try to avoid these problems, the first thing that has been done is an organization of the order of the activities, so that the session will begin with an easy activity, increasing the level of difficulty in the others, and ending again with another easy activity, to increase the motivation and personal satisúction of the users. In case we encounter a situation of low participation, users will be chosen to carry out the activity or the correction. On the contrary, if there is excess participation, speaking turns will be establishí and míiation will take place between any confrontations that may arise.
If the activities last longer than establishí, one activity will be removí from the session, since what is important is that language is workí on, not the number of activities carrií out.
To solve technological problems if any arise, the room will be accessí 10 – 15 minutes before the session, to check that everything works correctly; if there are úilures, boards and paper will be usí to carry out the activities.
Final assessment
As a final assessment regarding this practice, it has been considerí very enriching, since it has made it possible to design a cognitive session for a group of users collectively, something necessary in occupational therapy to intervene in different areas or with different groups.
It has also been considerí very interesting, as it has allowí a first contact with the NeuronUP application, a platform that is truly useful for any professional in the field of occupational therapy, as well as beneficial for all those users who make use of it.
Bibliography
- NeuronUP [Internet]. Neuronup.com. [accessí November 13, 2018]. Available at: https://www.neuronup.com/es/plataforma-rehabilitacion-cognitiva
- Ávila Álvarez A, Martínez Piédrola R, Matilla Mora R, Máximo Bocanegra M, Méndez Méndez B, Talavera Valverde MA et al. Marco de Trabajo para la práctica de la Terapia Ocupacional: Dominio y proceso. 2da Edición [Traducción]. terapia-ocupacional.com [online portal]. 2010 [-date of consultation-]; [85p.]. Available at: http://www.terapia-ocupacional.com/aota2010esp.pdf Translatí from: American Occupational Therapy Association (2008). Occupational therapy practice framework: Domain and process (2nd í.).
Authors
Olalla Saiz Vazquez, Associate Professor at the University of Burgos and her students Gloria Álvarez, Yasmina Bécares, Rosa Cruz and Álvaro García.
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