Rehabilitation approaches in dementia: an evaluation of three interventions from an occupational therapy perspective
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Dementia is a complex, progressively degenerative condition resulting in loss of cognitive and functional capabilities, along with a significant increase in degree of dependency. In recent years a number of non-pharmacological interventions for individuals with Dementia have been developed and this has coincided with the reduction in the use of pharmacological interventions (Spector et al, 2008). Similarly, there has been an increase in good quality research to support these non-pharmacological interventions (Copper, 2012), (Logsdon, 2007). This study aims to build on this evidence base through its research into three rehabilitation approaches in dementia. This study was carried out in two phases. Phase one was a single blind prospective controlled trial which examined and compared two group intervention approaches, Cognitive Stimulation Therapy (CST) and Sonas - with 28 participants with moderate dementia. Significance levels were set at 0.05. Parametric tests used were the t test (t), ANOVA (F) and Pearson correlation coefficient (rho). Non-parametric tests used were the Mann-Whitney U test (U), the Wilcoxon signed rank test (W), the Kruskal-Wallis test (K) and the Spearman’s rank order correlation (rho). Results of phase one supported CST to a greater extent than Sonas with participants in the CST group showing significant changes in cognition (p=.032), and communication (p=.006). Both groups had significant changes in carer rated quality of life (CST p =.019; Sonas, p =.035) and occupational performance within a group setting (CST p=.005, Sonas p=.002). Phase two presents two single case studies which examine the impact of goal focused Errorless Learning (EL) interventions combined with compensation and modification of the environment with two community dwelling participants. Results supported the use of the interventions in both cases with significant changes in the participants’ abilities to carry out their desired occupations as a result of intervention. Specifically, the numbers of errors made during the task were reduced for both participants and both participants were more efficient with the tasks. The outcomes of this study are positive. This study provides evidence that OT intervention can impact on the trajectory of the condition with people with dementia and demonstrates clearly that they do have rehabilitation potential. Participants responded to all three interventions tested to varying degrees. These interventions could be implemented immediately within existing services and have potential to have a significant impact on the lives of people with dementia and their carers.