ITS THERAPY JIM ……BUT NOT AS WE KNOW IT ! Reminiscence from the Original Star trek
Service introduction As part of a joint Slaintecare, Pobal ,HSE initiative the project was designed to provide services to people recently diagnosed with dementia. (These services included CST, advice and prescription of assistive technology, Validation ,Counselling ,Dementia awareness Training , mental health education , neuropsychology and specialised befriending). Clients had been identified, their carers and supporters had been referred into the project ,training had already been provided for those facilitating /providing the services and things were ready to go.Group sessions being organised in venues in local hotel settings With coronavirus and restrictions things just couldn’t go as planned and the project was put on hold People with dementia were noticeably deteriorating with the closing of day care facilities ,reduction in social interaction and all the isolation , loneliness and risk goes along with these The project was given the green light to go if it could be “covid proofed” The virtual platforms were the only way of providing services other than very limited face to face contact with PPE and precautions in place.
Cognitive stimulation therapy ? Cognitive Stimulation Therapy has been developed and established as an effective treatment for people living with dementia. It is run as a programme of sessions with a group of people over time Aims of the sessions are to encourage social interaction, communication, promote use of new ideas, improve orientation ,maximise potential and provide an opportunity to have fun A session would include a mixture of themed activities or exercises of a sensory nature (games ,music, sound, reminiscence, current affairs language and creativity ) The whole ethos of the therapy is based on face to face interaction between therapist and group members Holden Spector 2018
Necessity is the mother of all invention - this was not planned as a development more a coping strategy when face to face contact and groups were as no longer safe and groups were not permitted Paediatric Occupational Therapists were already using Attend Anywhere as a platform and Primary care therapists were using photos ,YouTube clips and electronic communication to compliment their practise Dilemma for OT How do we reach people? Can we really use virtual platforms to encourage interaction between people who were already experiencing problems with communication, orientation, before the covid restrictions ? How do we continue with the Plan to provide CST? Some guidelines were available from UCL/Hong Kong University on how to provide CST for maintenance groups however our group of people had no prior experience of CST at all and had no established connection with each other as group members and limited involvement from the Occupational Therapist
Developing a telehealth service -CST • Establish a rapport, and get to know the people and care givers involved .face to face visits ,life story interviews and OT assessments • Providing or facilitating the use of the platforms . Awareness of factors likely to distract • Starting off with individual sessions and once confidence and familiarity are established then progress to introducing people to each other and create small therapeutic groups • Making it person centred - Giving people feedback Oh you’ve had your hair done,It looks like you have been busy, I can see you better when you are near the window ,we love hearing that story) • Needing to be flexible with the other people involved. Setting up, times family could be present ,not booking a session when others were planned later by other professionals • A need to be realistic about what can be achieved (it wasn’t possible to stick to the programme, the principles sometimes were changed because of personal interests or other people decided to join in)
Challenges and Benefits • Connections both HSE and community networks • Quality of connections leads to delay in sound and vision beind disrupted and people are constantly out of sync • Making the intervention person centred and meaningful • Fear of failure and embarrassment • Concern over taking part in front of others (therapist and cleient) • Awareness of factors that are likely to distract • A need to be realistic about what can be achieved (it wasn’t possible to stick to the programme, the usual ways of doing things had to be changed because other people decided to join in) • Starting off with individual sessions and once confidence and familiarity are established then progress to introducing people to each other and create small therapeutic groups • People need feedback ….Oh you’ve had your hair done, It looks like you have been busy, I can see you better when you are near the window ,we love hearing that story…… https://youtu.be/HGo4mPa_bWc
Early Zoom meeting Are you on mute ?
In reality ….Its difficult but worth it Singing with other people when lips, rhythm and tunes were not synced was like a cats Chorus • Its difficult to keeps someone's attention when someone is mopping the floor behind them • Its frustrating to see someone frantically looking for someone to help when they have lost the connection • Its hard to establish a conversation with two people when they cant hear each other properly and the other person has “frozen” ☺ Someone starts chatting to the other ones granddaughter about a trip to the beach or a song they sang when they were five • When Tootsie met Lucky online and lead to a rendering of “How much is the Doggy in the window ! “ incorporating woof woof !! • When the person with dementia reassures you that its a problem with the technology and shares how they first managed a mobile phone • When the weather forecasts are shared between people in different geographical locations in real time • When people are really pleased to see you and respond
They can see you !!!! The state of your office notice board ,cups of tea lettuce in your teeth Tiredness ,distraction, hear phones buzzing ,voices in the background …and they know when they are not having your FULL attention. People who live with dementia often compensate by picking up on the non verbals ! You can see them !!! Observe the background ,pick up on the family pets weather ,washing on a drier ,books or magazines in the background ,cups of tea You can use all of these to bring the person into the virtual shared experience …even the cup of tea …favourite mug, biscuitsetc as a conversation piece. You cannot control what people might say or do …. just be ready !!!!! (bad words, politically incorrect language, gestures or behaviour)
Tips and tricks for success • Breaking it down into manageable pieces and starting off slowly • Establish rapport ,face to face or mask to mask if necessary • Acknowledging the limitations honestly and sharing experiences • Be aware of the background, people ,items, noise& animals • Be creative ,use prior knowledge to build the virtual picture • Get to know the care givers/Supporters ,pets and encourage others to contribute • Use life story ,find connections and similar interests • Make it feel like a natural conversation ,use facial expression, eye contact and props • Sending out emails prepping people for sessions and debriefing after catastrophic failure • Pitch to your target group ,eg dementia ,bold contrast ,images • Stamina & determination and a sense of humour • Always have plan B ready in the wings • Always have plan C ready in the wings
Next steps Introduce others to the groups already set up ,Story book at home ,Local dementia choir Develop and establish a local Alzheimer's café ( the service had already been started but wasn’t sustainable due to transport and attendance – pre covid) Encourage the care givers and supporters to meet up to provide ongoing support to each other (there is currently no local Alzheimer's support or carer groups) Involve the supporters initially then let them pull back a little Sharing material and ideas to promote meaningful activity in everyday involvement at home Establish a routine of sessions and encourage relationships between people Use the experience to promote other virtual services available, social gatherings, online concerts ,dementia choirs
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