Occupational Therapy for Patients with Neurodegenerative - PowerPoint Presentation

Occupational Therapy for Patients with Neurodegenerative Diseases: Evaluation and Assessments SLUHN Neurorehabilitation Symposium March 12, 2016 Stephanie Forbes, MS, OTR/L

DisclosureThe author and presenter of this presentation has no conflicts of interest to disclose

Objectives To provide information concerning… …the role of occupational therapy with patients with neurodegenerative diseases …occupational therapy evaluation of ADL/IADL performance, cognition, and upper extremity motor skills and coordination  for patients with neurodegenerative diseases …standardized assessments used by occupational therapists to evaluate patients with neurodegenerative diseases

Role of Occupational Therapy (OT)To help patients across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations ) To help patients function in all of their environments (e.g., home, work, school, community) To address the physical, psychological, and cognitive aspects of patients’ well-being

Role of OT for the Patient with a Neurodenegerative Disease To address self care (ADL) and home management (IADL) performance deficits resulting from symptoms and disease processTo help the patient compensate and adapt as function declinesTo adapt environments to fit the patient’s current functional level and prepare for future changes in function

Role of OT for the Patient with a Neurodenegerative Disease To implement exercise programs that address flexibility/maintaining ROM, endurance, and strength as appropriate to stage of disease To address issues of fatigue and physical demands by teaching energy conservation strategies and activity modifications to everyday routine

Role of OT for the Patient with a Neurodenegerative Disease To identify appropriate meaningful and purposeful activities , especially leisure activities, to promote self-efficacy and quality of lifeTo train caregivers to safely care for the patient and cope with decline of physical and cognitive functionTo help patient and caregivers identify community support and resources

Occupational Therapy AssessmentADL/IADL performance Cognitive function Motor skills and coordination Associated functional vision deficits Impact of fatigue Psychosocial impact of disease Ability to fill work and caregiver rolesLeisure and social participation

Types of Occupational Therapy AssessmentsInterviewsChecklists Observation of task performance Rating scales Standardized Assessments

Benefits of Standardized AssessmentsNorm-referenced and/or criterion-referenced S tandard scoring and terminology for clinical practice and research

Assessment of ADL and IADL FunctionFunctional Independence Measure (FIM) Assessment of Motor and Process Skills (AMPS) Kohlman Evaluation of Living Skills (KELS)

Functional Independence MeasureI nterdisciplinary functional assessment 18 items, each with 7 scoring levels Assesses severity of disability, not impairment

Functional Independence MeasureItems cover independence in self-care, sphincter control, mobility, locomotion, communication, and social cognition Items typically addressed by OT: eating, bathing, grooming, upper body dressing, lower body dressing, toileting, toilet transfers, shower/tub transfers, bed/chair transfers

Assessment of Motor and Process SkillsAdministered by occupational therapists who have completed the AMPS training course Observational assessment that m easures quality of performance of ADL and IADL Uses 4-point Likert scale to rate 16 motor and 20 process skill items 2-3 familiar ADL or IADL are chosen from list of over 120 standardized tasks (8 th edition)

Kohlman Evaluation of Living Skills Typically administered by occupational therapists Quick and simple evaluation of a patient’s ability to perform basic living skills Can help determine degree of patient’s independence and appropriate living or discharge situation17 items in five categories: self-care, safety and health , money management, transportation and telephone, and work and leisure Expected availability of fourth edition through American OT Association: 4/30/2016

Assessment of CognitionMini-Mental State Exam (MMSE)Montreal Cognitive Assessment ( MoCA ) Allen Cognitive Level Kitchen Task Assessment Executive Function Performance Test

Mini-Mental State ExamShort, simple quantitative measure of cognitive performance 11 questions in five areas of cognition: orientation, registration (memory), attention and calculation, recall, and language (following oral and written instructions) Maximum score of 30 points Mean score for normal sample was 27.6 with range of 24-30

Montreal Cognitive AssessmentQuick cognitive performance screening instrument Was developed to detect mild cognitive impairment Currently, can be administered by anyone who follows the instructions but can only be interpreted by health professionals with expertise in the cognitive field

Montreal Cognitive Assessment 8 domains: attention and concentration, executive functions, memory, language, visuospatial skills, conceptual thinking, calculations, and orientation Maximum score of 30 points 18-26 = mild cognitive impairment 10-17 = moderate cognitive impairmentLess than 10= severe cognitive impairment

Montreal Cognitive Assessment

MMSE versus MoCAMoCA assesses cognitive functioning more broadly than MMSE MoCA is superior to MMSE at detecting mild cognitive changes MMSE requires cost; MoCA is freely available MoCA is more effective in identifying cognitive impairment in patients with Parkinson’s disease and Huntington’s disease

Montreal Cognitive AssessmentElectronic test format coming soon: “E-MoCA ” MoCA training and certification program is currently being developed

Kitchen Task AssessmentPractical and objective measure of organizational, planning, and judgement skills as performed in a common food preparation task S core ranges from 0 to 18, with higher scores indicating higher severity of impairment P erformance on the subtests provides information on level of assistance needed and strategies useful to the caregiver

Executive Function Performance TestPerformance-based standardized assessment of cognitive function Used to identify an individual’s impaired executive functions capacity for independent functioningrequired amount of assistance for task completion 

Executive Function Performance TestFour tasks: simple cooking, telephone use, medication management, and bill payment The EFPT assesses the client’s ability to complete three executive function components of the task: Task initiation Task execution (comprising organization, sequencing, and judgment and safety)Task completion

Assessment of Upper ExtremityNine Hole Peg Test Functional Dexterity Test Jebson -Taylor Hand Function Test Box and Blocks Test Moburg Pick-Up Minnesota Manual Dexterity TestPurdue Pegboard Test

Nine Hole Peg TestTimed performance test Measures unilateral finger dexterity to determine the extent of fine motor impairment in people experiencing difficulties with functional performance

Functional Dexterity TestTimed performance test Provides information regarding functional dexterity in activities that require a dynamic three-jaw chuck prehension pattern

Jebson-Taylor Hand Function Test Assesses effective use of the hands in everyday activity by having the patient perform seven timed tasks representative of functional manual activities Provides objective measures for comparison with norms to assess capabilities and effectiveness of treatment

Box and Blocks TestMeasures unilateral gr oss manual dexterity Clients are scored based on the number of blocks transferred from one compartment to the other compartment in 60 seconds; higher scores are indicative of better manual dexterity

ReferencesAmerican Occupational Therapy Association. (2015). The role of occupational therapy in chronic disease management. Retrieved from http :// www.aota.org Amini , A. (2007). Motor Assessments. In I. E. Asher (Ed.) Occupational Therapy Assessment Tools: An Annotated Index ( 3rd ed.). Bethesda, MD: American Occupational Therapy Association, Inc.Baum,C. & Edwards,D.(1993).Cognitive performance in senile dementia of the Alzheimer’s type: The Kitchen Task Assessment . American Journal of Occupational Therapy, 47, 431–436.Baum, C. M. & Wolf, T.J. (2013). Executive Function Performance Test. Retrieved from http:// www.ot.wustl.edu/about/resources/executive-function-performance-test-efpt-308 Burnett , J. et al. (2009). Convergent validation of the Kohlman Evaluation of Living Skills as a screening tool of older adults' ability to live safely and independently in the community. Archives of Physical Medicine and Rehabilitation, 90(11) , 1948 – 1952.Center for Innovative OT Solutions. (2015). Assessment of Motor and Process Skills. Retrieved from http://www.innovativeotsolutions.com/content/amps / Centers for Disease Control and Prevention. (2014). Chronic disease prevention and health promotion. Retrieved from http://www.cdc.gov/ chronicdisease /index.htm Cooke, D. M. and Kline, N. F. (2007). Assessments of Process Skills and Mental Functions: Part 1: Cognitive Assessments. In I. E. Asher (Ed.) Occupational Therapy Assessment Tools: An Annotated Index ( 3 rd ed.). Bethesda, MD: American Occupational Therapy Association, Inc . Dalrymple-Alford , J. C., MacAskill, M. R., Nakas , C. T., Livingston, L., Graham, C., Crucian, G. P.,…Anderson, T. J. (2010). The MoCA : Well-suited screen for cognitive impairment in Parkinson Disease. Neurology, 75 , 1717-1725. Furphy , K. A. (2007). Assessments of Activities of Daily Living and Instrumental Activities of Daily Living. In I. E. Asher (Ed.) Occupational Therapy Assessment Tools: An Annotated Index ( 3 rd ed.). Bethesda, MD: American Occupational Therapy Association, Inc . Heart and Stroke Foundation: Canadian Partnership for Stroke Recovery. Assessments. Retrieved from http://www.strokengine.ca/find-assessment / Kalron , A., Greenberg- Abrahami , M., Gelav , S., & Achiron, A. (2013). Effects of a new sensory re-education training toll on hand sensibility and manual dexterity in people with multiple sclerosis. Neurorehabilitation, 32 , 943-948. Lam, B., Middleton, L., Masellis , M., Stuss , D., Harry, R., Kiss, A., & Black, S. (2013). Criterion and convergent validity of the Montreal Cognitive Assessment with screening and standardized neuropsychological testing. Journal of the American Geriatrics Socieity , 61 (12), 2181-2185. Kim, J., Jang, W., Cho, J., Ahn , J., & Kim, H. (2013). Bedside cognitive assessments and falls risk in Parkinson’s disease. Journal of Neurological Sciences, 34 , 75-78. Mathiowetz , V., G. Volland , et al. (1985). Adult norms for the Box and Block Test of manual dexterity .“ American Journal of Occupational Therapy, 39 , 386-391. Montreal Cognitive Assessment. (2015). Retrieved from www.mocatest.org Proud, E. L., Miller, K. J., Martin, C. L., & Morris, M. E. (2013). Upper-limb assessment in people with Parkinson disease: Is it a priority for therapists , and which assessment tools are used? Physiotherapy Canada, 65 (4), 309-316. Schultz- Krohn , W., Foti , D., & Glogoski,C . (2006). Degenerative Diseases of the Central Nervous System. In H. Pendleton & Schultz- krohn (Ed.) Pedretti's Occupational Therapy Practice Skills for Physical Dysfunction (6th ed.). Tsoi , K., Chan, J., Hirai, H., Wong, S., & Kwok, T. (2015). Cognitive tests to detect dementia : A systematic review and meta-analysis. JAMA International Medicine, 175 (9), 1450-1458. Waldron-Perrine, B. and Axelrod, B. (2012). Determining an appropriate cutting score for indication of impairment on the Montreal Cognitive Assessment. International Journal of Geriatric Psychology, 27 , 1189-1194.

Use of Music in Therapy

Use of Music in Therapy: What is Music? Music is defined as sound which is organized to stimulate a person or group of people Music is an individually meaningful, motivating phenomenon which is experienced physically, psychologically, and affectively

Use of Music in TherapyMusic is a motivating and versatile therapy tool Music can be used in therapy to help patients work toward physical, motor, cognitive, speech/language, functional vision, behavioral, and psychosocial goals Music can be used to reduce subjective experience of pain

Use of Music in Therapy:Movement Music can affect: I nitiation and continuation of movement Quality and coordination of movement When physical performance or exercise occurs to music, the following have been noted: I ncreased active movement and range of motionHigher work outputLonger muscle contractionsGreater endurance

Use of Music in Therapy:Arousal and Cognition Music can evoke powerful emotion, which can activate many different brain areas and optimize arousal level and attention Music can be used to either increase arousal and focus/alertness or decrease arousal and anxiety This allows for optimal arousal level, which enhances functioning of attention, memory, and higher cognitive functions

Use of Music in Therapy:Communication and Behaviors Music can be used as a medium for communication and socialization for those who have lost verbal abilities Music has been found to decrease agitation and disruptive behaviors which can detract from therapy and participation in functional activities

Use of Music in Therapy:Pain Reduction Music allows for focus on other stimuli and disregard of pain/discomfort sensations Possible connection to gate-control mechanisms, as music can be experienced as an auditory stimulus as well as a kinesthetic , proprioceptive, vestibular, and tactile stimulusAffective system changes and relaxation responses to music have been linked to decreased pain responses

ReferencesBernard, A. (1992). The use of music as purposeful activity: A preliminary investigation. Physical and Occupational Therapy in Geriatrics, 10 (3), 35-45. Casby , J. & Holm, M. (1994). The effect of music on repetitive disruptive vocalizations of persons with dementia. American Journal of Occupational Therapy, 48 (10), 883-889. Craig, D. (2008). An overview of evidence-based support for the therapeutic use of music in occupational therapy. Occupational Therapy in Health Care, 22(1), 73-95.Cottrell, R. & Gallant, K. (2003). The Elders Drum Project: Enhancing quality of life for long-term care residents. Physical and Occupational Therapy in Geriatrics, 22 (2), 57-79. Hagen, B., Armstrong-Esther, S., & Sandilands, M. (2003). On a happier note: Validation of musical exercise program for persons in long-term care settings. International Journal of Nursing Studies, 40 , 347-357. Johnson, R. & Taylor, C. (2011). Can playing pre-recorded music at mealtimes reduce symptoms of agitation for people with dementia? International Journal of Therapy and Rehabilitation, 18 (12), 701-710. MacRae, A. (1992). Should music be used therapeutically in occupational therapy? American Journal of Occupational Therapy, 46(3), 275-277.Ma, H., Hwang, W., Lin, K. (2009). The effects of two difrerent auditory stimuli on functional arm movement in persons with Parkinson’s disease: A dual-task paradigm. Clinical Rehabilitation, 23 , 229-237. Mei- Ching , C., Pei- Luen , T., Yu-Ting , H., & Keh -Chung, L. (2013 ). Pleasant music improves visual attention in patients with unilateral neglect after stroke. Brain Injury, 27 (1): 75-82. Powell, J. (2010). How music works: The science and psychology of beautiful sounds, frm Beethoven to Beatles and beyond. New York, NY: Little, Brown and Company. Soto, D., Funes , M., Guzman-Garcia, A., Warbrick , T., Rotshein , P., & Humphreys, G. (2009). Pleasant music overcomes the loss of awareness in patients with visual neglect. Proceedings of the National Academy of Sciences USA 2009;106 , 601-6016.