Background. Acknowledgement. Content. Unexplained Problematic Behaviors

Transcription

1 Application of Sensory Integration Therapy to the Geriatric Population: An Experience Sharing on Reducing Unexplained Problematic Behaviors in People with Neurological Disorders 感 觉 统 合 治 疗 于 长 者 康 复 的 应 用 : 减 低 脑 神 经 科 患 者 问 题 行 为 之 临 床 经 验 分 享 My Heavenly Father For HIS creation, gift of life & inspiration For HIS complete supply In the beginning God created the heaven and the earth. Genesis 1:1 The unfolding of thy words gives light; it imparts understanding to the simple. Psalms 19:130 Haven of Hope Christian Service Operation Santa Claus Acknowledgement Thanks! 2012 International OT Conference 2012 国 际 作 业 治 疗 研 讨 会 26/02/2012 TAM Hiu Yan, Janette 谭 晓 茵 CHAN Yan Chi, Samuel 陈 恩 赐 Occupational Therapists 作 业 治 疗 师 Content Background Background Interventions Results & Case Studies Discussions Conclusions Nursing home 58 elderly (stayed 3 months or above) 90% Aged 75+ (Mean: years old) 91% Moderately to severely dependent Mean Barthel Index Score: 34.93/100 (Severe) 53% with 1 or more unexplained problematic behaviors Abnormal qualitative or quantitative deviance Likely to affect physical safety of the person or others Cause significant distress to the person or others Significantly add impairment Likely to seriously limit or delay access to and use of ordinary community facilities (Einfeld & Aman, 1995; Emerson, 1987) Video 1

2 Influences: Staff: Difficulties in personal Care Injury-on-duty Elderly: Additional medications Artificial restrictions Further isolations Poor human environment (After ruling out organic & psychosocial causes) Withdrawals, e.g. refusal of meals, Lack of responses, Soullessness, depressed Aggressive behaviors, e.g. fight-backs, yelling?self-stimulation e.g. eating / painting excretions, tearing diapers etc Re-understanding Elderly Sensory Integration is a theory & concept initially developed by Dr. A. Jean Ayres, PhD, OTR, since early 1970 s A Neurological process Re-understanding Elderly Feedbacks Sensory Input Sensory Integration (Register, modulate & process) Adaptive Responses (Miller 2007) graph Re-understanding Brain Viscous Cycle in Frail Elderly (Diagram) - Decreased ability to receive environmental info thro senses - Troubles processing & integrating the info - Inability to plan and execute adaptive responses functionally (Tam, 2010) 2

3 New Definition Unexplained Problematic behaviors could be a presentation of Sensory Processing Disorder (also known as Sensory Integration Dysfunction) (Refers to the inability of the central nervous system to perform effective S.I.) Interventions Experience Sharing: 12 Nursing home residents 7 female, 5 male Aged 75+ Suffered from 1 or more neurological disorder(s) Joined rehab and/or routine services < 3 months 1 or more non-organic problematic behavior(s) Interventions Interventions Experience Sharing: Deranged Sensory Profile level 2/7 (mean) in Ayres 7 Levels of Adaptive Responses (Data) (= Norm of 65+ years old + 1 S.D. more than norm - 1 S.D. less than norm) Individual Sensory Integration therapy x sessions Sensory diet in daily routine with regular review Usual programs continued Review after 1 year (Diagram of Practice Model) Results (Despite 2 missing data due to medical issues) Similar results in sensory profile with a trend towards norm Slight increase in B.I. scores (functional independence) Significant reduction in unfavorable behaviors Significant increase in adaptive responses Increased self-expression, participation & interaction with fellow staff, carers & the environment. Results (Data) 3

4 F/73 Dx: Lt. MCA infarct w/ post CVA epilepsy Bil. Cerebral infarcts (Lt. total anterior Rt. partial circulation infarct, large intracranial artery atherosclerosis) Other MHx: HT, DM, CHF, GI bleed & anemia, bil. Chronic frontal subdural haematoma, cerebral atrophy, Rt. knee degenerative changes, cataract, tinea pedalis Pre-mobid: ADL indep, owner of a small resturant O/E: ADL dep. (B.I. 1/100; MMSE: N/A), R/T feeding Strongly refusal of diet, drooling+ Nil vocalization, nil localization to sound Rt. visual neglect; Active control of Rt. U/L Response to passive stimuli (Sensory Profile data) Classical S.I. once a week x 10 sessions Consultative S.I. interventions added during routine rehab session (3 / week) Therapeutic listening during APT & passive standing Vibrations on joints Aroma massage Sensory diet carried our by daughter Oral feeding, massage Progress Increase alertness & awareness to environment Simple conversations Demonstrated localization of sound w/ eye contact & head turning Drooling decreased Tolerate routine oral feeding (100ml) (x2 / day) Discharged to C&A Home (Sensory Profile Data) Conclusions Video It appears that S.I. therapy is Effective in modifying elderly unexplained problematic behaviors Improving their awareness & interaction with the environment Treating sensory integrative dysfunction / sensory processing disorder in the geriatric population may be the missing pre-requisite of re-engaging frail elderly into daily living. 4

5 1. Acknowledge the importance of sensory integration functions in frail old-olds Essential function towards connection & responses STOP! Vicious cycle of mal-nutrition of the brain Decreased sensory-seeking behaviors Decreased sensory-processing ability 2. Trans-disciplinary approach for Sensory Diet *Unified Handling, Management & Routine* 3. Interventions needs for strengthening individual S.I. functions Need of prevention, early detections & interventions to potential S.I. dysfunction 4. Manage external sensory environment Creates CNS friendly environment Avoid confusions of sensory input in routine E.g. Ensure enough lights during daytime References 5. Need of further research - Model of Practice - Risk management - Evaluation tools *Sensations are the drugs & food of the brain Use Wisely! Otherwise, would be a nightmare!* 5

6 Thank You! Further discussion is welcome: Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. (II Co4:16) 6