Hand Outs on Body-Based Treatment for Dementia


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Hand Outs on Body-Based Treatment for Dementia

  1. 1. Trauma at the End of Life: Somatic Experiencing and Other Touch-Based Treatments for Neurocognitive Changes We are all temporarily able minded... Alzheimer’s Disorder (Forgetting): The primary presenting problem for is often poor memory and forgetfulness. In middle stages: reductions in the ability to conceptualize, organized expressive and receptive speech, and motor planning. In late stages: behavioral difficulties, agitation, delusions, and halluci- nations. Psychological Reactions: To the individual it can feel like a deadly disease that has no cure and will inevitably rob them of everything they have. People can often feel angry at having to go through the cogni- tive changes; they may feel betrayed, and questions of existential value can surface. Transference Issues in Therapy: Clinicians often feel as if their work is futile due to the client’s progres- sive decline. Efforts to help the client and/or family can often seem like failure. Clinicians finding the exis- tential meaning in each moment of life can help. Parkinson’s Disease (PD), Parkinsonian Disease Dementia (PD-D), Lewy Body Dementia (LBD): These disorders are likely a spectrum of disorders affecting the sub-cortical movement, motivational and affective centers of the brain All of these dis- orders present with tremors, slowing of movement, difficulty initiating movement, difficulty with bal- ance and cognitive slowing. LBD can mimic Al- zheimer’s and have visual/ auditory hallucinations. Psychological Reactions: Depression is common in all forms of basilar dementia disorders. Individu- als who experience these disorders can face social stigmas. Individuals with LBD particularly experi- ence paranoia and difficulty distinguishing dreams from reality. Transference Issues in Therapy: The feeling of sitting with depression can be very heavy, especially when the depression is associated with dementia. Cli- nicians can feel confused and hopeless. For individu- als with LBD the clinician needs to be able to flexibly work with the client in multiple and fluid realities. Vascular Dementias (VAD): These disorders are highly heterogeneous. They reflect damage to the brain from multiple classes of ischemic attacks, including burst blood vessels, occlusions and aneurisms. They tend to follow a step-wise loss of cognitive abilities. Psychological Reactions: This disorder often has a sud- den onset. The suddenness and the severe consequences of the cognitive changes can impact the family and indi- vidual as a traumatic loss. Transference Issues in Therapy: Reactions to VAD are diverse. Sudden changes over time can be destabilizing to the counseling process. Facing one’s own fragility of mind can help the clinician support their client and family to integrate the experience. Fronto-temparal Dementias (Changes in Self): FTD most likely not one dis- order but a group of related disorders. There are two main initial presentations a. The loss of language ability and b. Behavioral disinhabition. The later individual can look and act anti- social, lack social awareness and neglect hygiene. Over the course of the changes both groups begin to develop symptoms of the other group. Psychological Reactions: Language Loss: People can limit the scope of their social life due to fear that they cannot communicate effectively with others. Behavior disinhabition: People can ruin their reputation with impulsive, unethical actions, display lack of insight, appear cold, rigid and impersonal. Transference Issues in Therapy: Transference Issues in Therapy: Initially clinicians can feel powerless to com- municate without words. Impulsive behaviors often make it necessary for the clinician to manage his/her frustration with the client and to be very clear with boundary setting while holding space for compassionate understanding.
  2. 2. Affect Regulation 1. Individuals can still learn and change their emotions, psycho- logical reactions even with out memories of distinct events. 2. Working with the autonomic nervous system can help both the practitioner and the client return to rest after stress. 3. Evoking one positive emotion increases how quickly a person returns to rest after stress. 4. Signs of Rest: Stomach Gurgles, Deep Breath, Jaw relaxes, Hands relax. Psychobiological Effects of Touch Treatment 1. Reduced Cortisol 2. Increased Dopamine 3. Increased Serotonin 4. Increased Oxytocin 5. Increased Sleep 6. Decreased Substance P 7. Reduced Blood Pressure 8. Reduced Pulse Rate 9. Reduced Agitation 10. Reduced Pacing Ethical Use of Touch 1. Always obtain informed consent. 2. Have a clear objective for the intervention 3. Respect a clients changing boundaries 4. Obtain appropriate training, consultation and supervision Use of Touch - Treatment Planing For Elders 1. Obtain and Use Appropriate Informed Consent Protocol 2. Assessment: A. Obtain neuropsychological evaluation. B. Identify patient/caregiver goals and current coping strategies (some challenges simply need to be accepted, some need be adapted to, and some corrected). C. Assess motivation and beliefs about healing/health. D. Assess the level of insight the client displays about the cognitive changes. 3. Identify Touch Therapy Appropriate Goals: a) as an adjunct treat- ment for mood disorders, b) to reduce cortisol secretion and behavioral disruptions, c) to reduce anxiety, d) to reduce aggression, e) to support de-escalation if the individual becomes agitated, f) for pain reduction, g) to increase social support, h) to increase meaning and emotional commu- nication and i) increase sleep. 4. Identify Touch Techniques: Self-regulation, Co-regulation and De- escalation techniques. 5. Regularly assess and evaluate the outcomes of intervention. Touch techniques Self-regulation techniques teach an individual to use touch to sooth anxiety or agitation. Self-touch (e.g., self-massage, tapping, pushing feet into ground, and self-squeezing), contact with an animal (e.g., house pet, health advocate animal, therapy animal), or seeking contact with care provider (e.g., hand holding, asking for contact). Co-regulation techniques are techniques that a therapist, family mem- bers or care providers can use to provide desensitization to triggers and containment (e.g., providing listening, containing, or supportive touch; evoking a relaxation response; activating prefrontal emotional regula- tion areas to come online. De-escalation techniques can be used to reduce agitation and anxiety and increase positive mood (e.g., supportive touch on back, hand hold- ing, asking to squeeze the care provider’s hand, mirroring movements, allowing the person to take your arm and lead you). Ableism and Disabilities Religious/moral model: This model views disability as a moral failing. Medical model: Views disability as an illness or deformity to be fixed. Disability rights model: Recognizes differences and notes that social sys- tems hold biases that can impede the ability of the individual to adapt.