MA- IV SEMESTER

Unit- 5

• The goals of neurorehabilitation are to improve / maintain

function, decrease the impact of symptoms, and improve the
quality of life of the patient and caregiver.

Alzheimer's Disease

•Alzheimer’s disease causes a progressive decline in memory,

thinking, learning and organizing skills over time.
•It’s the most common cause of dementia and usually affects
people over the age of 65.
• There’s no permanent cure for Alzheimer’s, but certain
rehabilitation/medications/therapies can help to manage symptoms
temporarily.
• Some people develop Alzheimer’s disease in their 40s or 50s. This is
called early-onset Alzheimer’s disease.

Stages of Alzheimer’s disease

Mild or Early
Moderate or Middle
Severe or Late
Symptoms:
 Symptoms :
Mild stage of Alzheimer’s disease

• Forgetting newly learned information, especially recent

events, places and names.
• Having difficulty finding the right words to express
thoughts.
• Losing or misplacing objects more than usual.
• Having difficulty making plans or organizing.
• Having difficulty problem-solving.
• Taking longer to complete routine daily tasks.
 Moderate stage of Alzheimer’s dementia

• Need help with self-care, such as bathing, grooming, showering and

using the bathroom.

• Experience more personality changes, including being agitated or

acting out.

• They may show depression, apathy or anxiety as the disease

progresses.

• Develop groundless suspicions about family, friends and caregivers

(delusions).

• Have sleep disturbances.

 Severe stage of Alzheimer’s Disease

• Having almost total memory loss.

• Unaware of their surroundings

• Needs help with all basic activities of everyday living, such as

eating, sitting up and walking

• Loses their ability to communicate/ speech becomes limited to a

few words or phrases.

• Becomes vulnerable to infections, especially pneumonia and skin

infections.
 Causes
• The human brain contains over 100 billion nerve cells and

other cells. The nerve cells work together to fulfill all the

communications needed to perform functions such as

thinking, learning, remembering and planning.

• An abnormal build-up of proteins (Amyloid protein and Tau

protein — causes brain cells to die) in the brain causes

Alzheimer’s disease.
• The slow and ongoing death of the nerve cells results in the
symptoms of Alzheimer’s disease.

• Nerve cell death starts in one area of your brain (usually in

the area of the brain that controls memory - Hippocampus)
and then spreads to other areas.

• A combination of genetic, environmental and lifestyle

factors likely contribute to the cause
 Diagnostic methods before the rehabilitation
• Overall health.

• Current medications

• Medical history

• Ability to carry out daily activities.

• Changes in mood, behavior and personality.

• Perform a mental status exam,included assessment of memory, problem-solving,

attention, basic math and language

• To physical exam and a neurological exam (assess nervous system functioning)

• Brain imaging tests, such as a brain CT, brain MRI or positron emission tomography
 Neurorehabilitation Techniques:

Learning and Relearning

• Relearning refers to the number of successive trials to reach a

specified level of proficiency may be compared with the number of

trials he later needs to attain the same level.

• Both classical and operant conditioning of responses has been

demonstrated with Alzheimer patients

– (Camp et al., 1993; Burgess, Wearden, Cox, & Rae, 1992),

• The appropriate support for memory must be provided both at

encoding and at retrieval level, it is possible through regular

practices
• Elaboration and effortful processing can improve
memory performance.
• It is needed to be balanced with the goal of
reducing or eliminating errors during the learning
process.
• Errorless learning is useful in improving memory
related performance in early-stage Alzheimer’s
diseases.
 Interventions for people with early stage

• A careful assessment of the neuropsychological profile and

the person’s everyday functioning is required.

• This assessment should be made in the context of a

broader evaluation encompassing,

• The person’s past experience,

• Level of Psychological well-being,

• Awareness of difficulties and readiness to address them

• To be facilitated through provision of appropriate material or
suggestions. Information about memory problems and how
these may be tackled (e.g. Clare & Wilson, 1997) can be
helpful for the individual and for family members,
empowering them to identify their own solutions to specific
issues or problems.

• The assistance can be given with learning or relearning

information and skills, in order to enhance residual episodic or
procedural memory performance.
 Facilitating Residual Memory Functioning

• Interventions aimed at facilitating residual memory

performance need to incorporate the twin guiding principles
of effortfulness and errorlessness in the learning process.

• Expanding rehearsal, or spaced retrieval, has been used

extensively to achieve certain needed goal.

• To be used some techniques to enhance retention level:

– Face-name associations,
– Object naming
– Memory for object location
– Cueing methods (Clare et al., 2000)
Cueing methods:

• Forward cueing/ Increasing assistance: begins by offering just the initial letter
and adds a letter on each subsequent presentation until the word or name is
correctly completed.

• Vanishing cues/ Decreasing assistance: the number of cues is gradually

reduced.

• Other Strategies:
– Visual imagery

– Mnemonics

– Chunking of information,

– Method of loci

– Subjective association/the story method

 Providing External Support for Remembering
• External memory aids:
– Diaries and lists,

– Digital watch was set to beep every hour as a cue to

prompt engagement in a predetermined activity.

– Use of technology - computer and video equipment to

monitor and control the environment of the person
with dementia in order to support independent
functioning (Marshall, 1999).
 Three Main Cognitive Strategies

• Cognitive Stimulation is a nonspecific approach to stimulate all

cognitive domains through a wide range of activities such as :

– Reminiscence therapy (Reminiscence therapy: it is a treatment that

uses all the senses — sight, touch, taste, smell, and sound to help

individuals with dementia remember events, people, and places from

their past lives.)

– Reality orientation and Sensorimotor therapy (it uses mindfulness-

based techniques to increase awareness and acceptance of body

sensations and impulses).

• Cognitive Training(CT) involves the repeated practice of a set of
structured tasks intended to improve or maintain a particular cognitive
function.

• CT may be delivered individually or in a group session.

• Cognitive Rehabilitation is a person-centered intervention that

addresses the impact of cognitive dysfunction on everyday activities and
enables the person to execute the desired action to accoplish desired
goal.
Psychosocial and Cognitive Rehabilitation in the Elderly
Functional Adaptation Skills Training (FAST) - Patterson et.al (2003)

• It provides group sessions aimed at improving community

living skills such as managing finances, making/keeping a

schedule, taking transportation, communicating, and

managing illness.

• This approach uses modeling, rehearsal of skills, and positive

reinforcement to enhance significant improvement in social

skills and everyday functional skills

 Combined cognitive behavioral and social skills training (CBSST)
Granholm and colleagues [2005].

• It provides training in self-management skills in three modules for a total of 24 weeks.

• social functioning (involvement in leisure activities), cognitive insight, and performance on a

comprehensive module test

• blending of cognitive restructuring techniques with traditional skills training is a uniquely

effective method for enhancing living skills in older people

Combined skills training and health management intervention

Bartels and colleagues (2004)

• A model of integrated psychosocial rehabilitation and healthcare management for older

adults

• This intervention consists of weekly skills training on living skills and medication self
management, together with nurse preventive health care management
• Some other specific skills, training, and experiences designed to
boost:
– Resilience and mental toughness

– Problem-solving ability

– Self-esteem

– Social skills

– Stress management

– Holistic approach: to their overall physical and psychological well-being

– Person-Oriented training: Each client’s goals are individualized based

upon their specific needs or concerns