Virtual Cognitive Stimulation

Therapy (vCST)
Learning Objectives

What is Dementia

Cognitive stimulation therapy (CST) and its associated benefits

Telehealth, its benefits and barriers.

The virtual cognitive stimulation therapy programme

The roles and responsibilities of an occupational therapy assistant (OTA)

The roles and responsibilities of an occupational therapist

Overview of the OTA decision pathway

The importance of supervision

What is Dementia?
 Korsakoff’s
Alzheimer's Syndrome
Dementia disease

 ‘Umbrella term’

Lewy Body
 Estimated that 152 million syndrome
people globally will be
living with dementia in
2050 (Alzheimer’s Disease
International,
2020).people globally will be
living with dementia in 2050
(Alzheimer’s Disease International,
2020).

Vascular
Dementia
CST at a glance..
Cost-
effective

Maintains
Improves quality
function in
learning, Cognitive of life (Qol),
wellbeing, self-
storing and
retrieving Stimulation esteem and
confidence of the
information in
our brain. Therapy PwD

Provides the
PwD a sense of
belonging and
‘togetherness’

(Cheung, G., and Peri, K., 2020; MODEM, 2016; Kelly et.
Al., 2017; Orfanos, S., Gibbor, L., Carr, C. and Spector, A.
2020;Woods, Aguirre, Spector, & Orrell, 2012)
Benefits of cognitive stimulation therapy
Gibbor, L., Yates,
L., Volkmer, A. and
Spector, A. (2020)
1.Positive impact on mental
processes from the PwD and
caregiver perspectives
2.A positive change of view of
the PwD’s diagnosis from both
parties.
3.Improvement in mood and
communicating with others
following CST
Bailey et. Al., 2017
Kelly et. Al.,
(2017)
• Improved PwD’s and their
caregivers satisfaction with
the PwD’s:
1.mental abilities such as
retaining information
2.Level of self-esteem and
confidence
3. Level of participation and
engagement in the CST group
Lobia et. Al., 2020
• Across the research
analysed:
1.Improvement in cognitive
functioning specifically
language
2.Gains in QoL for PwD
3.Limited evidence for
benefit of CST for
improving Qol or health
for caregivers
Telehealth
Defined by AOTA as “the application of evaluative, consultative,
preventative, and therapeutic services delivered through
telecommunication and information technologies” (2013, p.
S69). 
 ICT benefits and barriers
Benefits to using ICT for CST Barriers to using ICT for CST
Caregivers: more engaging with the service Physical interact with the materials; may be
compared to face-to-face consultation. more reliant on communication prompts.
Increased accessibility for individuals with Cost- accessibility in client selection
dementia (such as mobility issues)
Receiving real time feedback- able to see the Privacy and security – read HSE IT Policy.
PwD within their home environment
Reduces social isolation for individuals with Awareness of possible interruptions Link:
dementia (connection, the outside environment such as https://www.hse.i
people or noise etc). e/eng/services/yo
urhealthservice/do
cumentation/links
2.html

Information and
Communications (Burton & O’Connell, 2018; Husebø, A.M.L. and Storm, M. 2014; Wallisch A., Little L., Pope E., & Dunn
Technology= ICT 2019).
Virtual Cognitive Stimulation Therapy (VCST)

 Aim: To actively engage and stimulate participants in a group setting

 6 participants with mild to moderate dementia.

 Pre-training provided to PwD and caregiver
 Structured intervention with use of CST manual completed virtually.
 14 sessions x2 a week for 7 weeks through tele-videoconferencing
 Each session as a theme on PowerPoint.
Link:
 Provide warm up activity. https://www.youtube.com/watch?v=
OuASky-rIcM
 Co-facilitators: OT and OTA (CST personnel optional)
 30-45 minutes in duration

(Cheung, G., and Peri, K., 2020; National Institute for Health and
Clinical Excellence, 2018).
 What is involved in a VCST?
Refer to CST
manual for
more
1. Ensure information.
everyone is
online
‘Reality Orientation
(5min) 2.Introduction:
For example: Board’
• Childhood ensure each person Includes:
Online is welcomed
• Word games friendly • Orientation (date,
• Food themes (10min) time, year, month)
• Creative games • Names of group
• Faces/scenes members
• Team quiz VCST • Establish group
• Current affairs name and song to
use
1. Warm up
Ending group
activity -song
session (5
• Reintroduce (slow tempo- 3
minutes)
orientation min)
2. 20 min: to
discuss,
engage and
participate
with theme
Chao, Nicpon, and Roduta Roberts,
(2020).
What is the foundational purpose of the OTA
within vCST?

Assist OTs in treatment programs such as

virtual cognitive stimulation therapy

Complete delegated tasks assigned by OT

Roles and responsibilities of an OTA in service delivery

Some examples….(refer to handout for more detail) (AOTA, 2010;2014;2018)

1. Establish rapport (meaning a relationship). Link: https://www.hse.ie/eng/about/our-health-

service/healthcare-communication/communication-skills-workshops.html
2. Respect confidentiality
3. Establish supervision with OT
4. Be ‘person-centred’
5. Involvement in administrative tasks
6. Be flexible, empathetic and creative in your approach.
Role and Responsibilities of OT in service
delivery
Some examples….(refer to handout for more detail) (AOTA, 2010;2014;2018)

1. Implement supervision with OTA

2. Ensure PwD meets inclusion/exclusion criteria of group
3. OT assessment with PwD and caregivers
4. Discharge planning
5. Collaborative care plan with OTA of individuals within CST
6. Ensure OT (myself) is practicing within my scope of practice and of OTA’s
Delegating tasks within the OTA’s scope of practice?

Am I within my competencies of this intervention?

Can this intervention be assigned to an OTA (refer to

standard 1)

Is the OTA competent to perform this intervention?

OTA
Clients risk factors, status and the community practice
appropriate to assign the intervention to the OTA?
Decisions
Has informed consent been obtained from PwD and their
Pathway
caregiver for OTA to participate in VCST?

Supervision and communication discussed with OTA? (standard 2)

Has record keeping standards been established with OTA

(Standard 3) (College of Occupational Therapists
of Ontario, 2018, p.12)
 Factors OT/OTA needs to consider prior to starting vCST.

Informed consent obtained from the PwD and/or their caregiver and the CST personnel (Occupational
therapy Australia, 2020).

Ensure a qualified CST personnel is connected to the telecall – aids implementation

Include 1:1 pre-training and note participants’ experience of technology throughout the session, and
their reliance on aid from caregivers for setting up in-home videoconferencing

Virtual fatigue– Utilise ‘break-out’ room function – promotes engagement and participation of the
PwD

(Cheng and Peri, 2020).

 Level of supervision
Purpose: Ensures both parties (OT/OTA) converse to progress or maintain a level of
competency within their performance
The level of supervision depends on the following factors in accordance with AOTA
(2014;2010):
1. Level of Experience and competency
2. Complexity and conditions of clients: range of complexities, supervision will be
increased accordingly.
3. Amount of clients/service users: 6
4. Type of setting

(AOTA
2014;COTO,2018)
  Standards for the supervision of OTA’s (AOTA, 2014)- refer to
handout provided today.
 OTA practice guidelines and checklist when utilising telehealth:
 Link:
https://otaus.com.au/publicassets/1eddc7c3-ad6c-ea11-9404-0050
56be13b5/OTA%20Telehealth%20Checklist%202020.pdf

Resources:  Informs you of CST training in Ireland (and internationally) and

who to contact if interested:
 Link:
https://www.ucl.ac.uk/pals/research/clinical-educational
-and-health-psychology/research-groups/international-cog
nitive-47
 HSE IT Policy and Standards (Health Service Executive, 2020).
 Link:
(Health Service Executive, https://healthservice.hse.ie/filelibrary/staff/clinical-telehealth-gov
2020;Occupational Therapy Australia 2020; ernance-guidance.pdf
UCL, 2021)
 The Global Dementia Observatory Knowledge
Resource: Exchange Platform (2021)

Promotes the ‘Global action plan in response to dementia care

2017-2025’
Access policies, procedures and guidelines on PwD

Case studies on examples of good practice

Mutual learning and exchange of information

Link: [https://globaldementia.org/en]
 OTA Awards

 In recognition of the contributions OTA’s provide to OT service delivery the

following awards are outlined on the AOTA website:

1. “OTA Award of Excellence”

2. “Roster of Honor”

3. “Terry Brittell OTA/OT Partnership Award”

Full details on the requirements of achieving the awards are outlined on AOTA’s website

Link: https://www.aota.org/Education-Careers/Awards.aspx
American Occupational
Therapy Association, (2021).
Any questions?
 References
 Alzhiemer's Disease International (2020), “ADI - Dementia Statistics.” Dementia Statistics, 2020, [Available online at:
www.alzint.org/about/dementia-facts-figures/dementia-statistics/#:~:text=Numbers%20of%20people%20with%20dementia&text=There%20are
%20over%2050%20million
] Accessed 11 Apr. 2021.
 American Journal of Occupational Therapy (2018), ‘Importance of Collaborative Occupational Therapist–Occupational Therapy Assistant
Interprofessional Education in Occupational Therapy Curricula.' American Journal of Occupational Therapy, 72(Supplement_2),
p.7212410030p1.
 American Occupational Therapy Association, (2014) “Guidelines for Supervision, Roles, and Responsibilities during the Delivery of
Occupational Therapy Services.” American Journal of Occupational Therapy, vol. 68, no. Supplement_3, 1 Nov. 2014, pS16,
10.5014/ajot.2014.686s03.
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 Bailey, J., Kingston, P., Alford, S., Taylor, L., & Tolhurst, E. (2017), ‘ An evaluation of Cognitive Stimulation Therapy sessions for people with
dementia and a concomitant support group for their carers.’ Dementia, 16(8), 985–1003.
 Burton, R. L. , & O’Connell, M. E. (2018), ‘Telehealth rehabilitation for cognitive impairment: Randomized controlled feasibility trial. JMIR
Research Protocols’, 7 (2), e43. Crossref PubMed.
 Chao, I.C.I., Nicpon, K. and Roduta Roberts, M. (2020). Effect of Cognitive Stimulation Therapy on Quality of Life: A Critical Review. Physical
& Occupational Therapy In Geriatrics, 38(3), pp.203–229.
 References
 Cheung, G., and Peri, K., (2020) ‘Challenges to Dementia Care during COVID-19: Innovations in Remote Delivery of Group Cognitive Stimulation Therapy.’ Aging & Mental Health, 7
July 2020, pp. 1–3, 10.1080/13607863.2020.1789945. Accessed 27 July 2020.#
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source/default-document-library/standards-for-the-supervision-of-occupational-therapist-assistants-2018.pdf?sfvrsn=f0051840_6, pp.1–12. Available at: https://www.coto.org/docs/default-
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 eHealthIreland (2020). ITS THERAPY JIM ……BUT NOT AS WE KNOW IT ! Reminiscence from the Original Star trek. [online] , pp.1–11. Available at:
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 References
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 UCL (2021). CST Training in Ireland. [online] UCL Psychology and Language Sciences. Available at:
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