Rehabilitation therapy

From the Summer 2016 edition of Care and cure magazine, a new type of therapy is being tested to see if it can help people with dementia to continue to do the things they want to do, engage in everyday activities and maintain their interests.

Many people with dementia can find themselves withdrawing from activities and pastimes they once enjoyed. Problems with memory loss and cognitive abilities can also make it more difficult for people to carry out everyday tasks.

Cognitive rehabilitation, a form of therapy developed from those offered to people who have sustained a brain injury, is thought to help manage some of the difficulties faced by people with dementia.

'With funding from Alzheimer's Society, we were able to complete the first randomised controlled trial of cognitive rehabilitation – an approach whereby people with Alzheimer's disease work with healthcare professionals to set personally relevant and meaningful goals and develop strategies to reach them,' says Professor Linda Clare at the University of Exeter. 

'Our trial showed that cognitive rehabilitation therapy could improve the quality of life of both people with early-stage Alzheimer's disease and close family members.'

All of the study participants set personal goals that ranged from resuming enjoyable activities such as reading, knitting or going on day trips to more practical things such as remembering details of jobs to be done around the house, learning to use a mobile phone or maintaining concentration when cooking. 

A therapist worked with the study participants who were allocated to receive cognitive rehabilitation individually to plan how to address each goal, taking into account what the person was able to do and what was needed to achieve the goal. The plan included ways of using their abilities better, for example how best to remember important details, and ways of getting around a difficulty by doing things differently, for example having a set of written instructions to follow. 

Professor Clare explains, 'The idea is to take a problem-solving approach and build on the skills that people still have.'

The results showed that people who received cognitive rehabilitation therapy improved their ability to carry out activities related to their goals and were more satisfied with how they were managing. Brain scans showed an increase in activity in certain areas of the brain for these participants when carrying out a memory task. 

'This is difficult to interpret exactly, but we think it shows that the brains of people in this group were able to deal with the demands of the task more efficiently,' says Professor Clare.

Professor Clare and her team are now running the GREAT trial, funded by £2.4 million from the National Institute for Health Research, to provide robust evidence of the effects of cognitive rehabilitation and how it can be integrated in clinical practice. It is hoped that the results of the study, expected in 2017, will guide practice within the NHS and will help develop the services provided by memory clinics.

Professor Clare says, 'This approach is about finding ways of making things possible. Obviously you have to be realistic. You can't take away someone’s memory problems, but you can try to address everyday challenges – to help people to remain engaged, and retain their confidence and self-respect.'