Academic journal article Journal of Medical Speech - Language Pathology

Evidence-Based Practice Recommendations for Working with Individuals with Dementia: Simulated Presence Therapy

Academic journal article Journal of Medical Speech - Language Pathology

Evidence-Based Practice Recommendations for Working with Individuals with Dementia: Simulated Presence Therapy

Article excerpt

The Academy of Neurologic Communication Disorders and Sciences (ANCDS), the American Speech-Language-Hearing Association (ASHA), its Special Interest Division 2 (SID-2: Neurophysiology and Neurogenic Speech and Language Disorders) and the Veterans Administration (VA) collaborated to establish evidence-based practice guidelines for diagnosing and treating individuals with dementia of the Alzheimer type (DAT). A committee was formed to review the literature and evaluate the evidence for effects of direct and indirect interventions on the communicative functioning of individuals with DAT. In this clinical report are a description and evaluation of the evidence for using simulated presence therapy (SimPres), using personal memories for enhancing well-being, for persons with DAT.

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The Dementia Practice Guidelines (DPG) Committee was formed to develop clinical practice guidelines for diagnosing and treating the cognitive-communicative problems of individuals with DAT. The DPG was charged with searching the literature, evaluating all research related to tests and therapeutic interventions reported to be used with individuals with DAT, and disseminating results of the committee's work through a series of clinical articles. Interventions judged to be within the scope of practice of speech-language pathologists (SLPs), such as those designed to facilitate cognitive-communicative functioning, were reviewed. In this clinical article, the research related to SimPres is evaluated.

CLASSIFICATION OF EVIDENCE

For evaluating research related to interventions for individuals with dementia, the DPG writing committee developed a protocol that included review of the purpose of the study; characteristics of enrolled participants; factors affecting internal, external, and content validity; dose-response characteristics (frequency, intensity, and duration) of the treatment; outcome measures; study results; and methodological issues related to the conduct of the study. To ensure reliability of judgments about the research evidence, each article was rated independently by two members of the DPG writing committee. In this article, one in a series of reports, evidence is presented related to the use of SimPres for persons with DAT.

Alzheimer disease is a neurodegenerative disorder that prominently affects memory and other cognitive domains and interferes with the ability to carry out daily life activities (American Psychiatric Association, 1994). Currently, approximately 4 million Americans have a diagnosis of DAT, and the prevalence doubles every 5 years after age 65 (National Institutes on Aging, 2000). Thus, the need for evidence-based behavioral intervention techniques for people with DAT has never been greater.

Behavioral interventions for persons with dementia are of two types--direct and indirect-depending on whether the interventions are implemented directly by SLPs with persons with Alzheimer disease or indirectly, through caregiver training, modification to the physical environment, and development of routines and activities carried out by others (see Clark, 1995; Hopper, 2001; Mahendra, 2001). SimPres is considered an indirect intervention for persons with DAT.

SIMULATED PRESENCE THERAPY

SimPres is a technique in which a family member, or established caregiver, makes an audiotape about positive events in the life of the individual with dementia that is played to simulate their presence. It is a patented intervention of SimPres Incorporated. Boston, Massachusetts, comprising a "telephonic audiotape recording module" that allows individual to tape only the caller's portion of a conversation. The authors claim that by exposing an individual with DAT to an audiotape made by a familiar person, an environment is created that may provide comfort and reduce problem behaviors through stimulation of preserved remote memories and positive emotions associated with those memories. …

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