Disorders of Everyday Actions in Subjects Suffering from Senile Dementia of Alzheimer's Type: An Analysis of Dressing Performance

Dressing disrupted: negotiating care through the materiality of dress in the context of dementia

This paper explores how the materiality of dress mediates and shapes practices of care in the context of dementia. Earlier research called for an approach to conceptualising care that recognised the role played by everyday artefacts. We extend this to a consideration of dress and dressing the body in relation to people with dementia that involves the direct manipulation of material objects, as well as the materiality of bodies. The paper draws on an ESRC funded study Dementia and Dress, which examined experiences of dress for people with dementia, families and care-workers using ethnographic and qualitative methods. Our analysis explores the process of dressing the body, the physicality of guiding and manipulating bodies into clothing, dealing with fabrics and bodies which 'act back' and are resistant to the process of dressing. We consider how the materiality of clothing can constrain or enable practices of care, exploring tensions between garments that support ease of dressing and those that sustain identity. Examining negotiations around dress also reveals tensions between competing 'logics' of care (Mol ).

Treatments and technologies in the rehabilitation of apraxia and action disorganisation syndrome: A review

BACKGROUND: Apraxia and Action Disorganisation Syndrome are characterised by an inability to use tools and carry out ordered sequences of movements in the absence of motor or sensory impairment. To date treatment for these complex but debilitating conditions has received little attention.

OBJECTIVES: To provide an overview of apraxia and action disorganisation syndrome and its treatment, providing a state of the art summary for practitioners including likely future therapeutic directions.

METHOD: Review of apraxia literature and treatment studies collated from internet searches involving MEDLINE, PubMed, PyscINFO and Google Scholar as well as the author’s own catalogue.

RESULTS: Evidence for current restitution and compensatory approaches is critically reviewed, with limited evidence to date in support of either method. Strategy training is the most promising intervention type with no support for sensory and exploratory interventions, practice effects only for direct task-specific training, and modest support for gestural training.

CONCLUSIONS: Larger controlled studies are needed but evidence is sufficient to indicate certain approaches over others. Advances in assistive technology have not translated into mainstream therapy but future interventions are likely to require a model-based approach which embraces current technologies in order to provide a more accessible, effective and cost-efficient approach to rehabilitation.

Resistiveness to care during assistance with activities of daily living in non-institutionalized persons with dementia: associations with informal caregivers' stress and well-being

OBJECTIVES

Resistiveness to care (RTC) refers to behavior problems that co-occur during assistance with activities of daily living (ADL). RTC are considered challenging, but are mostly studied in institutions with implications for patients and formal caregivers. RTC is associated with agitation, but agitation is considered a separate construct. Detection of RTC may be left out of common assessments of persons with dementia in studies of informal caregiving (e.g. global assessments of dementia behavioral symptoms, standard assessments of ADL function). This study examines how RTC (frequency and caregivers' stress appraisals of RTC) is related to caregivers' well-being.

METHOD

234 caregivers of people with dementia reported care receivers' ADL impairment (eating, bathing, dressing), RTC frequency (of eating, bathing dressing), and their stress appraisals of these behaviors (RTC appraisals). Caregivers also self-reported their role overload, role captivity, and depressive symptoms. Hierarchical linear regression models included independent variables (demographics, ADL impairment, RTC frequency, RTC appraisals) with three separate dependent variables (overload, captivity, depressive symptoms).

RESULTS

Two-thirds of informal caregivers reported RTC. Care recipients' ADL impairment was associated with caregiver outcomes, but only before RTC was entered into the models. RTC frequency significantly predicted caregivers' overload, captivity, and depression. RTC appraisals predicted overload and captivity.

CONCLUSION

RTC is common in persons with dementia residing at home, and RTC has more negative association with informal caregivers' well-being than assistance with ADL. Adding RTC frequency and appraisal items to standard ADL measures may better estimate caregivers' needs and risk, and identify modifiable environmental features by assessing behavioral symptoms in context.

Dress, dementia and the embodiment of identity

The article explores the significance of dress in the embodied experience of dementia, exploring questions of identity, memory and relationship. It suggests that clothing and dress are important in the analysis of the day-to-day experiences of people with dementia, giving access to dimensions of selfhood often ignored in over-cognitive accounts of being. As a result clothing and dress can be significant to the provision of person-centred dementia care. These arguments are explored through ideas of embodied identity, the materialisation of memories, and the maintenance, or otherwise, of appearance in care. The article forms part of the background to an ESRC-funded empirical study exploring the role of clothing and dress in the everyday lives of people with dementia, living at home or in care homes, and of their relatives.

Monitoring dressing activity failures through RFID and video

BACKGROUND

Monitoring and evaluation of Activities of Daily Living in general, and dressing activity in particular, is an important indicator in the evaluation of the overall cognitive state of patients. In addition, the effectiveness of therapy in patients with motor impairments caused by a stroke, for example, can be measured through long-term monitoring of dressing activity. However, automatic monitoring of dressing activity has not received significant attention in the current literature.

OBJECTIVES

Considering the importance of monitoring dressing activity, the main goal of this work was to investigate the possibility of recognizing dressing activities and automatically identifying common failures exhibited by patients suffering from motor or cognitive impairments.

METHODS

The system developed for this purpose comprised analysis of RFID (radio frequency identification) tracking and computer vision processing. Eleven test subjects, not connected to the research, were recruited and asked to perform the dressing task by choosing any combination of clothes without further assistance. Initially the test subjects performed correct dressing and then they were free to choose from a set of dressing failures identified from the current research literature.

RESULTS

The developed system was capable of automatically recognizing common dressing failures. In total, there were four dressing failures observed for upper garments and three failures for lower garments, in addition to recognizing successful dressing. The recognition rate for identified dressing failures was between 80% and 100%.

CONCLUSIONS

We developed a robust system to monitor the dressing activity. Given the importance of monitoring the dressing activity as an indicator of both cognitive and motor skills the system allows for the possibility of long term tracking and continuous evaluation of the dressing task. Long term monitoring can be used in rehabilitation and cognitive skills evaluation.

Scaffolding rehabilitation behaviour using a voice-mediated assistive technology for cognition

A variety of cognitive deficits can lead to difficulties performing complex behavioural sequences and thus, disability in the performance of routine and rehabilitation behaviours. Interventions to date involve increasing support or providing behavioural training. Assistive technologies for cognition have the potential to augment cognitive capacity thus enabling the performance of behavioural sequences. Guide is an assistive technology for cognition that scaffolds task performance by providing verbal prompts and responding to verbal feedback. Guide was used to provide verbal support and guidance for eight amputees (mean age 64), with cognitive impairment of vascular origin, putting on their prosthetic limbs. Participants were referred to the research due to problems learning the correct behavioural sequence. The research used repeated trials with random assignment to intervention and baseline conditions. The voice-mediated assistive technology for cognition resulted in a significant reduction of safety critical errors and omitted steps. Discussion focuses upon the relation between voice-mediated cognitive support for memory and executive function, and suggestions are made for future research.

Étude de la planification de l’action au moyen du test du plan du zoo dans la maladie d’Alzheimer

INTRODUCTION

Executive dysfunction is regularly reported in patients with Alzheimer's disease. Nevertheless few studies have focused on planning ability in this neurodegenerative disease.

OBJECTIVES

This study aimed to investigate the formulation and the execution of plans in Alzheimer's disease using an ecological planning subtask derived from the Behavioural Assessment of the Dysexecutive Syndrome test battery, the "Zoo Map Test". There are two trials. The first trial consists of a "high demand" version of the subtask in which the subjects must plan in advance the order in which they will visit designated locations in a zoo (formulation level). In the second, or "low demand" version, the subject is simply required to follow a concrete externally imposed strategy to reach the locations to visit (execution level). The test was given to 16 patients with Alzheimer's disease and 13 normal elderly subjects.

RESULTS

The two way ANOVAs mainly showed more difficulties in patients with Alzheimer's disease than in healthy elderly in both conditions. The difference between formulation and execution was greater in patients with Alzheimer's disease than in healthy elderly. Planning impairments mainly correlated with behavioural changes (in particular motivational changes) observed by patient's relatives.

CONCLUSION

These results suggest that patients with Alzheimer's disease have some problems to mentally develop logical strategies and to execute complex predetermined plans, which are partially related to behavioural changes.

Action errors and dressing disability after stroke: An ecological approach to neuropsychological assessment and intervention

A combination of detailed observation of dressing behaviour and neuropsychological assessment was used to identify the cognitive barriers to independent dressing in a series of eight stroke patients. For those with right hemisphere damage, dressing was disrupted by visuospatial problems or poor sustained attention. Those with left hemisphere damage and ideomotor apraxia were unable to learn the correct procedure to compensate for hemiparesis when dressing. The value of a therapeutic approach based on these observations was assessed in a single-blind randomised multiple-baseline experiment. A baseline phase of conventional dressing therapy which takes no account of individual patterns of cognitive impairment was contrasted with an approach which was formulated for each case. A permutation test demonstrated that there was a significant treatment effect for the right hemisphere cases but there was no therapy-related improvement for those with left or bilateral damage and apraxia. Observation of a naturalistic but controlled task (dressing with a standard item of clothing) appears to allow greater insight into the impact of specific neuropsychological deficits than has been found for more complex naturalistic tasks. The benefits of this ecological approach over conventional approaches to dressing therapy need to be evaluated further in a randomised clinical trial.

Naturalistic action impairments in dementia

Naturalistic actions are everyday tasks (e.g. cooking) that require one to use multiple objects and sequence steps to achieve a goal. Naturalistic action impairment has been attributed to executive dysfunction [Higher cortical functions in man. New York: Basic Books, 1966], semantic knowledge degradation [Brain 111 (1988) 1173], and, more recently, general limitations in cognitive resources [Neuropsychology 12 (1998) 13]. Action impairments were explored in 51 dementia participants with the short form of the multi-level action test (MLAT-S). A clinical neuropsychological test protocol was also administered. Regression analyses including measures of executive functioning, semantic knowledge, and global cognitive functioning showed that global cognitive functioning was the best predictor of MLAT-S errors. Furthermore, task demands significantly influenced the type and frequency of errors, and dementia participants showed a pattern of errors similar to that reported in other clinical populations [Cognitive Neuropsychology 15 (1998) 617; Neuropsychologia 37 (1999) 51; Neuropsychology 12 (1998) 13]. Taken together, the present findings are inconsistent with semantic and executive accounts, but support the limited-capacity resource theory of naturalistic action impairment.