Lori Letts, Jacqueline Minezes, Mary Edwards, Julie Berenyi, Kathy Moros, Colleen O’Neill, Colleen O’Toole; Effectiveness of Interventions Designed to Modify and Maintain Perceptual Abilities in People With Alzheimer’s Disease and Related Dementias. Am J Occup Ther 2011;65(5):505-513. doi: 10.5014/ajot.2011.002592.
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© 2016 American Occupational Therapy Association
An evidence-based review was undertaken to answer the question, “What is the evidence for the effect of interventions designed to modify and maintain perceptual abilities on the occupational performance of people with Alzheimer’s disease and related dementias?” A systematic search of electronic databases and application of inclusion and exclusion criteria guided the selection of 31 articles. Each article was critically appraised, and the evidence was synthesized. Some interventions use remaining perceptual abilities to enable people to find their way in a facility and decrease attempts at exiting. Preliminary evidence has supported use of visual stimulation and barriers. We found some evidence for the use of auditory stimuli and group therapy that aim to change perceptual abilities. Research with high-level evidence is required to validate these findings. Evidence on the benefits of Snoezelen® is not conclusive for occupational performance outcomes; further research to justify its use as an occupational therapy intervention may be warranted.
Light intensity or optical intervention (1 Level III, 1 Level IV)
Use of visual barriers (1 Level II, 4 Level III)
Environmental design (1 Level II, 1 Level IV)
Way-finding programs (1 Level I, 1 Level II, 3 Level IV).
Multisensory or Snoezelen® intervention (6 Level I, 2 Level III, 1 Level IV)
Sensory integration (1 Level I)
Group therapy (2 Level I, 1 Level II)
Exposure to sensory stimuli (1 Level III, 1 Level IV, 2 qualitative).
Occupational therapy practitioners should assess the environment to identify possible barriers or triggers for stress.
Occupational therapy practitioners should communicate the findings on environmental design, visual barriers, and strategies to decrease exiting behavior to caregivers and teams involved in rendering care to people with AD or related dementias.
The potential benefits of implementing music when working with people during their morning ADLs should be communicated to caregivers and staff who render such care.
Occupational therapy students need to have an understanding of the clinical manifestations of AD and related dementias, the occupational therapy interventions that are used, and the need to implement individualized care.
Skills in education and consultation are needed so that interventions can be shared with clients, caregivers, and teams rendering care to people with AD and related dementias.
The long-term benefits of engagement in occupational performance after interventions designed to modify and maintain perceptual abilities need to be examined. Examining whether people engage in functional activities once attempts at exiting have been controlled by using visual barriers or after participation in multisensory exercise programs would be useful for occupational therapy practitioners.
Further research is needed to examine how environmental cues and orientation to the environment affect social stimulation in people with dementia. Of particular interest would be whether changes in perception translate into greater participation and, inversely, whether occupational participation can influence perceptual function.
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