Ron To continue - What is your personal goal in this? Mine would be to help staff understand the behaviours (usually defensive in nature when a threat is sensed at this very low cognitive level) and modify their own behaviour to avoid the triggers for catastrophic reactions. The questions I posed are to tease out those triggers if they exist. Key is to find out if there are times or staff when the problems do not happen. Tracking occurrences can help especially as the patient is new to the facility. This would be my initial tx plan. There is no way to 'get' the patient to stop by using reason. Her current occupation is to protect herself at all costs against all comers. She doesn't know where she is or why she is there and she is incapable of understading an explanation. I suspect there is nothing familiar to her. Does anyone know Spanish nursery rhymes? I'm not kidding!
Joan Riches B.Sc.O.T., OT(C) Specialist in Cognitive Disability Riches Consulting High River, Alberta, Canada 403 652 7928 -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of Ron Carson Sent: December 13, 2008 6:06 PM To: Joan Riches Subject: Re: [OTlist] Help with Treatment Plan??? Thanks Joan. Interesting reference and something worth considering for my NEXT patient. Unfortunately, I need "help" NOW!! <smile> Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Joan Riches <[email protected]> Sent: Saturday, December 13, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Help with Treatment Plan??? JR> Hi Ron JR> The thing is you can make a big difference for this lady and for the JR> staff who work with her. The ACLS screening tool does not go as low as JR> she seems to be and all these questions help to identify her level in JR> order to create an effective plan for staff. One final one is Does she JR> pick up and manipulate objects other than for eating? JR> The reference that I have found most useful in all cases of problematic JR> behaviour is JR> A Cognitive Link: Managing Problematic Bodily Behavior by Delaune JR> Pollard JR> Available from Selectone Rehab www.selectonerehab.com and from S&S. I JR> wrote the foreword for this so I am understandably biased but for JR> practical understandable help I don't think it can be beaten. JR> Joan Riches B.Sc.O.T., OT(C) JR> Specialist in Cognitive Disability JR> Riches Consulting JR> High River, Alberta, Canada JR> 403 652 7928 JR> JR> -----Original Message----- JR> From: [email protected] [mailto:[email protected]] On JR> Behalf Of Ron Carson JR> Sent: December 13, 2008 5:20 PM JR> To: Joan Riches JR> Subject: Re: [OTlist] Help with Treatment Plan??? JR> Wow Joan, that's a lot of questions. <smile> Truth be known, I only JR> spent about 45 minutes with this patient and she was new at the ALF. JR> There just isn't much information to go on which is a big part of my JR> problem. Maybe I need to go back before I generate a treatment JR> plan??? JR> CGA- Min A is: contact guard assist and minimum assist. JR> Ron JR> -- JR> Ron Carson MHS, OT JR> ----- Original Message ----- JR> From: Joan Riches <[email protected]> JR> Sent: Saturday, December 13, 2008 JR> To: [email protected] <[email protected]> JR> Subj: [OTlist] Help with Treatment Plan??? JR>> Ron JR>> This can be a tough one. JR>> What is CGA - Min A? JR>> To start with you can assess her gathering all the information you JR> can. JR>> What does independent in eating mean - does she use cutlery? What JR> type JR>> of diet is she on? Is all her food in bite size pieces that do not JR> need JR>> to be cut? Does she eat her food without needing to be cued? JR>> Is her speech in Spanish any more complex than her speech in JR> English? JR>> Does she grab people and things and 'refuse' to let go? JR>> Has she been 'taken down' due to combative behaviour? JR>> If not, how is she being managed? JR>> Are there any staff members with whom she is not combative? JR>> At what points in the day or during what activities is she JR> combative? JR>> Are there complaints that she has voided urine in inappropriate JR>> containers? JR>> Is she being restrained? JR>> What are the characteristics of her combative behaviour? Does she JR> punch, JR>> kick, bite, spit etc. Is there a consistent pattern? JR>> Might the attitude and caution with which she is approached be JR> perceived JR>> by her as threatening? JR>> Under what circumstances is she settled and content? JR>> Is her behaviour both negative and positive being tracked and JR> charted? JR>> I suspect she is somewhere in Allen cognitive level 2 with cognitive JR>> ability analogous to 9 - 23 months, probably nearer to the top of JR> that JR>> range. JR>> Joan Riches B.Sc.O.T., OT(C) JR>> Specialist in Cognitive Disability JR>> Riches Consulting JR>> High River, Alberta, Canada JR>> 403 652 7928 JR>> JR>> -----Original Message----- JR>> From: [email protected] [mailto:[email protected]] On JR>> Behalf Of Ron Carson JR>> Sent: December 12, 2008 6:06 PM JR>> To: [email protected] JR>> Subject: [OTlist] Help with Treatment Plan??? JR>> Evaled a new patient who was just transferred to an Alzheimer's JR> ALF. JR>> The patient spoke primarily in Spanish but also in some English. JR> She JR>> was very non-cooperative and was physically combative with ALF JR> staff JR>> and myself. JR>> The staff says she is dependent for all ADL's except eating and JR> that JR>> she ambulates with CGA - Min A. JR>> What can I do with this patient? JR>> Ron JR> -- JR> Options? JR> www.otnow.com/mailman/options/otlist_otnow.com JR> Archive? JR> www.mail-archive.com/[email protected] JR> No virus found in this incoming message. JR> Checked by AVG - http://www.avg.com JR> Version: 8.0.176 / Virus Database: 270.9.17/1846 - Release Date: JR> 12/12/2008 6:59 PM JR> -- JR> Options? JR> www.otnow.com/mailman/options/otlist_otnow.com JR> Archive? JR> www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] No virus found in this incoming message. Checked by AVG - http://www.avg.com Version: 8.0.176 / Virus Database: 270.9.17/1846 - Release Date: 12/12/2008 6:59 PM -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
