Speech-language interventions in Alzheimer's disease. A functional communication approach.

Clinics in communication disorders Pub Date : 1993-01-01
J K Glickstein, G K Neustadt
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Abstract

Alzheimer's disease is a progressive degenerative neurogenic disease that is more prevalent among the old than the young. The primary symptoms are forgetfulness, repetitiousness, losing one's way, and the loss of ability to perform complex tasks on the job. Diagnostic confirmation of Alzheimer's disease is determined by autopsy. As of this writing, there is no specific drug that can stop or reverse the disease. Medical management is focused on treating behavioral symptoms and managing the individual's general well-being. The communication needs of the Alzheimer's client depend on the individual's level of cognition, degree of independence, circumstance, and communicative abilities. Due to their poor rehabilitation potential, the majority of persons with Alzheimer's disease are not suitable candidates for traditional therapy programs. An alternative to traditional therapies is the Tri-Model system. The Tri-Model philosophy of rehabilitation and service delivery systems (Glickstein and Neustadt, 1992) lends itself readily to the needs of the dementia client because the model is designed to maintain the continuum of rehabilitation care for individuals with "red flag" diagnoses such as dementia. Establishing a treatment protocol based on the Tri-Model philosophy of rehabilitation not only assures the individual treatment based on his or her level of functional ability and rehabilitation need, it provides a framework for the rehabilitation specialist to use as reference for the various stages of disability and change during rehabilitation. The Tri-Model System is a decision tree which allows movement in any direction according to the client's needs (Figure 1). Clients, staff, and families are encouraged to set realistic goals at the outset of the rehabilitation program. By delineating three overlapping phases in the recovery process a base is established which allows the rehabilitation professional to appropriately follow the client after discharge and maintain the continuum of care. Since each restorative phase in the system requires the design of restorative programs which address that particular phase of the rehabilitation process and cooperation of an interdisciplinary team, addressing all three phases of rehabilitation at the time of the initial evaluation maintains the continuity of the client's treatment protocol throughout the course of the disease. Inclusion of Restorative III (functional maintenance) assures the continuum of care. The strength of the Tri-Model philosophy and system of rehabilitation is the inclusion of the definition and delineation of functional maintenance, the most neglected and for many clients the most important part of a complete rehabilitation program. When an incomplete definition of rehabilitation is used, questions regarding the efficacy of treatment is common.(ABSTRACT TRUNCATED AT 400 WORDS)

阿尔茨海默病的语言干预。一种功能性沟通方法。
阿尔茨海默病是一种进行性退行性神经源性疾病,在老年人中比年轻人更普遍。其主要症状是健忘、重复、迷失方向,以及丧失完成工作中复杂任务的能力。阿尔茨海默病的诊断确认是通过尸检确定的。在撰写本文时,还没有特定的药物可以阻止或逆转这种疾病。医疗管理的重点是治疗行为症状和管理个人的整体健康。阿尔茨海默病患者的沟通需求取决于个人的认知水平、独立程度、环境和沟通能力。由于他们的康复潜力很差,大多数阿尔茨海默病患者不适合传统的治疗方案。传统疗法的另一种选择是三模型系统。康复和服务提供系统的三模型哲学(Glickstein和Neustadt, 1992)很容易满足痴呆症患者的需求,因为该模型旨在为患有“危险信号”诊断(如痴呆症)的个体维持连续的康复护理。建立基于三模型康复哲学的治疗方案,不仅保证了个体根据其功能能力水平和康复需求进行个体化治疗,而且为康复专家提供了一个框架,作为康复过程中残疾的各个阶段和变化的参考。三模型系统是一个决策树,允许根据客户的需求向任何方向移动(图1)。鼓励客户,员工和家庭在康复计划开始时设定现实的目标。通过描述康复过程中的三个重叠阶段,建立了一个基础,使康复专业人员能够在出院后适当地跟踪客户并保持连续的护理。由于系统中的每个恢复阶段都需要设计针对康复过程中特定阶段的恢复方案和跨学科团队的合作,因此在初始评估时解决所有三个康复阶段的问题可以保持客户治疗方案在整个疾病过程中的连续性。包括恢复性III(功能维持)确保护理的连续性。三模型康复哲学和系统的优势在于包含了功能维护的定义和描述,这是最容易被忽视的,但对许多客户来说,这是完整康复计划中最重要的部分。当使用不完整的康复定义时,关于治疗效果的问题是常见的。(摘要删节为400字)
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