*
For the Dementia Patient
*Leslie Austin-Chance, M.S., CCC-SLP
*SLP for 7 years
*Signature Rehab Operations
*Amie Cooke, M.A., CCC-SLP
*SLP for 5 years
*Director of Clinical Rehab
*
3 Pillars
73 Facilities
Learning,
Intrapreneurship,
Spirituality
Deliver innovative, evidence-based and
radical rehabilitative services through
specialized segments.
Innovation
*
Evidence-based
research
* SLPs asked for iPads
* Need to determine efficacy before expense
* Researched iPad use in therapy
* Pediatrics
* Stroke/TBI
* Very little on Dementia
*
*
* 78% of residents in nursing homes in U.S. have diagnoses of
dementia
* 14 million of the 79 million baby boomers are expected to
develop a form of dementia
* According to Mahendra, et al, PWD can and most definitely do
learn and retain new information and skills.
* information is generalized to procedures and situations outside of
training sessions.
* 3 different studies suggest that PWD (mild-moderate) can utilize
computer-assisted cognitive interventions and show improvements
in specific cognitive tasks using a computer.
*
* Portable, light
* User friendly
* Touch screen
* Bright
* Quick Response time
* Operates without accessories
* No viruses
* Millions of Apps
*
*Goal 1: To investigate the feasibility of using iPad
applications for cognitive therapy for PWD
*Goal 2: To document the outcomes on cognitive linguistic
ability by using iPad applications with PWD pre and post
therapy ABCD scores
*Goal 3: To investigate the efficacy of using iPad
applications to improve GDS/BCRS scores
*
4 SLPs
30 days
4 SNFs
11
Patients
5 times/wk
30-45 min
sessions
*
* Arizona Battery for Communication Disorders of
Dementia (ABCD)
* Used due to 18 subtests, 5 constructs
* Allowed for raw score comparison in each subtest
area
* Used to guide choice of iPad apps
* Global Deterioration Scale (GDS)/ Brief
Cognitive Rating Scale (BCRS)
* Used to determine the cognitive stage of each
study participant
*
*Candidate Selection
*Must have a dx of dementia
*Score as a stage 5 or less on the
GDS/BCRS
*No significant vision or hearing
impairment
*Only iPad can be used for tx
*
*iPad Application Selection
*Started with a list of approximately
20 apps
*Classified according to ABCD subtest
*SLPs added to list as appropriate
*Itune downloads
*Free to $4.99
*
*iPad applications
*Showcase of our favorite apps
*Refer to hand-out
Sketchy Memory
Memory Match
Chicktionary
*
* 84 year old female
* High school educated
* Occupations: Cook
* Prior level: lived with family
* Admitted due to recent falls and short term
memory loss
* No prior computer experience
*
*
ABCD pre-test
vs. post-test
GDS/BCRS pre-test
vs. post-test
57
49
4
Mild
Dementia
*
3
Mild cognitive
impairment
Improvement in the following subtests:
*Mental status
*Story retelling*
*Following
* Recognition
* Repetition
* Object Description
* Generative Naming
* Confrontation naming
* Concept definition
commands
*Comparative
Questions
*Word Learning total
recall*
*Both in Episodic
Memory Construct
*
*Apps used
* Favorite apps were:
* Chicktionary
* Flashcards
* Memory Match
* Word Search
* Puzzles
* Upon discharge she was alert & oriented x4
* Appropriate with all conversation
* Continued to return to therapy daily to use iPad
*
* 76 year old female
* LTC resident
* No high school diploma
* Independent in mobility
* Complaints of new onset cognitive deficits
*
*Case Study #2
ABCD pre-test
vs. post-test raw
scores
45
GDS/BCRS pre-test
vs. post-test
4.8
56
4
Mild dementia
Mild-Mod
dementia
*
Improvement in the following subtests:
*Mental status*
*Story retelling
*Following
*Repetition*
*Object Description
*Generative Naming
commands
*Word Learningrecognition
*Episodic Memory &
Comprehension
Contructs
*
*Apps used
* Favorite apps were:
* Calendar
* Magazine apps
* Sketchy Memory
* Solitaire
* Flashcards
* Memory Match
* Puzzles
* Upon discharge she was alert & oriented x4
* Appropriate with all conversation
* Continued to work with iPad during physical and
occupation therapy endurance tasks
*
* 70 year old male
* Referral secondary to increased confusion &
memory deficits
* Hx of depression & psychiatric behaviors
* Often refuses care
* High school education level
* Independent in mobility
*
*
ABCD pre-test
vs. post-test raw
scores
54
GDS/BCRS pre-test
vs. post-test
3.8
63
Mild cognitive
decline
*
3.2
Mild cognitive
decline
Improvement in the following subtests:
*Reading
*Following
comprehension
(sentence level)
commands
*Word Learningrecognition
*Generative Naming
*Expression &
Comprehension
Contructs
*
*Apps used
*Favorite apps were:
* Number recall
* Sketchy Memory
* Improve your memory
* Moron test
* Memory Match
* Puzzles
*Noted decrease in psychiatric behaviors
*
ABCD pre-test
vs. post-test raw
score average
GDS/BCRS pre-test
vs. post-test
40.4
4.5
Mild-Moderate
Dementia
*
53.7
3.84
Mild Dementia
*
* Portable
* User-friendly
* Innovative
* One stop shop
* Adjustable print size
* Same skills as tradition tx
* Therapist and patient
engagement
* Save $ on materials
* Free Apps
* Ease of access and
decreased prep
* Need Wi-fi for some apps
* Power/charging
* Some elderly adverse to
tech
* Learning curve
* Elders need assistance with
* Size of print in some apps
* Cost
*
*Apps created specifically for dementia
*Study on specific App correlation to
specific stages/impairments
*Larger sample size/longer time frame
*Gender/age/ethnicity/education level
*Statistical analysis
*Other standardized tests
*What does the future
hold?
Ipad Cost
* CPT 92507= $82.22 per visit
* $499 / $82.22= 6 treatments
* CPT 92507= $82.22 per visit
* $899 / $82.22= 10
* CPT 97532= $75.42 (3 units)
* $499 / $75.42= 7 treatments
* CPT 97532= $75.42
* $829 / $75.42= 11 treatments
*
Cost
Benefit
* Our study proves that the iPad is an effective
modality in treating cognitive-linguistic
impairments associated with dementia
* The benefits of using iPads as a treatment
modality outweigh the cost
* The iPad can be used as an interdisciplinary
approach
*
*Leslie Austin-Chance, M.S., CCC-SLP
* 561-312-7037
* [email protected]
*Amie Cooke, M.A., CCC-SLP
* 615-934-3584
* [email protected]
*