An article by Imara Hernández León, Psychologist at
When we age our body changes. The same thing happens in our brain. With the Aging changes occur in our brain structure: decreased weight, volume, atrophy in the cerebral hemispheres, increased size of the cortical sulci…
These structural changes in the brain result in disturbances in cognitive functioning. Aging is accompanied by lower performance in various cognitive functions and, depending on the impact of this brain aging on our abilities, what we call may or may not develop. cognitive decline.
Age-related brain changes do not have to mean that there is a latent neurodegenerative disease. The memory loss and other cognitive functions is a normal process associated with age, however, in some cases they are indicating an evolution towards dementia.
It is here where the importance neuropsychological assessment and the different neuroimaging tests used to distinguish between normative aging and cognitive deterioration.
Multisensory stimulation provides residents with severe cognitive impairment pleasant sensory experiences that allow you to satisfy your psychosocial needs
Diagnosis
There are various neuropsychological tests used in the diagnosis and screening of cognitive impairment. Among them are:
- Mini-Mental Cognitive Test (MMSEMini-Mental State Examination).
- Wolf Mini-Cognitive Test (MEC)
- Global Deterioration Scale (Global Deterioration Scale, GDS)
- Pfeiffer questionnaire (SPMSQShort Portable Mental Status Questionnaire)
These tests allow assess the person’s global cognitive state to establish its level of deterioration and be able to plan the appropriate intervention.
When talking about cognitive impairment, a distinction is made between mild, moderate and severe cognitive impairment.
- mild cognitive impairment
It is characterized by a memory alteration reported by the patient himself or by family members, general cognitive function is preserved and autonomy for activities of daily living is preserved.
- moderate cognitive impairment
In this phase of deterioration, a diminished memory of current and recent events is observed, deficits in the memory of their own history, in concentration, temporary and personal disorientation, difficulties in recognizing people or inability to perform complex tasks.
- severe cognitive impairment
When the deterioration is advanced, there is a progressive loss of verbal abilities, permanent assistance is needed for BADL, and basic psychomotor skills are lost. At this stage of deterioration, there is a global and significant affectation of all cognitive abilities and a great loss of functionality and autonomy.
therapeutic approach
The non-pharmacological strategies they play a fundamental role in the therapeutic approach of people with dementia or cognitive impairment. Non-pharmacological therapies seek maintain personal autonomy, delay cognitive decline and improve quality of life. These are interventions that improve the quality of life of people suffering from cognitive impairment without using drugs. From a multidisciplinary approach, they are effective in the treatment of different clinical symptoms.
There are several non-pharmacological therapies for the intervention with the population that presents cognitive impairment:
- cognitive stimulation
Cognitive stimulation represents one of the most studied non-pharmacological strategies for the treatment and prevention of cognitive impairment. It’s based on use different types of tasks to promote cognitive activity. Paper and pencil tasks, group dynamics, cognitive games, manual activities…
Within cognitive stimulation are included memory and reminiscence workshops, reality orientation therapy and all those activities that intervene on any of the higher cognitive abilities (attention, memory, language, perception, executive functions).
In those people with mild cognitive impairment, in whom there is not yet a significant functional repercussion, it serves as a preventive strategy (delay the development of dementia). In those people with moderate deterioration they promote the maintenance of those capacities conservedfacilitates the internalization of new learning and seeks to maintain autonomy for as long as possible.
However, in those people with severe cognitive impairment, whose cognitive abilities are greatly reduced, cognitive stimulation is no longer effective. This is because, despite being a therapy that must be adapted to the individual, requires minimal preservation of cognitive abilities which in patients with severe dementia may not occur. The intervention alternative for these patients is multisensory stimulation (EMS).
- multisensory stimulation
The EMS has as its main objective the stimulation of the primary senses focused on creating pleasant sensory experiences in a wellness environment. This is an intervention aimed at improving the quality of life of people by providing, in specially designed environments, the opportunity for the person to have a space and time for well-being, relaxation and contact with the environment.
Project “Awaken your senses”
Following this philosophy of intervention, the project was born in the Ballesol centers “Awaken your senses”a multisensory stimulation program (EMS) based on the Snoezelen concept that has been implemented in different centers to meet the needs of those with severe dementia.
Given the difficulty of intervention in the population with severe cognitive impairment without having specific technical means, the great alteration of their cognitive capacities and the sensory deficits typical of age, the Institutionalized people with advanced dementia are vulnerable to sensory deprivation. This lack of stimulation worsens their physical condition, decreases their social participation and their cognitive abilities.
Since this stimulation does not require higher cognitive abilities, it is suitable for people with greater cognitive impairment or with greater difficulties in their communication skills.
“Awaken your senses” seeks that people with severe cognitive impairment experience, explore, feel, perceive, internalize and identify the sensations and perceptions of one’s own body and/or external realityin order to enable a welfare state.
To achieve these objectives, the Ballesol centers that have this project underway have an EMS or Snoezelen room that allows adjust the level of stimulation and that it is composed of different sensory elements; a column of bubbles, projector, optimal fiber, mirror ball, touch panel, sensory balls, etc. These elements make it possible to create stimuli that encompass the different sensory modalities.
It is a person centered intervention. Depending on the cognitive and physical abilities of the user, an intervention and personalized objectives are established. For this, a sensory, neuropsychological, behavioral and affective assessment is carried out.
Be part of one sensory Life Story, a record of those relevant stimuli for each person, which helps the psychology department to design the individualized intervention plan for each user.
The intervention focuses on different types of stimulation:
- Somatic stimulation.
- Vibratory stimulation.
- vestibular stimulation.
- Stimulation of smell and taste.
- Auditory stimulation.
- Visual stimulation.
It intervenes in small group sessions of residents through a methodology that allows the room’s resources to be combined to stimulate different senses in the same session or use the elements individually. Sessions begin with an initial activation. It continues with the body of the session based on sensory activities and closes with an activity that promotes relaxation.
He center of sensory stimulation is the residentTherefore, during the sessions, the signs of liking/disliking of the users are observed to encourage the stimulation to generate a sensation of well-being. Throughout the sessions, the responses of the residents are monitored and recorded, adapting the intervention plan to the results obtained.
these sessions provide residents with pleasant sensory experiences, allow their psychosocial needs to be met, generating well-being and an improvement in their quality of life. It is a moment created to enjoy and experience pleasant sensations.
These multisensory stimulation programsin addition to having shown consistent results in the improvement of clinical symptoms in advanced stages of dementia are, on many occasions, the only way of stimulation that people with dementia receive advances. Therefore, they constitute an essential element in the intervention aimed at people with dementia or cognitive impairment.