Comparing Differences in ADL Outcomes for the STOMP Intervention for Dementia in the Natural Home Environment Versus a Clinic Environment

Research Article

Austin Alzheimers J Parkinsons Dis. 2014;1(1): 7.

Comparing Differences in ADL Outcomes for the STOMP Intervention for Dementia in the Natural Home Environment Versus a Clinic Environment

Ciro CA1*, Poole JL2, Skipper B3 and Hershey LA4

1Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, USA

2Department of Occupational Therapy, University of New Mexico, USA

3Department of Family and Community Medicine, University of New Mexico, USA

44Department of Neurology, University of Oklahoma Health Sciences Center, USA

*Corresponding author: Ciro CA, Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, 1200 N. Stonewall Ave, Oklahoma City, OK 73117, USA.

Received: August 26, 2014; Accepted: September 03, 2014; Published: September 04, 2014

Abstract

Background: Few studies have examined structured rehabilitation techniques for improving activities of daily living in people with mild-moderate dementia. We sought to examine the advantages to delivering the Skill-building through Task-Oriented Motor Practice (STOMP) intervention in the home environment (versus the clinic), hypothesizing that ADL improvement would be significantly better, time to meeting goals would be faster and fewer displays of behavior would be noted.

Methods: Compared results of two quasi-experimental studies of STOMP, one completed in the home, one completed previously in a clinic. Participants were English-speaking; community dwelling adults aged 50-90 diagnosed with mild-moderate dementia who could participate in an intensive rehabilitation program (5 days/week, 3 hours/day, for 2 weeks). Outcome measurements include examiner-observation of performance and proxy-report of performance and satisfaction with performance in patient-selected goals.

Results: No differences existed in the sociodemographic characteristics between the home and clinic groups where the groups were primarily white, married, had > high school education and had mild-moderate dementia. Results from the home group indicate that participants made significant improvement in ADL which was generally retained at the 90 day follow-up. These results were not significantly different than the clinic group. No significant advantages were noted for the home group in terms of time to meeting goals or exhibition of fewer behaviors.

Results: No differences existed in the sociodemographic characteristics between the home and clinic groups where the groups were primarily white, married, had > high school education and had mild-moderate dementia. Results from the home group indicate that participants made significant improvement in ADL which was generally retained at the 90 day follow-up. These results were not significantly different than the clinic group. No significant advantages were noted for the home group in terms of time to meeting goals or exhibition of fewer behaviors.

Discussion: The STOMP intervention appeared to work equally as well in the home and in the clinic. Future studies should continue to examine the benefits of massed practice using high-dose regimens.

Keywords: Dementia; Activities of daily living; Cognitive rehabilitation; Occupational therapy; Goal attainment scale

Introduction

People with Alzheimer’s disease and related dementias present with diverse cognitive and psychological deficits, yet all will report changes in how they function in daily activity [1,2]. Progressive loss in ADL is correlated with depression, anxiety and decreased quality of life for the person with dementia and increased burden for caregivers [3-5].

Despite the impact and progressive nature of ADL disability, we continue to lack standardized and effective treatments f or reversing ADL disability and delaying decline as the disease progresses [6,7]. New drug research is promising, but current drugs available to patients address short-term symptoms without modifying brain pathologies that cause ADL disability [8-10]. Previous behavioral research has focused on improving cognitive skills such as memory with little evidence of improvement in ADL [11]. Emerging research has broadened the focus to minimizing ADL disability through various forms of task-oriented training where individualized; therapy goals are practiced using the very tasks that people want to improve [6,12,13]. Results have indicated that people with mild dementia can improve in ADL performance, but transfer of the skill to and spontaneous initiation of the task within the natural environment is limited and few long term results are available [6,12].

We developed the Skill-building through Task-Oriented Motor Practice (STOMP) intervention to standardize the evaluation and delivery of task-oriented training for people with mildmoderate dementia using rehabilitation methods known to induce neuroplasticity in other progressive and non-progressive neurological populations [14,15]. Through our adaptation of the learned non-use phenomena as shown in Figure 1, we hypothesize that early disability in ADL is a negative behavioral response to errors in ADL performance and caregivers taking over tasks when only minimal supports may be needed to complete the tasks [16-18]. In people post-stroke, this phenomena is reversed by engaging the person in high-dose, taskoriented training which is shown to cause permanent change in neural circuits by creating new neural pathways and by-passing non-functioning circuits [15,19,20]. Through the power of neuroplasticity, we hypothesize that we can improve ADL performance and delay decline despite the progressive nature of dementia.