Occupational Therapy facilitates the function of motor and cognitive skills which are often affected by those with LBD. Activities include developing a common language with care. OT can help with hand-eye coordination, upper extremity functioning and stretching, visuo-spatial functioning, cognitive functioning, parkinsonian symptoms , simplifying words and commands to develop a common language, dressing, bathing, getting out of bed, drumming, rhythm.
Occupational therapy, provided on an outpatient basis, is used to help a patient learn how to safely manage activities of daily life (usually while recovering from an illness, injury, or procedure). Medicare Part B covers a limited amount of occupational therapy, provided on an outpatient basis in a doctor’s or therapist’s office, rehabilitation facility, clinic, hospital outpatient department, or patient’s home. The therapy must be prescribed and regularly reviewed by a doctor, and it must be provided by a Medicare-certified therapist. https://www.caring.com/medicare_information/medicare-coverage-of-occupational-therapy
Medicare Part A or Part B also covers occupational therapy as part of comprehensive in-home care provided by a Medicare-approved home healthcare agency.
Occupational therapy practitioners, through their expertise in activity analysis and handiwork with older people in various settings, address dementia–and particularly Lewy Body Dementia which has Parkinsonian elements–as a condition that affects occupational performance. These practitioners educate family members, concerned friends and those in the early stages of the disease about dementia and its functional implications. Occupational therapists evaluate a person with dementia to determine their strengths, impairments and performance areas needing intervention. The person may demonstrate improved function through adaptation and compensation. They also assist care providers in coping with the difficult role.
Practitioners can assist those with LBD to live in their own homes safely for as long as possible through environmental evaluation and adaptation. They also often provide wellness programs, exercises for motor skills and cognition, fall prevention and caregiver educational sessions . They help patients whether in long term care, assisted living facilities, or those living at home retain existing function for as long as possible. Throughout care, occupational therapy practitioners work both as direct care providers and as consultants.
Occupational therapy interventions for those with dementia involve various approaches based on the Occupational Therapy Practice Framework: Domain and Process (2nd ed., AOTA, 2008). These approaches include:
- Health Promotion. By focusing on maintained strengths of clients and promoting wellness of care providers, practitioners can enrich their lives by promoting maximal performance in preferred activities.
- Remediation. Although the remediation of cognitive skills is not expected, restoration of physical skills (range of motion, strength, and endurance) may still take place even with the backdrop of dementia.
- Maintenance. Practitioners can determine what is working well in the daily routine of the person with dementia, and provide supports to ensure that the person’s skills are maintained for as long as possible.
- Modification. This is perhaps the most frequently used intervention for those with dementia, as it ensures safe and supportive environments through adaptation and compensation.
Problematic Behavior – Potential Occupational Therapy & Team Intervention
Person forgets what season it is when choosing clothing: Helping the care provider set up limited clothing selection to fit the season, while still addressing client control and self-efficacy.
Person forgets how to dress: Helping the patient and care provider select clothing that is easy to put on and teaches both a systematized and easy mode of dressing.
Person forgets how to eat: Helps the person and caregiver develop a way of eating with code prompts to help make the eating process easier.
Person forgets where their essential belongings are: Helps with labeling drawers, cupboards and and establishing an awareness about locations within the home.
Person gets disoriented and wanders: Setting up the environment to enhance daily activity, including mobility within safe confines, and using technology to ensure safety. For example, a fenced courtyard with stop signs at the gates could be all that is needed to keep the person oriented to his or her own yard.
Personality changes: Teaching care providers the concepts of caring, non-defensive responding and orienting techniques, and working on determining the underlying emotion that may have precipitated the client’s behavioral outbursts.
Repetitive non-productive behavior: Providing opportunities for engaging in occupational tasks that fulfill the person’s need to be productive and help support relationships with others. For example if the person once enjoyed crossword puzzles, perhaps simplified puzzles or word searches would still be enjoyable.