Tools and skills to facilitate running Cognitive Stimulation Therapy (CST) groups effectively.
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Transcript of Tools and skills to facilitate running Cognitive Stimulation Therapy (CST) groups effectively.
Tools and skills to facilitate running Cognitive Stimulation
Therapy (CST) groups effectively.
Amy Streater & Elisa Aguirre
Research Assistants & PhD students
[email protected] OC077
Conflict of Interest DisclosureAmy Streater & Elisa Aguirre, MPhil.
Has no real or apparent conflicts of interest to report.
Overview
• CST for dementia
Background CST principles / structure / sessions
• Practicalities of running CST groups
Settings Facilitation Evaluation
NICE-SCIE guidance (2006) www.nice.org.uk
People with mild/moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation programme … irrespective of any anti-dementia drug received …’
CST Background
• ‘Reality Orientation’ (RO) marked a breakthrough in
dementia care
• Criticism of RO: applied in a rote, uninspired way,
(Dietch, Hewitt and Jones, 1989), insensitive to individual
needs (Powell-Proctor & Miller, 1982)
• RO Cochrane Review (Spector et al., 2000)
CST trial (Spector et al., 2003)
•multicentre Randomised Control Trial (RCT)
•n= 201 BL / 168 FU, 23 centres
•Found a significant improvement in the primary outcome
measures: cognition and quality of life.
•No significant results were found for the secondary outcome
measures: mood (depression and anxiety) & activities of daily
living.
•CST shown to be more cost-effective than usual activities
and compared favourably with anti- dementia drugs (Knapp et
al., 2005).
Maintenance CST
• Pilot Maintenance CST (Orrell et al., 2005) found that
maintenance CST led to continuous cognitive
benefits. Whereas, CST only led to a gradual decline.
- Pilot involved 16 weekly session following CST
programme
- Piloted in 2 experimental homes, 2 control homes
• Limitations: Small sample (35), homes volunteered
• Currently a multicentre RCT of Maintenance CST is
being carried out by UCL / NELFT
Cognitive Stimulation
Cognitive Stimulation Therapy…
★ Targets cognitive and social function
★ Social element enhanced by having in a group
environment or with the family caregiver.
★ Cognitive activities do not primarily consist of
practice on specific cognitive modalities
Concepts of CST sessions
• Aim to be mentally stimulating, yet for people to feel empowered rather than de-skilled
• 45 minutes / 14 sessions
• Group name
• Theme song
• Warm-up activities
• Roles for members
• RO board
CST Key Principles
• Orientating people sensitively / when appropriate
• Information processing and opinion rather than factual
knowledge implicit learning
• Multi-sensory stimulation
• Flexibility in the activities to cater to the groups needs
• Using reminiscence (as an aid to here-and-now)
• Building / strengthening relationships
• Empowering for staff running groups
CST PilotMCST
Theme MCST
1 8 Physical games 8
2 7 Sound 7
3 1 My life 1 & 23
4 Food 3 & 17
5 2 & 3 Current affairs 2 & 21
6 15 Faces/ Scenes 15
7 11 Associated Words, discussion 18
8 Being creative 4
9 9 Categorising objects 9
10 Orientation 19
11 Using Money 20
12 5 Number game 5
13 16 Word game 16
14 6 Team games. Quiz 6
NEW Useful tips 11 & 24
NEW 12 & 13 Thinking cards 12 & 22
NEW 14 Art Discussion 14
NEW Visual Clips Discussion 13
NEW 4 & 10 Household Treasures 10
CST/MCST
Sessions
Setting up the group
• Ideally 5-8 people in groups, run by two facilitators
• Each session has choice of activities, to cater for interests and abilities of group
• Group members should ideally be at similar stages of dementia, so activities can be pitched accordingly
• Attention should be paid to gender mix
Inclusion Criteria
THIS PERSON SHOULD NOT BE INCLUDED IN THE GROUP
Diagnosis of dementia(DSM IV)
with CDR
0.5 / 2
Can s/he
have a “meaningful” conversation?
Can s/he
hear well enough to participate
in a small group discussion?
Is her/his vision goodenough tosee mostpictures?
Is s/he likely to
remain in in a
group for 45 minutes?
YES
YES
YES
YES
NO N
O NO N
O NO
THIS PERSON CAN BE
INCLUDED INTHE GROUP
YES
Preparing for the groups
• Assessment of individuals – strengths, sensitive areas, interests, literacy, etc
• Explaining nature and purpose of CST groups.
• Discussing continued assent – that people can withdraw at any time, with no negative consequences.
• Organising transport, a room, staff.
• Preparing folders for group members.
Monitoring Progress
• Keeping records of attendance, notes following all sessions
• Monitoring progress form included in the CST manual
• Outcome measures, including:★ MMSE - to measure cognitive change★ QoL-AD - to measure quality of life
• Feedback from group
• Regular supervision is essential
Future of CST
• Development and evaluation of the Maintenance CST programme.
• An evaluation and comparison of the effectiveness of two different CST training approaches and its implementation in practice.
• Individual CST (iCST)
Useful resources
• Speechmark Publisherswww.speechmark.net
• Winslow www.winslow-cat.com
• The Robert Opie Collection (reminiscence)
http://www.robertopiecollection.com
• Toy museum www.pollockstoymuseum.com
Knapp M, Thorgrimsen L, Patel A, Spector A, Hallam A, Woods B and Orrell M (2006). Cognitive Stimulation Therapy for people with dementia: Cost Effectiveness Analysis. British Journal of Psychiatry, 188:574-580.
Orrell M, Spector A, Thorgrimsen L & Woods B (2005). A pilotStudy examining the effectiveness of maintenance CognitiveStimulation Therapy (MCST) for people with dementia. International Journal of Geriatric Psychiatry, 20:446-451
Spector A, Orrell M, Davies S & Woods B (2000). A systematicReview of the use of Reality Orientation in dementia. TheGerontologist, 40 (2): 206-212.
References
Spector A, Thorgrimsen L, Woods B & Orrell M (2005). Makinga difference…An evidence-based group programme to offer cognitive stimulation therapy (CST) to people with dementia. UK: Hawker Publications.
Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth M & Orrell M (2003). Efficacy of an evidence-based Cognitive stimulation therapy programme for people with dementia: Randomised controlled trial. British Journal of Psychiatry, 183: 248-254
CST website: www.cstdementia.com
Maintenance Cognitive Stimulation Programme (ISRCTN26286067)) is part of the Support at Home - Interventions to Enhance Life in Dementia (SHIELD) project (Application No. RP-PG-0606-1083) which is funded by the NIHR Programme Grants for Applied Research funding scheme. The grantholders are Professors Orrell (UCL), Woods (Bangor), Challis (Manchester), Moniz-Cook (Hull), Russell (Swansea), Knapp (LSE) and Dr Charlesworth (UCL).
This report/article presents independent research commissioned by the NationalInstitute for Health Research (NIHR) under its Programme Grants for Applied Research sheme (RP-PG-060-1083). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Acknowledgements