Lead From Where You Stand

Transcription

1 Lead From Where You Stand EXTRA Research Project: Reducing Antipsychotic Medications

2 Module 3:The Brain and Behavior

3 The Brain To expect a personality to survive the disintegration of the brain is like expecting a cricket club to survive when all of its members are dead. Bertrand Russell ( ) The brain: an approximately 3 lb. (1.4 kg.) mass of jelly-like fats and tissues the crown jewel of the human body

4 The Brain

5 The Brain Brain stem controls the body s vital functions eg. respirations, blood pressure, heart rate ( fight or flight ) Cerebellum (a wrinkled ball of tissue) helps control voluntary movement and balance functions eg. co-ordinates the many muscles used for speech (chest, mouth, throat and tongue) plays an important role in speed of information processing, planning, memory, etc. is responsible for learned movements eg. playing the piano

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7 Limbic System a walnut sized area located deep within the centre of the brain which has many functions: determines our emotional state damage can cause emotions that are extreme and change rapidly or you may see flat affect stores strong emotional memories connects the parts of the brain that affect behaviour and memory processes the sense of smell, controls sleep cycles and appetite, thirst, body temperature transfers short term memory to long term memory often affected early in Alzheimer s Disease

8 Cerebrum

9 Cerebrum the largest and most developed part of the brain divided into 2 hemispheres the 2 hemispheres look the same but function differently speaking very generally, the left hemisphere is the logical side (language and math) and the right is the creative side (abstract thoughts and spatial information) the two hemispheres can be further divided into four lobes

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11 Frontal Lobe Frontal Lobe at the front of the brain, directly behind the forehead responsible for the processing of complex information: the ability to form words and speak ability to plan complex movements

12 Frontal Lobe responsible for regulating behaviour helps us monitor, control and inhibit our behaviours (your mother ) responsible for social judgment and insight helps us interpret others feelings keeps us on track, and not easily distracted houses your personality not fully developed until age 25

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14 Parietal Lobe the top of the back part of the brain generally speaking controls movement, sensation of pain, touch, taste responsible for using words correctly, understanding numbers contains our 3D centre helps us locate objects in space eg. picking up a cup, getting dressed helps us find our way damage results in inability to recognize objects, faces and/or surroundings

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16 Occipital Lobe located at the back of the brain interprets the information your eyes send to the brain involved in the process of perception -processes information on colour, shape and movement, then forwards this information on to the parietal lobe, which combines it into a 3D picture

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18 Temporal Lobe at the sides of the brain deals primarily with memory functions eg. controls new learning and Short Term Memory responsible for: remembering words, faces, scenes smell and hearing works with the parietal lobe, in particular, to process language comprehension

19 The Brain In P.I.E.C.E.S. dementia care education we talk about: Instinctual brain: brain stem and cerebellum Emotional brain: limbic system Thinking brain: cerebrum(2 hemispheres, 4 lobes) frontal lobe, parietal lobe, occipital lobe, temporal lobe

20 The Brain we experience the world through all 3 levels of the brain different dementias tend to affect different parts of the brain you may see different behaviours that are very characteristic of a particular dementia, and/or behaviours that are common to the different dementias

21 The Brain in dementias, as the thinking brain becomes more impaired, behaviour becomes more determined by the instinctual and emotional parts of the brain -become more focused on survival -territoriality - Fight or Flight -foraging, rummaging, hoarding -Eg. parking lot

22 The Brain Normal Brain Brain with dementia

23 The Seven A s In P.I.E.C.E.S. dementia care education we use the Seven A s to help us understand the impact of dementia on the brain: Amnesia Aphasia Agnosia Apraxia Anosognosia Apathy Altered perception

24 Amnesia Amnesia loss of memory Area of brain affected: temporal and limbic think of memory as an onion memory is lost in reverse first in last out the memories most likely to be retained are those that are significant on an emotional level the mountain top experiences that brought great joy/pride, and the traumatic experiences such as war think of a pleasant memory

25 Amnesia frequently these are the memories laid down between 3 and 30 years of age a person with dementia does not live in the past, they live in the moment their only access to information may be years back we need to understand what those memories are, and enter into the person s reality Their reality is not our reality.

26 Amnesia as dementia progresses, the person will lose access to recent memories (loss of Short Term Memory - STM) but tend to retain remote memories (Long Term Memory -LTM) loss of STM makes learning much more difficult, but not impossible consider the importance of repetition and memory trails loss of STM may work to our advantage sometimes example of HCA giving a bath

27 Amnesia Changes in behaviour may include: becoming easily overwhelmed forgetting what they have been told accusing others of stealing refusing assistance with care accusing family of not visiting repetitive questioning, comments and/or behaviour memory of past events triggered by present stimulus uncooperative with previous requests

28 Amnesia Supportive Care Strategies: routine (their routine not ours) know their life history reassure avoid testing or arguing use distraction live in the moment with the resident

29 Aphasia Aphasia -loss of language Area of brain affected: mainly frontal and temporal depending on the type of dementia, the effects of a stroke, etc. and the part of the brain which is affected, speech (expressive language)and/or comprehension (receptive language)may be affected as language difficulties increase, individuals with dementia become more dependent on body language

30 Aphasia Changes in behaviour when speech is affected may include: substituting words using word salad reverting to another language

31 Aphasia Changes in behaviour when comprehension is affected may include: difficulty sorting out what was said becoming anxious, frustrated, angry when unable to find words and convey needs withdrawing socially becoming frustrated when trying to keep track of who to listen to if more than one person is speaking

32 Aphasia Supportive Care Strategies: non-verbal communication be aware of your body language, tone of voice maintain eye-contact allow time to respond don t assume they can report needs choose your words wisely avoid starting sentences with negative words

33 Agnosia Agnosia -loss of recognition Area of brain affected: temporal and parietal the person loses the ability to recognize faces, objects, places, sounds may identify another person as their spouse may become very upset when viewing themselves in a mirror loss of recognition of people can be very stressful for loved ones loss of recognition of objects may become a safety issue

34 Agnosia Supportive Care Strategies: introduce yourself each time cuing (with patience) use pictures cover mirrors

35 Apraxia Apraxia -loss of purposeful movement Area of brain affected: frontal, parietal and temporal unable to plan, sequence and carry out tasks lose the ability to initiate a particular motion or to know what step comes next may progress to difficulty remembering how to do basic ADL s and eventually may need help with all care last in, first out Eg. rotary dial phone vs. touch-tone

36 Apraxia Changes in behaviour may include: frustration and responsive behaviours if tasks are too difficult or exceed resident s capabilities distress because they can t remember how to do a task staff may interpret inability as refusal

37 Apraxia Supportive Care Strategies: cue for tasks break tasks down into small steps watch yourself for outpacing allow time avoid labeling the person as non-compliant

38 Anosognosia Anosognosia = no knowledge of their illness/disease a = no nosos = illness/disease gnosia = knowledge of Area of brain affected: frontal anosognosia increases the difficulty of caring for residents with amnesia, aphasia, agnosia and apraxia

39 Anosognosia impaired insight often leads to responsive behaviours such as resistiveness, agitation, striking out, irritability, etc. the individual is acting on what the brain is telling him/her is true confronting the individual DOES NOT work their reality is not our reality aggressive behaviour is really defensive behaviour

40 Anosognosia Changes in behaviour may include: being unaware of their surroundings and accessing a reality from their past eg. thinking they must go home to look after their children resistive to care attempting ADL s eg. self-transfers, going to bathroom on own when they really can t manage

41 Anosognosia Supportive Care Strategies: know the person use distraction avoid scolding or arguing understand they are not choosing their behaviour help others understand this

42 Apathy Apathy: loss of initiation Area of brain affected: frontal has lost the ability to initiate activities, but will still engage if someone else initiates the activity for them sometimes mistaken for depression but the person with depression will not participate even if someone else tries to engage him/her

43 Apathy Changes in behaviour may include: may sit in front of food but not get started until caregiver gets them started may sit in silence, but will respond, try to make eye contact and smile when someone else initiates contact may refuse to go to an activity when asked, but participates when someone takes them

44 Apathy Supportive Care Strategies: offer stimulating activities cue for activities eg. eating attempt to engage don t give up!

45 Altered Perception Altered perception: change in (depth) perception Area of brain affected: parietal affects 3D perception in particular

46 Altered Perception Changes in Behaviour may include: fear e.g. depth of water in tub looks greater than it is shiny floors may be perceived as a body of water may see a pole, chair, etc. as a person may miss a chair when sitting down focus on what is directly in front of them, so walks looking either down or straight ahead always bumping into objects, other people dark carpets/tiles may look like large holes in the floor people on TV appear real

47 Altered Perception Supportive Care strategies: increased lighting evaluate floor coverings coloured towel at bottom of tub

48 In Summary damage to the brain is irreversible and increases as the dementia progresses the behaviours we see are influenced by the location of the damage to the brain there is no quick fix when managing responsive behaviours your assessment is critical in knowing the whole person remember that behaviour is an attempt at communication all behaviour has meaning! remember the person is trying very hard to make sense of the world try and understand the reality of the individual live in the moment with them

49 Long term care isn t rocket science -it s harder Long term care workers are the angels of this world. Listen with the Ears of Your Heart D. Seman

50 QUESTIONS