head, hands, heart tutorial for therapists homecare rehab and nursing llc
TRANSCRIPT
Head, Hands, Heart Tutorial for Therapists
HomeCare Rehab
and Nursing LLC
What is Head, Hands, Heart?
• A simplified approach to working with patients with dementia:
Early (Head)
Middle (Hands)
Late/End (Heart)
How is the level determined?
• Many dementia assessments can be used including:
• Allen Cognitive Level Screen• Global Deterioration Scale• Brief Cognitive Rating Scale• Routine Task Inventory
• The score is then valued as either early, middle, or late/end stage dementia.
Why do I need to know the level of dementia?
• The treatment plan, goals, and outcomes will be influenced by what specific skills the patient still has.
• It is immeasurably valuable to have a level established for care of the patient for comparison as the dementia progresses- interventions and approaches will need periodic revision.
What is the Head?
• “HEAD” = thinking• Early Stage Dementia• Goal-directed in
function and may have some limited ability for new learning
HEAD– Loss of inhibitions (frontal lobe).– Unable to self-monitor.– No insight into deficits (nothing is wrong with
them)…problem is with the world.– Loss of independence and dignity, loss of role
in life.– Words are the best fighting tool they have.– Memory issues frustrate caregivers.
HEAD• Cognitive
skills/Communication: • Understands beginning, middle,
and end of an activity.• Can seek help but may not
remember emergency procedures.• Rigid, likes routine.• Self-centered communication,
confabulates, high verbal output.• Recognizes highly visible striking
cues in the environment.• Limited reading comprehension.• New learning possible with
maximum repetition if highly valued.
• Believe that nothing is wrong with them.
Well, maybe you say it’s wrong but that’s just the way I like it.
My way is the best way.
HEADPrecautions:• Unable to understand
precautions, complications, hazards.
• Written language is not reliable.
• Signs are not really effective.
HEADIf you tell me to go brush my teeth I will stay on task.
I just may forget to use toothpaste or rinse out my mouth.
• Feeding:• May eat too fast or too
slow.• Annoyed with others
eating near them.• Complains about food.
• Grooming:• May neglect unseen
surfaces (back of head).• Sequencing errors.
HEADDressing/Bathing:• Performs familiar self care
with decreased attention to unseen surfaces.
• Follows routine.• Remembers what they
are doing throughout task.• Clothing selection may be
based on striking features (brightest shirt in the closet).
• Quality may not be good.
I am really drawn to bold, striking visual input.Did you ever notice that I choose bright clothing and wear too much make-up?
HEADToileting:• May neglect parts of
the task.• May require verbal
reminders to initiate task.
• Completes the task although quality may not be good.
This is a huge loss of dignity for me- and a very overwhelming
task at times.
HEADFunctional Mobility:• Able to navigate using
familiar landmarks.• Transfer skills depend on
familiarity of environment.• Carries walker if
distracted, but will correct with cues.
• Notices barriers above and below knee.
• Trunk becoming more rigid.
I can remember new things with tons of patience and practice!
HANDS• “HANDS”= reaching,
grabbing, holding objects• Level 3 of the Allen
Cognitive Scale• Middle Stage Dementia• Medicare “Mod Assist”• Not goal directed, cannot
be expected to complete a task without assistance
Copyright © 2002
HANDS• Behaviors:• Pacing, repetitive actions• Agitated, worried,
trembling hands• Unpredictable with social
interactions• Confused, acts randomly
Have you seen my mother?
Has anyone
seenmy
mother?
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HANDS• Cognitive skills/
communication:• Able to name objects• Decreased sense of task
completion• Needs verbal cues to
sequence steps of an activity
• Responds best to demonstrated instructions
• Word finding problems• Loses the thread of a story• Jargons, incoherent
sentences
I have to get out of here. I’m late for work and the train is on that
other thing over the @#%*! out
that window day @#%*! right here
in Chantilly.
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HANDS• Precautions:• At risk for falls• Unable to understand
precautions, complications, or hazards
• Does not recognize need for help
• At risk for accidents- poison, sharp objects, elopement
I love to use my
hands...and touch
everything! I tend to get into things I
shouldn’t and carry them around with
me.
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HANDS• Self-care skills:• May initiate action with
familiar object- but not sustain to completion
• Resistant to care• Layers clothes until all
items used up, unable to orient clothing or sequence task
• Needs supervision or assistance with toileting
I am sometimes very resistant to care.
Don’t you sneak up on me or just might
get slugged!
Copyright © 2002
HANDS• Feeding:• May reach for food from
other place settings or centerpiece
• Unable to complete meal without redirection and set-up
• Plays with food and utensils
You may notice that I play with my food or grab
other’s food from their plates. I’m
easily distracted and
overstimulated.
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HEART• “HEART” = feeling, living • Level 1 and 2 of the
Allen Cognitive Scale.• Late and End Stage
Dementia• Medicare “Max Assist/
Dependent”• Respond to internal and
external stimuli through any of the five senses
Copyright © 2002
HEARTEnd Stage:• Mostly bedbound• Can move limbs and
head• Total assistance for
self care and mobility.
Late Stage:• Can overcome gravity• Can sit, stand and/or
walk (mobility)• Have a sense of
balance, although not good
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HEARTPrecautions:• Contractures• Skin Breakdown• Falls• Aspiration
Because I can’t move or communicate well, I’m really at risk for contractures, falls,
and skin breakdown. YOU can prevent this from happening
to me!
Copyright © 2002
HEARTCognitive Skills/
Communication:• Speech mostly
unintelligible, mumbles incoherently
• Unable to follow most verbal commands
• Poor attention span, distracted by moving objects
A funny trick I know:I may only be able to say
one or two words, but I can sing a whole song without
any errors.
Copyright © 2002
HEARTFeeding:• May be able to feed
self with limited or extensive assistance
• More successful with finger foods
• Can sip from a cup held to lips until very end stages- don’t introduce a straw too early!
I can only see things less than 12 inches from
my face. Bring the world to
me!
Copyright © 2002
HEARTDressing/Bathing/
Grooming:• Has no idea what to
do with objects• Assists caregivers by
holding positions, moving limbs, and standing
I have a major fear of falling. I may resist, hit, or kick but it’s only to protect myself from injury. I’m not just
being difficult.
Copyright © 2002
HEARTToileting:• Needs assistance with
managing clothing, perineal hygiene, and positioning on toilet
• Frequently incontinent• Inappropriate toileting
locations- sometimes the same place over and over.
• Can assist caregiver by holding onto grab bar.
You may know me by my
“death grip”. I have a hard time releasing things from my hands.
Copyright © 2002
HEARTFunctional Mobility:• Higher level “hearts”
walk aimlessly, pace, rock, and march.
• Lower level “hearts” can only respond with a grimace or glance.
• Seek stability and comfort
• Enjoy gross motor activities- without a sense of purpose.
I can turn my head to track a moving object even at the last stages
of my disease.
Give me moving stuff to look at!
Copyright © 2002