The Memory Unit OT

Okay. You’ve determined the current transfer status of your resident. You’ve determined that it’s functional, in a sense, but it could be better and you see potential for improvement. But how do you get there? How do you help that resident achieve a transfer status goal?

Let’s talk about it.

I want to start by clarifying something.

If we’re talking about an individual with mild cognitive impairment (MCI) or an early stage dementia, there is a good chance that standard exercises and transfer training will work. That individual may be receptive to the education you provide and may be highly motivated to improve his or her transfers and mobility. But if we’re talking about someone with a moderate stage dementia or someone who requires 24-hour supports and care, a typical exercise regime likely will not work. And I think the later is where many of us get stuck.

I think it goes without saying that functional activities are the crowd favorite on the memory unit.

When I ask my long-term care residents to do something just for the sake of doing it (ie. let’s stand up without any real point or reason for standing up), I’m often met with frustration and resistance. But if I incorporate something meaningful and purposeful, I’m met with agreement and engagement.

If you’ve done your Occupational Profile with your resident, you know what activities are meaningful and purposeful for this person. And those are the things you’re going to integrate into your transfer training sessions.

Now it’s important to remember that the biomechanics of transfer training still apply, even on the memory unit.

Meaning, if my resident is currently at a Hoyer level for transfers he’s not going to magically stand up to do an activity he enjoys. The muscles still require biofeedback and strengthening. Range of motion still matters. The proprioceptors and the vestibular system still need to be relatively intact.

There are basic activity and exercise swaps we can do to promote lower extremity strengthening.

Instead of performing rote lower body exercises, you might pop some ankle weights on and kick a ball back and forth or propel the wheelchair with both legs. You might transfer the individual onto the low mat to work on core strength and sitting balance before progressing to standing work. Maybe you break your sessions up into 15-20 minute intervals and start using the stand-lift instead of the Hoyer when the resident gets in and out of bed throughout the day.

Like any other form of transfer training, you progress the activity as strength and balance improve. So you might work on a tabletop activity at a standing counter. You might put some music on and dance. You might go out in the yard to look at flowers or prune the bushes. You might use short sessions to walk to the dining room or the bathroom or afternoon Bingo.

I’ll tell you from first hand experience that transfer status can improve, even on the memory unit.

Now does this mean that individuals might require a greater level of supervision after therapy discharge (because they used to spend all their time in a chair and now they’re able to get up on their own)? Yes. And that’s an intervention topic for a different day…..

For now, just remember that you’re assessment and activity analysis skills are strong and are so essential in improving the quality of life for your residents on the memory unit.