Gabriel, A 67-year old male has a history of Cognitive impairment and recently decreasing functionality in managing his finances. He presents today a frequent loss of memory, confusion and language issues. He lives miles away from his family due to his occupation which requires his full attention. He was under medication for a period not less than three months, suffering from depression due to both work and family issues. He is neither a drug addict of alcohol nor tobacco nor other related products. The challenge he has is; will he be able to run the business he is currently in, appropriately? How will he be evaluated for this?
The patient might present himself with some symptoms including, confusion, loss of memory and impaired judgment, of which are common signs of mild cognitive impairment. The patient might present some come problems towards physical therapy due to the assumption that it is not effective. That kind of attitude results to a self-fulfilling prophesy, moreover it is hard for the therapy to be referred to as an oxymoron. Surprisingly, it is becoming more evident that care management and assessment strategies, being employed by PTAs and PTs helping these patients feel the sense of trust and more comfortable towards the service. It crucial that physical therapists familiarize themselves with the best practices to deal with the challenges facing the therapy service.
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I would expect to see various systematic measures being conducted on the patient including, quality of life (HRQoL), mood, behavior, disease severity, functional performance, and independent living. It focuses on performing questions on the mentioned areas or other relevant areas to the patient. But these ask for better and accurate strategies towards the reporting of outcomes (Sara, 2016).
There are a variety of treatment methods available for intervention for this condition — namely, Cholinesterase inhibitors, Dietary supplements and Vitamins, and Nonpharmacological. The most suitable intervention for this patient would be Nonpharmacological interventions as the patient has presented the actual symptoms that he is suffering from cognitive impairment. Additionally, it has proved itself successful in controlling these conditions better than the other interventions. It includes exercises, programs specifically holistic cognitive rehabilitation and lastly cognitive training sessions with multimodal intervention.
The patient can go through a two-phase rehabilitative process treatment which demonstrates his progression towards his treatment. The cognitive training sessions, he is to pair up figures; it is a task that involves the training of selective attention whereby a client is supposed to match the same pictures. There is also a repeated word task word where a patient is required to pick on repeated words; it improves on working memory and attention. There is also a selection of items from a particular category; it is crucial in enhancing semantic memory. After results of the mentioned tasks are completed as expected by the patient, he now graduates to another level which is deemed more challenging. The patient is required to search for consecutive stimuli and task sequencing which improves on reasoning, planning, and comprehension.
The holistic cognitive rehabilitation is the second intervention, which includes the maintenance of social activities or else, social engagement. It comprises a variety of activities, either conversion or the structured group activities. Research done on this particular intervention has shown that a patient’s cognitive function is determined by the social network the client has. Gabriel may start with simple rehabilitative social tasks, like gardening and volunteering work, as he advances or shows signs of progress he can be subjected to hard tasks. For instance, tour gardening and club involvement, this will help him gain higher adherence to everyday tasks.
Lastly is the multimodal strategies which are the second phase of rehabilitation; it involves, reality orientation, music therapy or physical therapy. Furthermore, it is the most crucial intervention for the patient, in examining his in-office neurology. The strategies help in assessing his reflexes, movement, nerve functioning, balance, senses, and coordination. First, the patient can undergo simple physical exercises like tiptoeing, appropriate weight lifting, and general outdoor activities, if the patient shows signs of progression he may be subjected to more complex activities. Tai chi or yoga lessons require a lot of effort from the patient, as it involves a lot of reflex muscle movement and balancing, all these are suitable in the management of the condition (Kiosses et al., 2015).
As a PTA together with collaborating PTs, we are enabled by the Clinical practice guidelines (CPGs) to comprehend the nature of evidence as it is. We are the key to shrinking the knowledge translation gap, movement optimization and minimization of unjustified variation in practice. APTA has been continuously working in increasing resource availability to clinicians and educators to shed light on the roles of PTAs and PTs so that unwarranted variation may be reduced ( Jewell, 2014) . As a PTA it is my responsibility to follow the plan of patients’ care by the PT, for instance guaranteeing client/patient safety and comfort throughout the data collection or intervention process. It is also my role as a PTA to help in intervening components, while as for PT is to examine, evaluate, diagnose and give the outcome measures of a patient (Staff, 2018).
Provision of successful patient care from PTAs and PTs has been evident for more than four decades now. To make the service delivery of these of these specialists more profound and convenient, the PTs require more education about the PTA’s scope of work and education. Both will benefit if there is clarity in the roles they play.
References
Jewell, D. V. (2014). Guide to evidence-based physical therapist practice . Jones & Bartlett Publishers.
Kiosses, D. N., Ravdin, L. D., Gross, J. J., Raue, P., Kotbi, N., & Alexopoulos, G. S. (2015). Problem adaptation therapy for older adults with major depression and cognitive impairment: a randomized clinical trial. JAMA psychiatry , 72 (1), 22-30.
Sara B. Mitchell and Sandra E. Black. (2016). Recommendations on screening for cognitive impairment in older adults*Canadian Task Force on Preventive Health Care. CMAJ guidelines , 188(1).
Staff, P. (2018). Outcomes–A Strong Team Produces Better Results. Sat , 1 (2), 3.
