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Behavior-Based Ergonomics Therapies- A Good Thing



When I developed the Head, Hands, Heart Dementia Assessment System ten years ago, I had no idea that I was really developing a behavior-based ergonomic tool.  I thought I was using my occupational therapy background to flush out function amidst cognitive turmoil.  The HHH Program, based on the Allen Cognitive Level Scale and the Global Deterioration Scale, identifies what functional abilities are still intact and how to access and engage a person with dementia in functional activities.  It is helpful to know what areas of the brain are relatively healthy, and which are irrevocably damaged.  The end product is a plan that provides recommendations for calming, engaging, stimulating, or activating patterns of cognition and movement.  Although, anecdotally speaking, the program is a useful resource for caregivers, I have never found the time to put it through the paces of rigorous research.

So along comes a sister-program that provides some evidence that individualized interventions and activities, versus traditional, generic group activities, improves the quality of life for Alzheimer’s patients.  A  recent article in The American Journal of Alzheimer’s Disease and Other Dementias describes how an interdisciplinary team at a retirement community in Ohio developed BBET as a way to ward off challenging behaviors before they occur.  If they noticed a resident was withdrawing, or wandering, or repeating themselves, the staff would use a technique or an item from each resident’s action plan to promote a positive experience.  Interventions might include music therapy, or memory props, or games and puzzles- but the plan is specifically tailored to each resident.   Such behaviors, if ignored or addressed through traditional activity approaches, could easily escalate to a level that required medication.  The time the staff spent implementing a specific intervention to head off a challenging behavior took about 5 minutes.  The time spent dealing with an adverse behavior once it had escalated and if no BBET intervention was provided took 60 minutes.  Not only did the program decrease the time the caregivers spent dealing with difficult behaviors, but Ativan usage went down 57%.

The results of the research showed that using personalized, proactive approaches warded off difficult behaviors before they became upsetting, time-consuming issues that can only detract from a person’s quality of life.  How simply and beautifully illustrated.


Here is the abstract from that research.


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  1. This was a really good read and you are right on all accounts. I can remember how fascinated I was when I realized how effective behavior modification techniques could be. Never forget Pavlov’s dog!

  2. Nice writeup. A behavioral based approach looks like it can definitely pay dividends and has done so in these cases.

  3. Hi. I don’t see the abstract and would love to look at this paper. Thanks

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