It's easy to accept stereotypes about elderly clients in nursing homes. As we age, our bodies and minds deteriorate. Those stereotypes lead to assumptions. "Prior functional level" is a worthy goal. A video* has me rethinking my paradigm.
The video showcases Henry, a long-term resident in Brooklyn's Cobble Hill Health Center. Neurologist Oliver Sacks, MD, characterizes Henry's initial state, describing a patient who staffs at most nursing homes are painfully familiar with: "We first see Henry inert, maybe depressed, unresponsive and almost unalive."
As a therapist, what techniques do you use to engage the unresponsive client? To be clear here, we aren't talking about a patient in a coma. Nor are we referring to a client with a traumatic brain injury, though there is obvious cognitive impairment. In retrospect, a TBI framework may have benefited my cognitively impaired clients.
Working on a traumatic brain injury unit, I learned to utilize sensory stimuli to elicit responses that might not come through other channels. I wish I could say that treatment option stayed with me through the years, but I don't remember olfactory stimulation being in my bag of tricks when I worked in the nursing home. After watching Henry, perhaps it should have been.
Unfortunately, the routine of using sensory stimulation with a comatose patient status post an acute TBI didn't transition into other patient populations. I'm not sure when it happened, but at some point I failed to realize the possible benefit of sensory stimulation for the unresponsive patient after a brain event (seizures, strokes). I wonder now how many nursing home residents I discharged from therapy with unrealized potential.
I wish the nursing home would've had the foresight to tape Henry as he first appeared in Dr. Sacks' description. Watching him now, it's difficult to imagine that unresponsive being. His big, bright eyes make me smile. He is anything but unresponsive with those headphones on and his animation doesn't diminish after they are removed!
In the video, Cherie describes her father: "He was always fun-loving, singing. On every occasion, he would come out with a song. I remember as a child he would walk us, me and my brother, down the street and he would stop and do ‘Singing in the Rain' and would have us jumping and swinging around poles."
Henry's recreation therapist, Yvonne Russell, used a form of sensory stimulation to reignite Henry's passion for music. That passion now allows him to connect with his surroundings. I can't help but wonder what a difference his iPod therapy has made in his physical therapy!
*I sometimes get ideas from other bloggers' posts, discussing the same topic from different perspectives. This post isn't an example of that. I didn't realize Allison had already posted about the video until Brian Ferrie, ADVANCE blogs editor, brought it to my attention. I enjoy reading the other ADVANCE bloggers' posts and try to keep up. Unfortunately, the pace of these past few months has relegated blog following to hit or miss. Like Allison, a friend shared this video with me. After reading Allison's post and discussing it with Brian, we decided the two posts brought out different aspects, both relevant to ADVANCE readers. We hope you agree.