Westborough, MA May 25, 2017 Cognitive changes are common in patients with dementia. They become increasingly problematic with the disease progression. Some people suffering with dementia have difficulty with even the most basic activity of daily living like dressing themself. Things taken for granted like following directions become a chore as the progression of dementia effects individuals who suffer with the disease. This places a great burden on caregivers who must take over those important functions of daily life.
The clock drawing has been a feature on my blog for several years. It is fun to see people work through the task. Most people complete the task effortlessly. Some are a bit defensive because it seems like such a benign request – “draw a clock…” and I often get “I am not an artist…” in anticipation of failure. I have published over a dozen posts about the clock drawing as a measure of cognitive functioning. Patient with dementia often experience a slow cognitive decline whereby even tasks like constructing a clock become a challenge.
The clocks drawn in this post reflect the effort of a person of 89-years of age who tried very hard to get it right. She had enough preservation of her self- monitoring
3 Clocks drawn in succession by 89-year old female with hypoxia and underlying dementia of Alzheimer’s type – note size in centimeters
that she could tell something was wrong. As you can see the left most circle was the first attempt. It was too small according to the patient and she wanted to try again. The middle clock was her next attempt and shows her disorganization and minimal change in the size of the drawing – approximately 3 centimeters in size. In the center of the drawing there are 2 hands that roughly represent the time 11:10. She told me she needed more space to place the hands so that they could be clearly read and offered to try a third time. On the right is her final attempt. There are two hands (to the right of the number 9 and a second pointing to the number 2). As you can see the circle is only 2 cm in size and was a modest improvement over the first two attempts.
She had fun drawing the clock and did not feel as though she had failed the task. I was encouraging and praised her for staying with the task. At some point she had lost her capacity to plan and execute her visual motor function of crafting the circle. Each attempt was made with the goal of drawing a larger circle. This fine woman was still capable of doing many of her activities of daily living and enjoying her friends and family. She was not at all upset that I had been asked to help with her care.
Dementia requires family support and can be costly to those in need of care. The risk of caregiver fatigue exists in all families. As much as possible, I enourage people to allow the patient to work toward completing their own self-care unless there are risks such as falling due to poor balance. This requires herculean patience and sensitivity because there is often a degree of “awareness” of the cognitive changes experienced by the patient himself. Preserved dignity and sense of independence go a long way toward quality of life in the latter stages of dementia. Most spouses will do whatever it takes to support a loved one with whom they have shared 50 or more years of marriage and experience the decline in functioning as both a personal failure and a heart breaking loss.
WESTBOROUGH, MA May 15, 2017 Multiple Sclerosis is a demyelinating disorder that affects the brain and spinal cord of those so afflicted. MS is a disease that causes the immune system to attack the protective covering around the nerve fibers (Reference.com). Many of the nerves in the brain and spinal cord are covered with a myelin sheath – something like insulation on wire. This permits the instantaneous transmission of nerve impulses from one part of the body or brain to another. In patients suffering with MS their myelin is deficient sometimes having reduced efficiency or not working at all. It is a condition that for many gets better and gets worse. As you can see from this image taken from Google images the myelin sheath is the outer layer or membrane of fatty Schwann cells and other neuroglial support cells. MS may be linked to a virus and/or immunological compromise but its true etiology is not known.
We see a fair number of persons afflicted with M.S. in the rehabilitation hospital here in Massachusetts. MS is known to be relapsing and remitting in its quality which adds to treatment complexity and frustration for patients. They are a fiercely independent group of people and I can certainly understand why that might be. On some days they are able to get themselves out and into their cars for the drive to work something we might take for granted. While on other days, they may have difficulty putting on their their shoes and making lunch. Many are frustrated and angry that they cannot take care of themselves and sometimes wind up in our hospital getting physical therapy and other restorative therapies. Aquatic therapy is a great resource we offer at Whittier in Westborough, MA. I encourage people to become familiar with aquatic programs
in their area. They can provide support, pain management and effective physical therapy for those who may have limited energy resources. Fatigue becomes a problem in nearly all patients who suffer with multiple sclerosis. Cognitive changes are common in patients who experience long-term MS that sometimes make subtle changes in personality and all higher order problem solving, reasoning, and other executive functions. Some believe there are distinct personality features in those with MS
In addition to frustration and anger, some patients are resistant to restorative solutions suggested by rehabilitation team members who want to help. Some say “they want to do things their way” and resist rehabilitative suggestions that might offer energy conservation strategies or innovative methods for greater independence. Medication is used to reduce inflammation associated with MS and prevent relapse.
Reference.com. (2017) https://www.reference.com/health/treatments-multiple-sclerosis-2ed87c70dcd71896. Taken May 6, 2017
WESTBOROUGH, MA May 1, 2017 The return to school following a brain injury should be carefully planned. School nurses tend to be the point person for parents’ whose children are coming back to school after concussion. But let’s not forget the school psychologist. My wife, Mindy Sefton, Psy.D., is trained in concussion management and has crafted some of the best return-to-learn plans I have ever seen. She works closely with the nurse and classroom teachers to be sure no student be placed at risk for failure. At her middle school there is a protocol for re-entry that is specific and tailored for individual students.
Students with acute concussion and those suffering with post concussion syndrome require assistance at school or risk falling behind their peers. Some parents are not aware but it is true that when concussion sidelines and athlete he or she is highly vulnerable for school-related changes as well. Schools or educational teams who are interested in offering a comprehensive concussion education program are encouraged to contact CAMP or Dr. Sefton directly for consultation. Student athletes often require support in school while recovering from concussion. Support protocols like reduced work, extra time for tests, and deferred projects are just three commonly prescribed accommodations.
I am happy to help public schools with their protocols. They are critically important for student success. Individual programs can be integrated slowly on a team by team basis depending upon learning style, specific sport and unique student needs. Dr. Sefton has specialized training in pediatric brain injury, concussion and neuropsychological assessment and is a member of the Academy of Brain Injury Specialists. Training for coaches and trainers is available and recommended to identify updated return-to-play protocols and current standards of care. Both web-based and individualized ImPACT testing is available for preseason and after injury assessment. Return-to-play consultation is available with trainers and team physicians 24/7 at 508-579-0417 and email firstname.lastname@example.org
School districts interested in using CAMP for supporting athletes injured while playing sports can contact Dr. Sefton at 508-579-0417. Parents and physicians may call Dr. Sefton at any time to discuss individual injuries and school and sports re-entry after injury. Post injury testing and neuropsychological consultation is also available.
Return-to-Learn Care Plan
Some students who are injured playing in school sports may require a return to school care plan. Dr. Sefton will consult with student, parents, and school personnel to assist with short-term accommodations in school that can assure for continued success in academic domains. Not all children require changes in their educational programs but careful consideration of the child’s school functioning is essential.
Classroom teachers should be advised to monitor the student athlete for the following signs:
Increased problems paying attention/concentrating
Increased problems remembering/learning new information
Longer time required to complete tasks
Increase in physical symptoms (e.g., headache, fatigue) during schoolwork
Greater irritability, less tolerance for stressors