Tools and skills to facilitate running Cognitive Stimulation

Therapy (CST) groups effectively.

Amy Streater & Elisa Aguirre

Research Assistants & PhD students

a.streater@ucl.ac.uk

e.aguirre@ucl.ac.uk OC077

Conflict of Interest DisclosureAmy Streater & Elisa Aguirre, MPhil.

Has no real or apparent conflicts of interest to report.

Overview

• CST for dementia

Background CST principles / structure / sessions

• Practicalities of running CST groups

Settings Facilitation Evaluation

NICE-SCIE guidance (2006) www.nice.org.uk

People with mild/moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation programme … irrespective of any anti-dementia drug received …’

CST Background

• ‘Reality Orientation’ (RO) marked a breakthrough in

dementia care

• Criticism of RO: applied in a rote, uninspired way,

(Dietch, Hewitt and Jones, 1989), insensitive to individual

needs (Powell-Proctor & Miller, 1982)

• RO Cochrane Review (Spector et al., 2000)

CST trial (Spector et al., 2003)

•multicentre Randomised Control Trial (RCT)

•n= 201 BL / 168 FU, 23 centres

•Found a significant improvement in the primary outcome

measures: cognition and quality of life.

•No significant results were found for the secondary outcome

measures: mood (depression and anxiety) & activities of daily

living.

•CST shown to be more cost-effective than usual activities

and compared favourably with anti- dementia drugs (Knapp et

al., 2005).

Maintenance CST

• Pilot Maintenance CST (Orrell et al., 2005) found that

maintenance CST led to continuous cognitive

benefits. Whereas, CST only led to a gradual decline.

- Pilot involved 16 weekly session following CST

programme

- Piloted in 2 experimental homes, 2 control homes

• Limitations: Small sample (35), homes volunteered

• Currently a multicentre RCT of Maintenance CST is

being carried out by UCL / NELFT

Cognitive Stimulation

Cognitive Stimulation Therapy…

★ Targets cognitive and social function

★ Social element enhanced by having in a group

environment or with the family caregiver.

★ Cognitive activities do not primarily consist of

practice on specific cognitive modalities

Concepts of CST sessions

• Aim to be mentally stimulating, yet for people to feel empowered rather than de-skilled

• 45 minutes / 14 sessions

• Group name

• Theme song

• Warm-up activities

• Roles for members

• RO board

CST Key Principles

• Orientating people sensitively / when appropriate

• Information processing and opinion rather than factual

knowledge implicit learning

• Multi-sensory stimulation

• Flexibility in the activities to cater to the groups needs

• Using reminiscence (as an aid to here-and-now)

• Building / strengthening relationships

• Empowering for staff running groups

CST PilotMCST

Theme MCST

1 8 Physical games 8

2 7 Sound 7

3 1 My life 1 & 23

4 Food 3 & 17

5 2 & 3 Current affairs 2 & 21

6 15 Faces/ Scenes 15

7 11 Associated Words, discussion 18

8 Being creative 4

9 9 Categorising objects 9

10 Orientation 19

11 Using Money 20

12 5 Number game 5

13 16 Word game 16

14 6 Team games. Quiz 6

NEW Useful tips 11 & 24

NEW 12 & 13 Thinking cards 12 & 22

NEW 14 Art Discussion 14

NEW Visual Clips Discussion 13

NEW 4 & 10 Household Treasures 10

CST/MCST

Sessions

Household Treasures

Session Structure

Introduction

Theme Song

Current Affairs

Main Activity

Closure

Setting up the group

• Ideally 5-8 people in groups, run by two facilitators

• Each session has choice of activities, to cater for interests and abilities of group

• Group members should ideally be at similar stages of dementia, so activities can be pitched accordingly

• Attention should be paid to gender mix

Inclusion Criteria

THIS PERSON SHOULD NOT BE INCLUDED IN THE GROUP

Diagnosis of dementia(DSM IV)

with CDR

0.5 / 2

Can s/he

have a “meaningful” conversation?

Can s/he

hear well enough to participate

in a small group discussion?

Is her/his vision goodenough tosee mostpictures?

Is s/he likely to

remain in in a

group for 45 minutes?

YES

YES

YES

YES

NO N

O NO N

O NO

THIS PERSON CAN BE

INCLUDED INTHE GROUP

YES

Preparing for the groups

• Assessment of individuals – strengths, sensitive areas, interests, literacy, etc

• Explaining nature and purpose of CST groups.

• Discussing continued assent – that people can withdraw at any time, with no negative consequences.

• Organising transport, a room, staff.

• Preparing folders for group members.

Monitoring Progress

• Keeping records of attendance, notes following all sessions

• Monitoring progress form included in the CST manual

• Outcome measures, including:★ MMSE - to measure cognitive change★ QoL-AD - to measure quality of life

• Feedback from group

• Regular supervision is essential

Future of CST

• Development and evaluation of the Maintenance CST programme.

• An evaluation and comparison of the effectiveness of two different CST training approaches and its implementation in practice.

• Individual CST (iCST)

Useful resources

• Speechmark Publisherswww.speechmark.net

• Winslow www.winslow-cat.com

 • The Robert Opie Collection (reminiscence)

http://www.robertopiecollection.com

• Toy museum www.pollockstoymuseum.com

Thank you for listening

Knapp M, Thorgrimsen L, Patel A, Spector A, Hallam A, Woods B and Orrell M (2006). Cognitive Stimulation Therapy for people with dementia: Cost Effectiveness Analysis. British Journal of Psychiatry, 188:574-580.

Orrell M, Spector A, Thorgrimsen L & Woods B (2005). A pilotStudy examining the effectiveness of maintenance CognitiveStimulation Therapy (MCST) for people with dementia. International Journal of Geriatric Psychiatry, 20:446-451

Spector A, Orrell M, Davies S & Woods B (2000). A systematicReview of the use of Reality Orientation in dementia. TheGerontologist, 40 (2): 206-212.

References

Spector A, Thorgrimsen L, Woods B & Orrell M (2005). Makinga difference…An evidence-based group programme to offer cognitive stimulation therapy (CST) to people with dementia. UK: Hawker Publications.

Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth M & Orrell M (2003). Efficacy of an evidence-based Cognitive stimulation therapy programme for people with dementia: Randomised controlled trial. British Journal of Psychiatry, 183: 248-254

CST website: www.cstdementia.com

Maintenance Cognitive Stimulation Programme (ISRCTN26286067)) is part of the Support at Home - Interventions to Enhance Life in Dementia (SHIELD) project (Application No. RP-PG-0606-1083) which is funded by the NIHR Programme Grants for Applied Research funding scheme. The grantholders are Professors Orrell (UCL), Woods (Bangor), Challis (Manchester), Moniz-Cook (Hull), Russell (Swansea), Knapp (LSE) and Dr Charlesworth (UCL).

This report/article presents independent research commissioned by the NationalInstitute for Health Research (NIHR) under its Programme Grants for Applied Research sheme (RP-PG-060-1083). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Acknowledgements