On-The-Job Cross Pollination Part 2

Using IPE to Develop Clinicians

“Mary” was readmitted to Genesis Rehab Center after a recent hip fracture. Evaluators at the assisted living center ordered physical therapy and speech-language treatment to address her disorientation and inability to communicate basic needs. She had a medical history significant for Parkinson’s disease, dementia and depression. She had refused speech and physical therapy services in the past.

To assess Mary’s current functioning, the speech-language pathologist and physical therapist used tools they had learned together recently in a foundations course on dementia. The SLP administered the Brief Cognitive Rating Scale, which revealed Mary was functioning at a Global Deterioration Scale stage 4, moderate cognitive decline. She shared this finding with the PT so that together they could establish a plan for Mary’s care based on her stage.

All our clinicians—including SLPs, occupational therapists, PTs and respiratory therapists—take the dementia course that informed this SLP’s and PT’s approach, because all members of the rehabilitation team need to have a common understanding of the needs of residents with dementia.

The course is taught by an interdisciplinary team to interdisciplinary teams to ensure a consistent approach to care. Participants learn to identify dementia-related behavioral and functional performance changes according to the Global Deterioration Scale. They also learn to use the GDS and other staging tools to identify stages of dementia and appropriate discipline-specific interventions.

This joint training benefits clinicians and patients alike, as illustrated in Mary’s case: Based on what they’ve learned in the course, the SLP and PT understood that patients at Mary’s stage of dementia typically deny services, demonstrate flattened affect, quickly become anxious or angry, and appear depressed. However, Mary should still understand the essential focus of a therapy program. She can be goal directed and can understand the basics—and complete some steps—of familiar tasks and activities. However, due to increased rigidity and reduced ability to solve problems, she needs a highly structured, familiar routine and to develop trusting relationships with clinicians before being open to treatment.

The SLP and PT realized that if they provide treatment in places where Mary feels comfortable—her apartment or the activities room instead of the therapy gym—she is perfectly receptive to regular physical therapy and speech-language treatment.

In addition to the joint training on dementia, we provide clinicians tools and training to help with supervision and mentoring. This training course is approved for 0.2 ASHA CEUs. We’ve run into some difficulties trying to support clinicians’ supervision efforts across varying disciplines, because each discipline requires different amounts of supervisory episodes and site visits. So, in an attempt to reduce frustration, we’ve set up post-training follow-up calls to field clinicians’ concerns. We’ve also established pages on our internal website to update clinicians on requirements in their respective areas.

Through these varying IPE efforts, we empower clinicians to better collaborate and successfully meet the challenges of the geriatric population.

Erin Knoepfel, MS, CCC-SLP, BRS-S, director, speech-language pathology clinical services, Genesis Rehab Service

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