Hhh-Tutorial for Therapists

8/3/2019 Hhh-Tutorial for Therapists

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W hat is Head, Hands, Heart?

A simplified approach to working withpatients with dementia:

Early (Head)

Middle (Hands)

Late/End (Heart)


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How is the level determined?

Many dementia assessments can be usedincluding:Allen Cognitive Level ScreenGlobal Deterioration ScaleBrief Cognitive Rating ScaleRoutine Task Inventory

The score is then valued as either early, middle,or late/end stage dementia.


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W hy do I need to know

the level of dementia?The treatment plan, goals, and outcomeswill be influenced by what specific skills

the patient still has.It is immeasurably valuable to have a levelestablished for care of the patient for comparison as the dementia progresses-interventions and approaches will needperiodic revision.


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W hat is the Head?

HEAD = thinking Early Stage DementiaGoal-directed infunction and mayhave some limitedability for new

learning


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HEAD Loss of inhibitions (frontal lobe). U nable to self-monitor. No insight into deficits (nothing is wrong with

them)problem is with the world. Loss of independence and dignity, loss of role

in life.

W ords are the best fighting tool they have. Memory issues frustrate caregivers.


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HEADCognitiveskills/Communication:U nderstands beginning, middle,and end of an activity.Can seek help but may notremember emergency procedures.Rigid, likes routine.Self-centered communication,confabulates, high verbal output.Recognizes highly visible strikingcues in the environment.Limited reading comprehension.

New learning possible withmaximum repetition if highlyvalued.Believe that nothing is wrong withthem.

Well, maybe yousay its wrongbut thats justthe way I like it.

My way is thebest way.


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HEADPrecautions:

U nable to understandprecautions,complications,hazards.W ritten language is

not reliable.Signs are not reallyeffective.


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HEADIf you tell me to go brushmy teeth I will stay on task.

I just may forget to usetoothpaste or rinse out mymouth.

F eeding:May eat too fast or tooslow.Annoyed with otherseating near them.Complains about food.

Grooming:May neglect unseensurfaces (back of head).Sequencing errors.


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HEADDressing/Bathing:

Performs familiar self care with decreasedattention to unseen

surfaces.Follows routine.Remembers what theyare doing throughouttask.Clothing selection may bebased on striking features(brightest shirt in thecloset).Quality may not be good.

I am really drawnto bold, strikingvisual input.Did you ever notice that Ichoose brightclothing and wear too much make-up?


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HEADToileting:

May neglect parts of the task.May require verbalreminders to initiatetask.

Completes the taskalthough quality maynot be good.

T his is a huge lossof dignity for me-

and a veryoverwhelming task

at times.


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HEADFunctional Mobility:

Able to navigate usingfamiliar landmarks.Transfer skills depend onfamiliarity of environment.Carries walker if distracted, but will correctwith cues.

Notices barriers aboveand below knee.Trunk becoming morerigid.

I can remember newthings with tons of patience and practice!


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HANDSHANDS = reaching,grabbing, holding objectsLevel 3 of the Allen

Cognitive ScaleMiddle Stage DementiaMedicare Mod AssistNot goal directed, cannot

be expected to completea task without assistance

Copyright 2002


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HANDSBehaviors:Pacing, repetitive actionsAgitated, worried,

trembling handsU npredictable with socialinteractionsConfused, acts randomly

Have youseen mymother?

Has anyoneseen

my mother ?

Copyright 2002


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HANDSCognitive skills/communication:Able to name objectsDecreased sense of taskcompletionNeeds verbal cues tosequence steps of anactivityResponds best todemonstrated instructions

Word finding problemsLoses the thread of a storyJargons, incoherentsentences

I have to get out of here. Im late for

work and the train ison that other thing over the @#%*! out that window day

@#%*! right here in

Chantilly .

Copyright 2002


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HANDSPrecautions:At risk for falls

U nable to understand

precautions,complications, or hazardsDoes not recognize needfor help

At risk for accidents-poison, sharp objects,elopement

I love to use myhands...and

toucheverything! I

tend to get into things I shouldn t

and carry them

around with me.

Copyright 2002


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HANDSSelf-care skills:May initiate action withfamiliar object- but not

sustain to completionResistant to careLayers clothes until allitems used up, unable toorient clothing or sequence taskNeeds supervision or assistance with toileting

I am sometimes veryresistant to care. Don t

you sneak up on me or just might get slugged!

Copyright 2002


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HANDSF eeding:May reach for food fromother place settings or

centerpieceU nable to complete mealwithout redirection andset-upPlays with food andutensils

Y ou may notice that I play with myfood or grab other s

food from theirplates. Im easilydistracted andoverstimulated.

Copyright 2002


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HEARTHEART = feel ing, l iving Level 1 and 2 of the

Allen Cognitive Scale.

Late and End StageDementiaMedicare Max Assist/Dependent

Respond to internal andexternal stimuli throughany of the five senses

Copyright 2002


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HEARTEnd Stage:

Mostly bedbound

Can move limbs andheadTotal assistance for self care and

mobility.

Late Stage:Can overcome gravity

Can sit, stand and/or walk (mobility)Have a sense of balance, although not

good

Copyright 2002


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HEARTPrecautions:

ContracturesSkin BreakdownFallsAspiration

B ecause I cant move or communicate well, Im

really at risk for contractures, falls, and skin

breakdown. YOU canprevent this from happening

to me!

Copyright 2002


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HEARTCognitive Skills/

Communication:Speech mostly

unintelligible,mumbles incoherentlyU nable to follow mostverbal commands

Poor attention span,distracted by movingobjects

A funny trick I know:I may only be able to say

one or two words, but Ican sing a whole song

without any errors.

Copyright 2002


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HEARTF eeding:

May be able to feedself with limited or extensive assistanceMore successful withfinger foodsCan sip from a cupheld to lips until veryend stages- dontintroduce a straw tooearly!

I can only seethings less than12 inches from

my face.B ring the world

to me!

Copyright 2002


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HEARTDressing/Bathing/Grooming:

Has no idea what todo with objectsAssists caregivers byholding positions,

moving limbs, andstanding

I have a major fear of falling. I may resist, hit, or kick but its only to protectmyself from injury. Im not

just being difficult.

Copyright 2002


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HEARTToileting:

Needs assistance withmanaging clothing,perineal hygiene, and

positioning on toiletFrequently incontinentInappropriate toiletinglocations- sometimes the

same place over andover.Can assist caregiver byholding onto grab bar.

You may knowme by my

death grip. Ihave a hard

time releasingthings from my

hands.

Copyright 2002


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HEARTF unctional Mobility:

Higher level heartswalk aimlessly, pace,rock, and march.Lower level heartscan only respond witha grimace or glance.Seek stability andcomfortEnjoy gross motor activities- without asense of purpose .

I can turn my head totrack a moving object

even at the last stagesof my disease.

Give me moving stuff to look at!

Copyright 2002

Hhh-Tutorial for Therapists

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