{"id":62002,"date":"2013-05-13T19:58:10","date_gmt":"2013-05-13T19:58:10","guid":{"rendered":"http:\/\/webapp2.wright.edu\/web1\/community\/?p=3082"},"modified":"2013-05-13T19:58:10","modified_gmt":"2013-05-13T19:58:10","slug":"unlocking-memories","status":"publish","type":"post","link":"https:\/\/webapp2.wright.edu\/web1\/newsroom\/2013\/05\/13\/unlocking-memories\/","title":{"rendered":"Unlocking Memories"},"content":{"rendered":"

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Golf tournaments, Italian music, the late Julia Childs\u2019 cooking shows, and family photos\u2014lots of family photos. These are among the contents of \u201cmemory boxes,\u201d part of a revolutionary program called Behavior-Based Ergonomics Therapy, or BBET, for dementia patients being pioneered by a Wright State University biomedical engineering adjunct professor.<\/p>\n

Govind Bharwani, Ph.D., developed the program for Alzheimer\u2019s patients at the St. Leonard Franciscan Living Community in Centerville, Ohio. The program is spreading quickly. It is now being used at more than a dozen institutions in Ohio, Kentucky, and Kansas. And there is a six-month waiting list for those who want to implement some form of it.<\/p>\n

\u201cWe are getting calls from around the world,\u201d said Bharwani. \u201cThis is changing the way Alzheimer\u2019s care will be done.\u201d<\/p>\n

Alzheimer\u2019s disease is the most common form of dementia. Symptoms include memory loss, confusion, irritability, aggression, and withdrawal. The disease gets worse as it progresses, eventually leads to death, and there is no known cure. An estimated 5.4 million Americans are living with Alzheimer\u2019s, which is the sixth-leading cause of death in the United States, according to the Alzheimer\u2019s Association.<\/p>\n

Alzheimer\u2019s can place a great burden on caregivers. St. Leonard turned to Wright State and the College of Nursing and Health\u2019s Nursing Institute of West Central Ohio for help with the physical wear on its staff and with Alzheimer\u2019s patients, who would sometimes fall and injure themselves.<\/p>\n

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A therapy room at the St. Leonard facility<\/p><\/div>\n

\u201cThe staff on the Alzheimer\u2019s unit were always fighting fires; there was always a crisis; there was always somebody upset. Then it snowballs to other people,\u201d said Bharwani\u2019s daughter, Meena, who helps implement the therapy program and train the staff. \u201cIt\u2019s hard to get control of the unit when everyone\u2019s got so much stress.\u201d<\/p>\n

Enter her father, an ergonomics expert with 30 years\u2019 experience. Ergonomics is the science of reducing physical and mental stress, which can afflict Alzheimer\u2019s patients. Their loss of memory can make them agitated and combative, leading to behavior problems and the use of anti-psychotic medication.<\/p>\n

\u201cOur research has shown that boredom and disengagement in a long-term care facility can lead to these types of behaviors,\u201d Bharwani said. \u201cIf they\u2019re not engaged in a meaningful way, they run into emotional problems; that eventually leads to behavior problems and also causes a lot of stress on the caregivers.\u201d<\/p>\n

The question became how best to engage them.<\/p>\n

Bharwani formed a team from Wright State, the Alzheimer\u2019s Association, and St. Leonard\u2019s\u2014members with a total of 90 years\u2019 practical experience. He also toured retirement and nursing facilities around the state that focused on Alzheimer\u2019s care.<\/p>\n

He found that Alzheimer\u2019s residents are often put into group activities and sessions, which can engage some of them but not others. He also discovered that an array of different therapies was being used with the residents\u2014from music therapy to aroma therapy to pet therapy. However, the therapies often called for specialists, which was expensive and impractical for the institutions and didn\u2019t work for every resident.<\/p>\n

So Bharwani decided to focus on the most effective therapies and then create therapy programs customized for each resident. He developed personality profiles through family histories and cognitive assessments. A computer software program would then spit out a therapy prescription that could be easily implemented by the nursing staff. It is believed to be the first non-pharmacological customized therapy program for Alzheimer\u2019s patients in the nation.<\/p>\n

The therapies include a music library of CDs that features hymns, oldies, television theme songs, Lawrence Welk, and other soothing sounds. Then there are videos of sports, travel, music sing-alongs, hobbies, comedies, cooking, and gardening. Called \u201ccomforting\u201d libraries, these two therapies are designed to reduce cognitive stress.<\/p>\n

A third therapy stimulates the brain through the use of games and puzzles. And the use of individual memory boxes constitutes the fourth leg of the program by providing reminiscent therapy. The residents\u2019 families supply sentimental items in the memory boxes such as old photos and stuffed animals.<\/p>\n

\u201cThese customized therapies in combination can reduce resident stress and prevent difficult behaviors,\u201d Bharwani said.<\/p>\n

The memory boxes are a crucial component of the therapy. Dementia patients often cannot remember recent events, but retain pleasant experiences from the distant past and even remember details that an average person would likely have long forgotten.<\/p>\n

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Another therapy room at the St. Leonard facility<\/p><\/div>\n

\u201cAs the disease progresses, they begin to enjoy what they were many years ago,\u201d Bharwani said. \u201cYou can put them in front of a mirror, and they would not recognize who the person is. But you give them a picture of what they were 20 or 30 years ago, and they\u2019ll know exactly who it is.\u201d<\/p>\n

The therapy items are housed in a small room on the unit called the BBET Resource Center, which is open around the clock. The caregivers on the unit use an individualized
\ntherapy action plan and often add to the items themselves if they see the need. One nurse once went out and bought a model train for a resident.<\/p>\n

Laura Spain, a nursing assistant who has worked on the unit for 14 years, said the therapy items are\u00a0 especially helpful in the middle of the night, when some residents get anxious and begin pacing. A 30- to 60-minute BBET therapy session is usually sufficient to keep a resident calm for up to four hours and they eat, sleep, and bathe in a relaxed manner.<\/p>\n

\u201cIt just stops the behavior and stops the anxiety so they\u2019re not hurting,\u201d she said.<\/p>\n

Nurses and other workers on the unit were initially skeptical\u00a0of the therapy program and concerned it would add to their already-heavy workload. It was tested on five of the 18 residents during the pilot.<\/p>\n

\u201cIn the first week, they saw such a change in their behavior that the staff was absolutely blown away,\u201d Bharwani said.<\/p>\n

When the Bharwanis\u2019 program was implemented unit-wide, the moods and behaviors of residents dramatically improved. Within six months, resident falls had decreased by 40 percent and the use of behavior medicines\u2014including anti-psychotic medication\u2014had been reduced by up to 70 percent. Bharwani found himself presenting the results at conferences around\u00a0the country.<\/p>\n

\u201cIt\u2019s all about individual engagement as opposed to medication,\u201d said Tim Dressman, executive director of St. Leonard. \u201cWe\u2019ve had tons of tours and attention from the outside, internationally. You use it, it works. I can\u2019t say enough.\u201d<\/p>\n

Eric VanVlymen, executive director of the Alzheimer\u2019s Association, Miami Valley Chapter, said the Bharwani program empowers the staff to help residents with dementia in an engineered and systematic way.<\/p>\n

\u201cThat\u2019s the beauty of it,\u201d VanVlymen said. \u201cI have seen a lot of different programs, and what makes this special is it thinks about the staff and how to reduce their stress and it thinks about people with dementia and how to reduce their stress through
\nthose therapies. What I have really come to appreciate is Dr. Bharwani\u2019s engineering mind, which addresses the problem from a different perspective.\u201d<\/p>\n

Since the first BBET Resource Center at St. Leonard was established in 2010, the program has expanded into their new memory support facility with a resource center in each of four wings. In late 2012, St. Leonard opened yet another center
\nto benefit the community\u2014this one to help early-stage\u00a0dementia patients who are being cared for in their homes,\u00a0often by their children.<\/p>\n

\u201cIt gives the caregivers a respite,\u201d Bharwani said. \u201cThey are struggling. For them, it is a tremendous amount of stress.\u201d<\/p>\n

The BBET program has been honored with five national awards, including the 2011 Dorland Health Silver Crown Award for Alzheimer\u2019s Care and the 2011 American Medical Directors Association Foundation Quality Improvement Award.<\/p>\n

Bharwani grew up in New Delhi, India. His neighbors encouraged him to pursue engineering at a nearby engineering college, the Birla Institute of Technology & Science.<\/p>\n

He obtained his mechanical engineering degree in India, master\u2019s degrees in industrial engineering and business administration from Lehigh University in Pennsylvania, and his Ph.D. from Wright State in biomedical engineering.<\/p>\n

Bharwani has now begun working on a book that\u2014based on his research and experience\u2014will serve as a practical guide to caring for people with dementia.<\/p>\n

He said he initially approached the St. Leonard\u2019s project like the engineer he is, focusing dispassionately on the results. Later it became an emotional experience, with Bharwani often getting hugs from grateful family members.<\/p>\n

\u201cThey say, \u2018You\u2019ve given my mother a new life\u2019 or \u2018You\u2019ve\u00a0given my father a new life,\u2019\u201d he said. \u201cImproving the quality of life for people with Alzheimer\u2019s disease is what this program is\u00a0all about.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Golf tournaments, Italian music, the late Julia Childs\u2019 cooking shows, and family photos\u2014lots of family photos. These are among the contents of \u201cmemory boxes,\u201d part of a revolutionary program called Behavior-Based Ergonomics Therapy, or BBET, for dementia patients being pioneered … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":17,"featured_media":60362,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[722,4827,715,746],"tags":[],"class_list":["post-62002","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-academics","category-magazine","category-news","category-science-mathematics"],"_links":{"self":[{"href":"https:\/\/webapp2.wright.edu\/web1\/newsroom\/wp-json\/wp\/v2\/posts\/62002","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/webapp2.wright.edu\/web1\/newsroom\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/webapp2.wright.edu\/web1\/newsroom\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/webapp2.wright.edu\/web1\/newsroom\/wp-json\/wp\/v2\/users\/17"}],"replies":[{"embeddable":true,"href":"https:\/\/webapp2.wright.edu\/web1\/newsroom\/wp-json\/wp\/v2\/comments?post=62002"}],"version-history":[{"count":0,"href":"https:\/\/webapp2.wright.edu\/web1\/newsroom\/wp-json\/wp\/v2\/posts\/62002\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/webapp2.wright.edu\/web1\/newsroom\/wp-json\/wp\/v2\/media\/60362"}],"wp:attachment":[{"href":"https:\/\/webapp2.wright.edu\/web1\/newsroom\/wp-json\/wp\/v2\/media?parent=62002"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/webapp2.wright.edu\/web1\/newsroom\/wp-json\/wp\/v2\/categories?post=62002"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/webapp2.wright.edu\/web1\/newsroom\/wp-json\/wp\/v2\/tags?post=62002"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}