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Experiences Matter: The Science Of Using Therapeutic Activities As Interventions For Neuropsychiatric Symptoms Linda L. Buettner, PhD, LRT, CTRS. Physician ordered Individualized Time limited treatment with goals

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Experiences Matter:

The Science Of Using Therapeutic Activities As Interventions For Neuropsychiatric Symptoms

Linda L. Buettner, PhD, LRT, CTRS

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  • Physician ordered

  • Individualized

  • Time limited treatment with goals

  • Provided by a licensed or certified therapeutic recreation specialist (CTRS).

    Treatment is designed to

    improve function or behavior.


What is recreational therapy?

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Four Major Points Today

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Recreation Therapy Intervention (RTI) Study (n=107) funded by the Alzheimer’s Association.

At-home RTI Study (n=30) funded by the Retirement Research Foundation.

Total N=137 individuals with severe dementia and neuropsychiatric behaviors.

Studies I Will Draw On

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Comprehensive Model of Engagement

By Dr. Cohen-Mansfield

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  • Enrolled 6 participants at a time.

  • Baseline evaluation included 5 days of observation of current lifestyles, mood, behavior, functioning, interests.

  • Three randomly assigned to recreation therapy treatment – three to usual care.

  • Pre-Post evaluations by blind evaluators and RT session documentation

Research Design

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21 Hours

Buettner, Fitzsimmons, & Atav, 2006

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Had One Engaging Experience In 5 Days

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11% agitation

30% apathy and isolation

59% mixed behaviors

Not relaxed or enjoying free time

Buettner, Fitzsimmons,& Atav, 2006

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More medications:

  • Less activities

  • Poorer mobility

  • More behavior problems

  • More cognitive impairment

    Setting (special care in nursing home and assisted living significantly worse behavior problems and significantly less activity)

Interesting Correlations: less activity

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Existing Activity Offerings*

*Buettner, L. & Fitzsimmons, S. (2003) Activities calendars: want you see is not what you get, American Journal of Alzheimer’s Disease, 18(4), 215-226.

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Prescribing RTIs

  • Determined target behaviors by gathering data on

  • the type of behavior the participant exhibited

  • throughout the day and current routine

    • Coded for eight time periods in two-hour blocks

    • Started at 6AM and ended at 10PM

  • Assessed level of function, unmet needs for

  • stimulation, and recreational interests

  • Used information to prescribe the tailored

  • recreational therapy – daily for 2 weeks.

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Tailored Recreational Therapy Interventions (RTIs)

A. To calm individuals with agitation

B. To alert individuals with apathy

Ultimate goal: active engagement in meaningful recreational activities to change a behavior at the right time.

Could we predict the outcome physiologically?

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  • Physical ***.000

  • Cognitive ***.001

  • Feelings ***.001

  • Life roles ***.000

  • Relaxation ***.001

  • Aroma n.s.

Categories of Interventions

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What we measured

  • Used Biofeedback to

    measure the physiology of


  • N=137 participants over 3


  • Baseline: Demographics,

    Function, Depression,

    Current Experiences

  • Pre and Post Apathy, and


Alzheimer’s Association & Retirement Research Foundation, 2001-2003

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Typical Biograph™ Reading

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Summary and Key Points

Highly significant decrease agitated and

apathetic behaviors with person-centered recreational therapy interventions.

2. Delivery of treatment just before problem rountinely occurs is important concept.

3. Intervention chosen had the desired effect

97% of the time.

Average activity engagement 27 minutes, with WC biking found as the most engaging treatment.

Once we know what works a care plan can be provided for others (Time limited and cost effective)

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  • http://www.uncg.edu/rth/faculty/lindabuettner.html


  • Buettner, L., Fitzsimmons, S., Dudley, WN, (2010) MODERATING EFFECT OF DEPRESSION ON TREATMENT OF NEUROPSYCHIATRIC SYMPTOMS IN OLDER ADULTS WITH DEMENTIA: TREATMENT IMPLICATIONS, Accepted for special issue on depression summer 2010, Research in Gerontological Nursing. Guest Editor for this issue.  

  • Buettner, L. & Fitzsimmons, S. (January, 2010) RECREATIONAL THERAPY INTERVENTIONS: A FRESH APPROACH TO TREATING APATHY AND MIXED BEHAVIORS IN DEMENTIA. Volume 1,( 1) ,Journal of Non-pharmacological Therapies in Dementia.

  •  Buettner, L. & Fitzsimmons, S., PROMOTING HEALTH IN ALZHEIMER’S DISEASE: EVALUATION OF A 12-WEEK COLLEGE COURSE FOR INDIVIDUALS WITH A NEW DIAGNOSIS (2009) Journal of Gerontological Nursing. This paper won the Edna Stillwell Award for Gerontological Nursing. Presented at the Gerontological Society of America, November, 2009.

  •  Buettner, L. & Fitzsimmons, S., N.E.S.T. (NEEDS, ENVIRONMENT, STIMULATION, TECHNIQUES): INTERDISCIPLINARY DEMENTIA PRACTICE GUIDELINES. (2009) Venture Publishing, State College, PA.[Book]

  • Buettner, L. (2006), PEACE OF MIND: A PILOT COMMUNITY BASED PROGRAM FOR PEOPLE WITH MEMORY LOSS, American Journal of Recreation Therapy, (3), 33-41.

  •  Buettner, L. & Fitzsimmons, S., Atav, S. (2006) PREDICTING OUTCOMES: THERAPEUTIC RECREATION FOR BEHAVIORS IN DEMENTIA, Therapeutic Recreation Journal. Arlington: First Quarter 2006. Vol. 40, Iss. 1; p. 33

  •  Buettner, L. & Fitzsimmons, S. (2006) RECREATION CLUBS: AN OUTCOME BASED ALTERNATIVE TO DAY CARE FOR OLDER ADULTS WITH DEMENTIA, Activities Directors Quarterly, (3) 12-14.

  • Buettner, L. & Fitzsimmons, S. (2006) MIXED BEHAVIORS IN DEMENTIA: A NEW PARADIGM FOR TREATMENT, Journal of Gerontological Nursing. Thorofare: Jul 2006. Vol. 32, Iss. 7; 15-22.

  • Buettner, L. & Fitzsimmons, S. (2003) Activities calendars: what you see is not what you get, American Journal of Alzheimer’s Disease, 18(4), 215-226.