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Cognitive and Physical Stimulation Therapy. Kelsey Firsick , BSW Mitchel P. Kohnen , BS Kinesiology Jeff Loraine RN,DON NHC Healthcare of Maryland Heights. Learning Objectives. To allow for alternative programing to help reduce need for antipsychotic medications

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Cognitive and Physical Stimulation Therapy

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Cognitive and physical stimulation therapy

Cognitive and Physical Stimulation Therapy

Kelsey Firsick, BSW

Mitchel P. Kohnen, BS Kinesiology

Jeff Loraine RN,DON

NHC Healthcare of Maryland Heights

Learning objectives

Learning Objectives

  • To allow for alternative programing to help reduce need for antipsychotic medications

  • To assist care givers in developing therapeutic techniques to manage difficult behaviors

  • To promote strategies to assist with improving cognition and decreasing depression

  • To facilitate programs to maintain or improve functionality in dementia patients with behaviors

Program development

Program Development

  • Initial program started to increase quality of life in dementia patients with behaviors

  • Later developed to comply with CMS initiative to reduce antipsychotic usage in dementia patients with behaviors

  • Aimed at reducing difficult behaviors

  • Enhanced programing to combine cognitive stimulation and physical exercise

Cognitive stimulation therapy

Cognitive Stimulation Therapy


  • Cochrane Database concluded:

    • “CST programs benefit cognition in persons with mild to moderate dementia as much as cholinesterase inhibitors”

    • “Shown to improve quality of life and be cost effective

  • Professor Martin Orrell, University College of London

  • Performed training for our center and region

Cognitive stimulu s training cont

Cognitive Stimulus Training(cont.)

  • Two Comprehensive training manuals, “Making A Difference” &”Making A Difference” volume 2. Manual for group leaders by Aimee Spector, LeneThorgrimsen, Bob Woods, & Martin Orrell by Hawker Publications & The Journal for Dementia Care


  • $30 each

Cognitive stimulus training

Cognitive Stimulus Training

Program development1

Program Development

Cognitive Stimulation Therapy

Physical Stimulation Therapy

  • Small groups (6-10) people

  • Groups meet twice a week

  • 3 groups formed

  • Consist of a set warm up followed by a predetermined topic of interest

  • All residents get involved

  • Multiple visual and tactile aids

  • Walking and exercise program performed before each meeting

  • Residents walk an average of 10 minutes and perform 6-8 repetitions of resistance exercises

Program development2

Program Development

  • Appointed 2 “Memory Care Liaisons”

  • Assist with memory care unit and operations as well as program development for Cognitive and Physical Stimulation

  • Different focus for each

    • Exercise

    • Activity

  • Work in conjunction and combine specialties to enhance programing



  • Participants where assessed for baseline cognition and depression before program began and after7weeks



SLUMS & BIMS utilized to measure baseline cognitive function

PHQ-9 for depression

Resistance therapy

Resistance Therapy

Dosage reduction

Dosage Reduction

  • Program participants reviewed for potential reduction

  • Anti-psychotic utilization reviewed by Medical Director, Consultant Pharmacist, & Primary Physician

  • Decrease in psychotropics done gradually

Dosage reduction1

Dosage Reduction


NHC MH – 93%

MO – 67.9%

Nat’l Avg. – 82.2%

Psychiatric DX.

NHC MH- 61.9%

MO- 59.8%

Nat’l Avg. – 55.4%

Antipsychotic Usage

NHC MH – 14.9%

MO – 28.4%

Nat’l Avg. – 25.2%



  • Enhanced the quality of life of the cognitively impaired

  • Programming has allowed for increased resident and family satisfaction

  • Allowed healthcare center to diversify it’s services and provided additional referral source

  • Decreased hospital readmission rates

  • Staff acquisition of new skill sets to assist with caring for the cognitively impaired



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