Promoting supported ambulation in persons with advanced Alzheimer’s disease: a pilot study

Abstract Purpose: This study assessed the effects of an intervention program, which combined the use of a walker with assistive technology, on the ambulation and indices of positive involvement of persons with advanced Alzheimer’s disease. A social validation assessment of the program was also carried out. Method: The study included 10 participants with moderate to severe Alzheimer’s disease and inability to walk independently. During baseline, the participants sat in their chair or were provided with a walker. During the intervention, the participants were provided with the walker and assistive technology, which delivered (a) preferred stimulation contingent on step responses and (b) encouragements to ambulate if needed. Results: The participants’ mean step frequencies were between 17 and 45 per session during the baseline and between 83 and 127 per session during the intervention. Sessions lasted 3 min. Most participants also had an increase in indices of positive involvement during the intervention sessions, thus showing an interest in those sessions. The social validation assessment showed that staff personnel rated the program favorably. Conclusions: A program combining the use of a walker with assistive technology may be a practical resource for improving ambulation and positive involvement of persons with advanced Alzheimer’s disease. Implications for rehabilitation A program based on relatively simple technology combined to a walker device may support ambulation in participants with advanced Alzheimer’s disease who are no longer able to walk independently. The same program may also help increase the indices of positive involvement (i.e., improve the general attention/activity and mood) of most participants. The staff’s positive ratings of the program suggest that there may be a favorable attitude toward the acceptance and application of the program in daily contexts.

[1]  Y. Gustafson,et al.  Walking Aids Moderate Exercise Effects on Gait Speed in People With Dementia: A Randomized Controlled Trial. , 2017, Journal of the American Medical Directors Association.

[2]  Nirbhay N. Singh,et al.  Technology-Aided Programs to Support Positive Verbal and Physical Engagement in Persons with Moderate or Severe Alzheimer’s Disease , 2016, Front. Aging Neurosci..

[3]  S. Siegel,et al.  Nonparametric Statistics for the Behavioral Sciences , 2022, The SAGE Encyclopedia of Research Design.

[4]  A. E. Kazlxn,et al.  Behavior Modification in Applied Settings , 1975 .

[5]  A. Kurz,et al.  Efficacy of memantine hydrochloride once-daily in Alzheimer’s disease , 2014, Expert opinion on pharmacotherapy.

[6]  Jeffrey Cummings,et al.  Age and rate of cognitive decline in Alzheimer disease: implications for clinical trials. , 2012, Archives of neurology.

[7]  D. Roane,et al.  Assessment of Stimulus Preferences in Multisensory Environment Therapy for Older People with Dementia , 2003 .

[8]  Alan E. Kazdin,et al.  Behavior modification in applied settings, 6th ed. , 1989 .

[9]  A. Mihailidis,et al.  Predicting the role of assistive technologies in the lives of people with dementia using objective care recipient factors , 2016, BMC Geriatrics.

[10]  C. Williams,et al.  Exercise training for depressed older adults with Alzheimer's disease , 2008, Aging & mental health.

[11]  Nirbhay N. Singh,et al.  Persons with moderate Alzheimer's disease use simple technology aids to manage daily activities and leisure occupation. , 2014, Research in developmental disabilities.

[12]  Nirbhay N. Singh,et al.  Technology-aided pictorial cues to support the performance of daily activities by persons with moderate Alzheimer's disease. , 2012, Research in developmental disabilities.

[13]  M. Vitiello,et al.  Predictors of Short- and Long-Term Adherence to a Daily Walking Program in Persons With Alzheimer’s Disease , 2010, American journal of Alzheimer's disease and other dementias.

[14]  Ronald Baecker,et al.  Reconstructing the Past: Personal Memory Technologies Are Not Just Personal and Not Just for Memory , 2012, Hum. Comput. Interact..

[15]  C. Ambrose Neuroangiogenesis: a vascular basis for Alzheimer's disease and cognitive decline during aging. , 2012, Journal of Alzheimer's disease : JAD.

[16]  S. Andrieu,et al.  Weight loss and rapid cognitive decline in community-dwelling patients with Alzheimer's disease. , 2012, Journal of Alzheimer's disease : JAD.

[17]  C. Caltagirone,et al.  The role of persistent and incident major depression on rate of cognitive deterioration in newly diagnosed Alzheimer's disease patients , 2012, Psychiatry Research.

[18]  M. Sabbagh,et al.  Investigational drugs in Alzheimer's disease: current progress , 2014, Expert opinion on investigational drugs.

[19]  James A Lenker,et al.  Consumer perspectives on assistive technology outcomes , 2013, Disability and rehabilitation. Assistive technology.

[20]  D. Barlow,et al.  Single Case Experimental Designs: Strategies for Studying Behavior Change , 1976 .

[21]  K. Makimoto,et al.  Degree of ambulation and factors associated with the median distance moved per day in Alzheimer's disease patients. , 2013, International journal of nursing practice.

[22]  Nirbhay N. Singh,et al.  Patients with moderate Alzheimer’s disease engage in verbal reminiscence with the support of a computer-aided program: a pilot study , 2015, Front. Aging Neurosci..

[23]  D. Bennett,et al.  The natural history of cognitive decline in Alzheimer's disease. , 2012, Psychology and aging.

[24]  Wendy Wood,et al.  Dying of boredom: an exploratory case study of time use, apparent affect, and routine activity situations on two Alzheimer's special care units. , 2009, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[25]  C. Brayne,et al.  Health-related quality-of-life instruments for Alzheimer's disease and mixed dementia , 2013, International Psychogeriatrics.

[26]  P. Stapley,et al.  Effects of Physical Exercise on Health and Well-Being of Individuals Living With a Dementia in Nursing Homes: A Systematic Review. , 2016, Journal of the American Medical Directors Association.

[27]  Sokratis G. Papageorgiou,et al.  Current and future treatments for Alzheimer’s disease , 2013, Therapeutic advances in neurological disorders.

[28]  Pouria Khosravi,et al.  Investigating the effectiveness of technologies applied to assist seniors: A systematic literature review , 2016, Int. J. Medical Informatics.

[29]  R. Henson,et al.  Social Validation of Evidence-Based Practices in Autism by Parents, Teachers, and Administrators , 2008, Journal of autism and developmental disorders.

[30]  Elazar J. Pedhazur,et al.  Measurement, Design, and Analysis: An Integrated Approach , 1994 .

[31]  P. Scheltens,et al.  Assessment of Instrumental Activities of Daily Living in Dementia , 2013, Journal of geriatric psychiatry and neurology.

[32]  Nirbhay N. Singh,et al.  Persons With Moderate Alzheimer's Disease Improve Activities and Mood via Instruction Technology , 2009, American journal of Alzheimer's disease and other dementias.

[33]  Min-Huey Chung,et al.  The effects of reminiscence therapy on psychological well‐being, depression, and loneliness among the institutionalized aged , 2010, International journal of geriatric psychiatry.

[34]  Whitney L. Mills,et al.  Technology-Driven Interventions for Caregivers of Persons With Dementia , 2013, American journal of Alzheimer's disease and other dementias.

[35]  J. Ashford Treatment of Alzheimer's Disease: The Legacy of the Cholinergic Hypothesis, Neuroplasticity, and Future Directions. , 2015, Journal of Alzheimer's disease : JAD.

[36]  M. Albert,et al.  Why has therapy development for dementia failed in the last two decades? , 2016, Alzheimer's & Dementia.

[37]  Alex Mihailidis,et al.  Performance of daily activities by older adults with dementia: The role of an assistive robot , 2013, 2013 IEEE 13th International Conference on Rehabilitation Robotics (ICORR).

[38]  C. Caltagirone,et al.  Neuropsychological correlates of behavioral symptoms in Alzheimer's disease, frontal variant of frontotemporal, subcortical vascular, and lewy body dementias: a comparative study. , 2014, Journal of Alzheimer's disease : JAD.

[39]  Nirbhay N. Singh,et al.  A computer-aided telephone system to enable five persons with Alzheimer's disease to make phone calls independently. , 2013, Research in developmental disabilities.

[40]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[41]  L. Letts,et al.  Using occupations to improve quality of life, health and wellness, and client and caregiver satisfaction for people with Alzheimer's disease and related dementias. , 2011, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[42]  Antonio Egidio Nardi,et al.  Treatment of Cognitive Deficits in Alzheimer's disease: A psychopharmacological review. , 2016, Psychiatria Danubina.

[43]  F. Stella,et al.  Physical activity attenuates neuropsychiatric disturbances and caregiver burden in patients with dementia , 2011, Clinics.

[44]  Carl D. Cheney,et al.  Behavior Analysis and Learning , 1998 .

[45]  M. Scherer,et al.  The relationship of personal factors and subjective well-being to the use of assistive technology devices , 2011, Disability and rehabilitation.

[46]  Alan E. Kazdin,et al.  Single-Case Research Designs: Methods for Clinical and Applied Settings , 2010 .

[47]  C. Cotman,et al.  Preserving Cognition, Quality of Life, Physical Health and Functional Ability in Alzheimer's Disease: The Effect of Physical Exercise (ADEX Trial): Rationale and Design , 2013, Neuroepidemiology.

[48]  Ling-Hui Chang,et al.  Indicators of perceived useful dementia care assistive technology: Caregivers' perspectives , 2015, Geriatrics & gerontology international.

[49]  Nirbhay N. Singh,et al.  Walker devices and microswitch technology to enhance assisted indoor ambulation by persons with multiple disabilities: three single-case studies. , 2013, Research in developmental disabilities.

[50]  Nirbhay N. Singh,et al.  Persons with Alzheimer's disease engage in leisure and mild physical activity with the support of technology-aided programs. , 2015, Research in developmental disabilities.

[51]  T. Kraemer,et al.  Fall management in Alzheimer-related dementia: a case study. , 2009, Journal of geriatric physical therapy.

[52]  J. González-Bernal,et al.  The Efficacy of Nonpharmacological Treatment for Dementia-related Apathy , 2011, Alzheimer disease and associated disorders.

[53]  N. Harris,et al.  Using simple technology to prompt multistep tasks in the home for people with dementia: An exploratory study comparing prompting formats , 2015, Dementia.

[54]  L. Volicer,et al.  ENHANCED AMBULATION AND QUALITY OF LIFE IN ADVANCED ALZHEIMER'S DISEASE , 2003, Journal of the American Geriatrics Society.

[55]  L. Rubenstein,et al.  A multivariate fall risk assessment model for VHA nursing homes using the minimum data set. , 2007, Journal of the American Medical Directors Association.

[56]  M. Dixon,et al.  Using indices of happiness to examine the influence of environmental enhancements for nursing home residents with Alzheimer's disease. , 2007, Journal of applied behavior analysis.

[57]  R. Owen Memantine and donepezil: a fixed drug combination for the treatment of moderate to severe Alzheimer's dementia. , 2016, Drugs of today.

[58]  Anna Gerber,et al.  Single Case Experimental Designs Strategies For Studying Behavior Change , 2016 .

[59]  Viviana Perilli,et al.  Video Prompting Versus Other Instruction Strategies for Persons With Alzheimer’s Disease , 2013, American journal of Alzheimer's disease and other dementias.