Elder Rehab by Students

(An Alzheimer’s Disease intervention research and student training program
funded by the National Institute on Aging)
Sharon M. Arkin, Psy.D., Principal Investigator

University of Arizona

Department of Speech and Hearing Sciences
arkinaz@earthlink.net
(520)760-5595

 

Introduction:

The Elder Rehab program is a student-administered Alzheimer rehabilitation research program that was conceived of and directed by clinical psychologist Sharon Arkin. The program took place between 1996 and 2001 at the University of Arizona, Department of Speech and Hearing Sciences. Funded by the National Institute on Aging, the program measured the effects of a multi-modality intervention program on the language performance, rate of decline, physical fitness, and mood of persons with early to moderate stage Alzheimer’s disease. Outcome information and a list of publications by Arkin is at the end of this website. To connect to Arkin's monograph on Exercise and Alzheimer's on the website of the National Center for Physical Activity and Disability, click here: http://www.ncpad.org/disability (Click on Alzheimer's Link) The Elder Rehab program was a winner of the 2001 Mind Alert award of the American Society on Aging. A continuing education correspondence course based on this program was published in January, 2005. See publications list at the end of this website.

 

Dr. Arkin's mother,Bee Schultz, was diagnosed with Alzheimer's Disease during Arkin's first semester of graduate study. Many of the interventions her students use with their elderly partners were first tried out on Bee. Arkin's dissertation was dedicated to her mother who "at age 79 is still helping me with my homework!" Bee died in May of 1997 at the age of 84.

Interventions

Interventions consisted of twice weekly physical fitness workouts, one supervised by a student, one by a caregiver; 10-12 memory and language stimulation activities, administered by the student during one of the weekly fitness workouts; and a weekly student-supervised session of community volunteer work alternating with a recreational activity.

Students provided transportation for their elderly rehab participants, did related academic work, and earned three undergraduate credits for one semester of participation. Liability insurance, secondary to the student’s own coverage, was provided by the University. Happily, there was not a single accident or injury that occurred during the course of more than 2000 student-supervised round-trips and exercise sessions.

Memory and Language Stimulation Protocol

1.             Category Fluency. (While on treadmill or bike.)  Name as many_____ (fruits, modes of transportation, types of clothing, etc.)as you can in 60 seconds.  Alternative: Tell subject you will name a category and count to ten, during which he or she is to name something from that category.  Use a series of categories. Have subject give categories for you to name from.

2.         Picture description. (During rest period.) Present Norman Rockwell or other evocative picture. Say “tell me what you see in that picture – what’s going on.”  Record free response. Then ask prompt questions. 

            Example: Homecoming (Picture of soldier coming home and being greeted by family and neighbors.)

Prompt questions used after free response is recorded:

            What is the occupation of the young man in the picture with his back to us?  How can you tell? (uniform). Who are the people on the back porch? What kind of emotion are the people in the picture feeling? How can you tell?  Do you think he’s home for a short visit or for good?  (small bag - probably short visit). What kind of neighborhood does this soldier live in? How can you tell? Who do you suppose the young woman is who is leaning against the side of the house?  How do you think she is feeling? What do the mother and all of her children in the picture have in common? (red hair) About how old would you guess that mother is?  What could be causing her legs to be so fat? (fluid retention from heart problems). Do women of that age look like that nowadays?  How does being well-to-do financially help a woman look younger than poor women of the same age? Did you ever have a loved one in the service? Who? What was that like? If you were in the service, what were short visits home like? How did you and your family keep in touch? Have you saved any letters from those years? What famous entertainer used to give shows at overseas military bases at Christmas time? (Bob Hope).  

3.         Word Associations (While on treadmill or bike). Tell me all the (childhood) (adult) thoughts and memories the word reminds you of …(e.g., birthday, garden, graduation, funeral, thunderstorm). Student shares stories from his/her life on same topic).

4.            Opinion & Advice Questions (During rest period) A situation involving a moral issue or personal values is presented to subject and his/her opinion is solicited. A series of probing questions is asked after free response is recorded. 

        Example:

Affair  

Suppose your found out that your best friend’s husband was having an affair and spending a lot of money on an attractive widow living in your community. Your friend and her husband are living on a limited retirement income, half of it from the wife’s pension.  You’re afraid for her financial well-being, but don’t want to hurt her. 

What would you do?

Prompt questions after free response is recorded:

Would you say anything to the cheating husband?  What? Would you say anything to your friend?   What?  What would you advise her to do?   Do you think trust can be rebuilt in a marriage after one partner has been unfaithful?  How? If it were your husband (or wife) having an affair, would you want to be told about it? Would you feel appreciative or resentful towards the friend who told you about the affair? 

5.         Story Recall (During rest period) Student reads brief story containing 6-7 facts and asks subject to repeat story.  Student then rereads story, posing a question about each fact after it is stated, pausing for the subject to answer, if able, then gives the correct answer. Student then repeats the 6 questions that were embedded in the story and records answers, giving correct answer, if necessary.  Subject is then asked to tell the story again. When all six questions are answered correctly and subject recalls 4 major facts about the story, a new story is introduced for the following session.  

        Example:  

Poor Puppy

A cocker spaniel puppy that is usually kept in the basement got into the living room when the owner was at work.  When the puppy’s owner got home, she found a wet spot on the carpet.  She spanked the puppy with a newspaper.  Then she noticed water dripping from the ceiling right over the wet spot on the carpet. She apologized to the puppy and gave him a biscuit.

This story is about a cocker spaniel puppy. What kind of puppy is the story about?______________(cocker spaniel). The cocker spaniel puppy is usually kept in the basement. Where is the puppy usually kept? __________________(in the basement) One day, the puppy got into the living room when the owner was at work. Where did the puppy go while the owner was at work?  ___________________(into the living room).   When the puppy’s owner got home, she found a wet spot on the carpet.  (What did the puppy’s owner find on the carpet when she got home?__________________(a wet spot).  She spanked the puppy with a newspaper.  What did the owner do to the puppy__________________ (spanked him with a newspaper.)  Then she noticed water dripping from the ceiling right over the wet spot on the carpet.  What really caused the wet spot on the carpet that the puppy was blamed for?  __________________________(water dripping from the ceiling).

6.            Proverb Completion. (While on treadmill or bike) Give the beginning line of a proverb; ask subject to give the ending.                

                 Example:

                  You can lead a horse to water___________(but you can’t make him drink)

             Proverb Interpretation (During rest period).

 Read proverb beginning to see if they know the ending. Write down what they say.  Ask them the meaning of it and write down what they say.  If subject gives a concrete or incorrect response, then read the abstract interpretation. Then read proverb again and ask subject to interpret it.  Write it on record sheet. 

Example:

 A bird in the hand_______________________( is worth two in the bush).

(The things we already have are more valuable than the things we only hope to get.  Better to hang on to what you have than to take a chance on something you might not be able to get). Good source of proverbs: Dictionary of Cultural Literacy by Hirsch, Kett, & Trefil (1988)

7.         A My Name is game. (During rest period or while on treadmill or bike)

            Subject is told that this exercise is to practice producing words quickly. Have subject read or say the framework phrase with the student and produce a word beginning with the target letter for each blank.

            Example:

            A My Name is _____________and my (husband’s/wife’s) name is_____________and we come from_______________and we’re going downtown to buy                 ___________, B my name is______________, etc.

8.         Similarities (While on treadmill or bike)

             Subjects are asked what the two words in each pair of items have in common – how they are alike.  Examples:

                       Cup and plate________

                       Shark and tuna_______

                       Vodka and gin_______

9.         Famous Names (While on treadmill or bike)

            Subjects are read a series of first names and are asked to name a famous person with that first name. Students then ask if the subject can tell something about that person and students share what they know.  Examples:     

                       George   -    (Washington/Gershwin/Burns) (president, composer, actor/comedian)

                       Jimmy    -    (Carter//Hoffa/Durante) (president, union leader, comedian/actor)

 

10.        Pros and Cons (While on treadmill or bike)

             Subjects are read a series of topics or objects. For each one, they are asked to tell what’s good about it and, then, what’s bad about it. Student uses topic and responses as launchpad for a conversation, sharing his or her opinions during the dialogue.

              Examples: 

                       Television

                       Being retired

                       Cell phones

 

11.        Sentence Completions (While on treadmill or bike)     

              Subjects are given a series of sentence stems and are asked to complete them.  Students offer responses also and engage subject in dialogue about the topic.

              Examples:

              If I had a million dollars, I___________

              I’m afraid of______________________

              My favorite dessert is______________

 

12.        Picture Naming and Quiz (During rest period)

             Pictures of, alternating with questions about items in a category of objects (study task), are presented over a period of weeks following a period of weeks when the subject was repeatedly asked to name objects from that category during 60 second category fluency tests.  An hour after the study task, the category fluency test is given. Exposure to the quiz typically results in the subject naming objects that appeared on the quiz, as well as “novel” objects from the target category -that is, not named during the previous fluency tests and not on the study task. Good way to maintain and increase lexical fluency. Example:  (Category - Modes of Transportation)

             1. Picture of a hot air balloon is shown and subject is asked. What is this?

             2. What do you call the moving staircase that is found in department stores? (Escalator)

 

13.        Object Description (During rest period)

             A common object is presented and subject is asked to describe it. After subject finishes free response, cue questions are asked to elicit information not spontaneously given:

            What is its shape? What color is it? What is it used for? Where can you get it?

             Examples: Lemon, Pencil, Toothbrush.

 

14.        Traveling Bingo (While riding to and from activity site).

             A card is created that contains 12 or 16 squares, each containing the name of something one might see from a car window, e.g.: red  pick up truck, school bus, police car, driver with a beard, passenger with a pony tail, pizza delivery truck.  Depending on capability of subject, whole card is played or one or more objects are targeted for a particular trip, (Great for long car trips with children!) Involve subjects (or kids) in suggesting items to put in the squares.

Physical Fitness Training Protocol

 

General procedures: 

Use scale at back of cardio room to record subject’s weight at first visit on visit record sheet.

Observe subject’s gait.  If you notice instability, be extra vigilant when he/she is walking.

Use “talk test.” Make sure subject can talk to you comfortably during exercise. If he or she can’t, he or she is probably over-exerting.

Establish and record seat adjustments and starting weight levels, using previous semester’s record card, staff person, former student partner, or family member for guidance.

Be sure subject drinks water at regular intervals and rests between sets on the weight machines. 

 

Six Minute Walk Test:  This is a standardized test for assessing baseline fitness level and measuring progress. Subjects are timed while they walk as far as they can in six minutes. If they stop to rest, clock keeps going. (UMC has a room that measures 40 feet in length, with ceiling tiles at two feet intervals.  This is the “course” used for the 6-minute walk test.) This will be done at the beginning of the program and at the end of each semester.

Upper and Lower Body Strength Tests.  Lower:  Subjects are asked to press substantially more weight on the leg press machine than they’ve been pressing; weight should be enough so that they can’t do more than 6 or 8 reps.  Upper: Same, but on chest press machine.  The weight they lift and the number of repetitions they achieve are plugged into a formula used to estimate their “1 Repetition Maximum” - the heaviest weight they could theoretically press or lift one time.  Subjects should be working out at 70-75% of their 1 Repetition Max.  Someone will do these tests with you.

 

                                                        ORDER OF ACTIVITIES

Check in. Subject’s ID number on grey box which contains record cards. Type it in or give it to attendant.  Fill in record card fully each visit. DO NOT REMOVE FROM CENTER. Include time in/out. Your phone number. (These tend to change.)

 

Weigh in. First session only . Record with date on record card.

 

Resting Pulse.  This is obtained after several minutes of sitting quietly after arriving at the Center.  Exercise is not to proceed unless resting pulse is below 100. (Use lower reading on machine.) Subjects engage in language stimulation activities during the rest period. (e.g., Category fluency, picture description)

Warm-up Walk.  This has generally been accomplished through walk from the parking lot.

 

Stretches.  Subjects are guided through a series of stretches, most of which are done sitting down: Neck stretch, (right, left, forward); arm across chest (r & l); hamstring stretch: sit, extend legs, one bent, one straight. Slide arms down straight leg, head looking forward, then switch.  calf stretch (r & l). Do each stretch twice. Hold for 16 seconds.    

 

Calf raise.  Up on tip toes and down, holding lightly onto bar.  16 times. 

 

Step up on Reebok step aerobics box and down (without bringing other leg to rest on box) – right,  then left.  One set per side. Add 2 reps per week.

 

Balance practice: Have subject stand on box on right foot, holding onto bar lightly. Have subject 

signal when ready to let go and count seconds held; do 3 times for each foot and record longest time.

 

Wrist roll-ups.  Two sets (each set = one rolling up of rope and one unrolling). Use velcro strap-on weights, as tolerated.

 

WATER

 

Aerobics:  Treadmill.  Subjects are monitored while walking on a treadmill. Fasten safety clip.  Elevation is set at 0 and rate is set at 1.0 or more, depending on ability of subject. Most subjects should be at 15-20 minutes by now. Do word associations activity, converse, sing with participant to help pass time. Subject must straddle moving part before getting on. Hold start button for 3 seconds to start. Take exercise pulse for 10 seconds before end of exercise. (Multiply by six and record.)  Use exercise button to stop gradually. Record distance, mph, time.  

 

Aerobics: Bike.  Most subjects use either Aerodyne bikes, which provide upper and lower body workout, or the recumbent bike, which is better for persons with balance problems, knee problems, etc.  Advice/opinion questions given during bike. One subject uses arms only bike (arm ergometer).  Airdyne: Adjust seat height. (Seat should reach subject’s hip when he/she is standing). Press on and enter. Enter weight. Use up and down arrows to set weight and time. Hit start. Record distance, RPM (average), time. Recumbent: Adjust seat. Hit self pace/enter; weight (of subject)/enter: time/enter.

1.            Rest/Cooldown.  WATER.  Story Recall.  Proverb Interpretation

 

2.            Weight training. Subjects are monitored as they do 2 sets of 10-12 reps on 5 different machines that work large muscle groups.  Rest for at least 30 seconds after each set.  After two successful workouts of 2 sets of 10 at a given weight, increase to 12 reps. Then increase weight – 2-6  pounds, as tolerated, for upper body machine; 10-20 pounds for leg press. If subject complains or seems to be working too hard, drop back. As a rule, we’ve been under-challenging our participants.

 

Leg Press.  Strengthens muscles of the legs and buttocks. Has three adjustments, in addition to the weight. On card, record each stack separately, e.g.: 160/160 (means total of 320 lbs., 160 per side). Back should be in most upright position possible. Shoulder pads should just touch shoulders. Legs, when on plate, should be at about 6 inches apart and at 90 degree angle (slightly greater than 90 for subjects with knee problems (Winifred, Blanche)). (Some subjects (Blanche) place ball between knees during this exercise.

 

Chest Press. Strengthens muscles of the chest and shoulders.  Two adjustments: back and seat.

Back should be so that vertical sidebar is parallel to subject’s shoulder and upper arm when he or she is leaning back.  Seat height should be so that crook of arm handle is at armpit level.  Ankles  should be crossed.

 

Row: Strengthens muscles of the arm shoulder, and upper torso. One adjustment. Adjust seat so that center padded column is against subject’s bs (stomach), but subject is sitting up straight, not slouched over the pad.  Move subjects as close to hand grips as possible. If they are still out of reach, place grips in subject’s hands at the beginning of each set.

 

Torso Arm: Strengthens muscles of the arm, shoulder, and upper torso.  Back in upright position, adjustable seat height. Seat raised in order for subject to reach hand grips. If uncomfortable high off the ground, grips can be lowered to them. Use seat belt.  Several  subjects with should pain don’t do this; they use bicep machine instead.

 

Overhead Press: Strengthens chest and shoulder muscles.  Adjust seat so that subject’s shoulder is at the crook of the hand grip.  Ankles should be crossed. Use seat belt. Several  subjects with should pain don’t do this; they use tricep machine instead.

 

Cooldown.  WATER.  Final rest period and language activities from worksheet.  Take resting pulse again. Should be close to start rate. 

Volunteer work and community activities and sites:

- The Sandbox and Jewish Community Center preschools: reading and playing with children; taking them for walks using rope with

  loop handholds to keep group together
- The Community Food Bank: Bagging bulk rice and beans; filling food boxes
- The Hermitage "No Kill" Cat Shelter: Socializing with free roaming cats.
- Tucson Humane Society: Cleaning cat cages, grooming and walking dogs; picking up poop in dog park.
- Life Care Center Nursing Home: Taking residents for walks in their wheelchairs; bringing pet dogs to visit with residents.
- Tucson High School band practice (for former musician)
- Bowling (for former bowling alley owner)
- Miniature golf (for former golf enthusiast)
- Tucson Audubon Society: Office work and gift shop stocking for bird enthusiast
- Casa de los Ninos: Cuddling infants at a children’s home.
- School Libraries: Stamping in and reshelving books

 

Below are scenes illustrating various components of the program

           

                    Jennifer leads her partner Betty in a stretching exercise.

 

               

Heather supervises Al on the chest press machine. Al is a retired "big band" drummer.

                            

                   

Dorothy rides an exercise bike while Decemna asks her opinion on a controversial topic.

 

                                           

Ros walks on the treadmill while Dania asks her about memories suggested by a prompt word.  Ros' son, who brings Ros for a workout on the weekends, looks on.

 

                           

Students work on biographical memory tapes with their senior partners.  Tapes provide brief factual statements about the subject's life and questions about the facts at strategic intervals.  After each question, there is a pause to allow subject to answer, if able, and then the correct answer.  Most subjects relearn and retain most of the forgotten facts covered by the tape.

 

                       

                                       

Former kindergarten teacher Bernice volunteers by reading to children at a daycare center while her student partners keep her on track.

 

                   

Brad and his partner Eleanor bring Eleanor's dog "JJ" to a nursing home for regular visits.

 

                     

        Dorothy stamps in new books at the library of her local elementary school.

                  

Norman enjoyed his volunteer work at the Food Bank so much that his wife participates in the session with him and his student partner.

 

                  

        Mary gets art lessons from the octogenarian friend of her student partner.
        She donated the picture she painted to the adult daycare center she attends.

                                              

Helen, a former nurse who retired from the Air Force as a lieutenant colonel, finds miniature golf an acceptable substitute for the game that used to be her passion.

 

               

Al jams with the Tucson High School Steel Band.  Al remembered meeting the bandleader 20 years ago when they both worked at the same music store.

 

                  

Al's student partner Sena leads Al and Doris under the limbo stick during a steel band performance at the local junior high school.

                   

Woody and student partner Barbie enjoy a western buffet at the end-of-semester awards party at Tucson's  Tanque Verde Guest Ranch.

 

                   

                                           

Outing included a hayride, singalong, and concert by Dean Armstrong, popular Tucson cowboy singer. Other end-of-semester awards events were at Reid Park Zoo, Sabino Canyon State Park, the Arizona Sonora Desert Museum, Westin La Paloma hotel, Randolph Park Golf Clubhouse, Hacienda del Sol resort, and La Mariposa fitness and tennis club.

 

 

Course Requirements for Elder Rehab Student Partners
(SPH 399)

(For application form, request by email: arkinaz@earthlink.net) or by phone:
Sharon Arkin: 760-5595

1. Accompanying and supervising an early stage Alzheimer patient (partner) in a weekly physical fitness workout at the UMC Wellness Center (stretches, treadmill, bike machine, and weights) - about 3 hours, including transportation time.

2. Accompanying and supervising partner in a weekly (one hour) volunteer work task or other activity meaningful to the partner, such as reading to children at a daycare center, pushing nursing home residents in their wheelchairs, picking up trash in Sabino Canyon or UA Mall before or after a visit to campus museum, packaging beans or rice at the Community Food Bank, etc. Attending an Elder Rehab mall walk session or "Showtime" concert counts as a community activity. (See below).

3. Doing memory and language stimulation activities with partner during the course of the fitness session and recording patient performance on prepared session report forms.

4. Attending 6 2-hour seminars. Topics include physiology and psychosocial consequences of dementia, with emphasis on Alzheimer's Disease; training on interventions used; caregiver issues; community resources; assessment instruments. Several individual supervision and training sessions at UMC Wellness Center required as well.

5. Reading assigned handouts - articles and/or book chapters on Alzheimer's and rehabilitation methods and writing brief summaries of five articles.

6. Transcribing and coding a language sample from a tape recording. Training provided.

7 . Writing a final report about partner's progress and/or deterioration, using an outline and forms for summarizing data from the weekly session reports.

8. May make a photo-illustrated "This is Your Life" Memory Book for partner, if he or she doesn't already have one. (Substitutes for one article summary.)

9. Attending a final outing and awards ceremony with your partner - such as a lunch, hayride and singalong at Tanque Verde Guest Ranch, lunch, tour, concert at Desert Museum, etc.

10. Participating, if available, in annual Alzheimer's Association Memory Walk (October) and/or as volunteers at events such as Alzheimer's Association caregiver conferences, etc.

Elder Rehab "Showtime" Concert Series

This program was created as a community outreach service to frail and memory-impaired elderly persons, their family members, friends, and caregivers. Concerts were attended by Elder Rehab research participants and their student partners, residents of assisted living facilities and adult care homes, are open to the community, and were free of charge, though donations were encouraged.

Concerts were held at Streams in the Desert Lutheran Church (unless otherwise specified). Church is at 5360 E. Pima Street (2 blocks west of Craycroft), in Tucson; Reverend John Witkop is pastor. Hosts for the concerts were the staff of DayBreak, an adult day health and respite care center which is housed at the church in donated space. Refreshments were donated by local businesses and assisted living and adult care facilities. Most of the performers donated their talent. Donations were used to cover transportation and incidental costs of UA and Tucson high school performance groups - approximately $100 per concert.

The Elder Rehab concert series was continued for one semester after the end of the Elder Rehab program in August, 2001, thanks to a grant from the Sage Foundation.

Below is a typical twice monthly performance schedule. In 2000 and 2001, concerts were held weekly.

1999-2000 concert schedule: (Call DayBreak: 325-1114 to confirm time & RSVP)

August 24, 1999 Sweetheart and her Pals - a string quartet. (6-7 p.m.)
Sept. 14, 1999 Desert Aires - piano & clarinet, piano soloist , Singalong Singers (6-7 p.m.)
Sept. 28, 1999 Tucson Junior String Orchestra, Dennis Bourret conducting (6-7 p.m.)
October 12, 1999 Harp Soloist Jaymee Schmuck of UA Harpfusion (10:30-11:30 a.m.)
October 26, 1999 Prune Juice Follies - Broadway-type show; performers age 50+. (6-7 p.m.)
November 9, 1999 Pirates of Penzance Highlights by Santa Rita H.S. Show Choir. (At Handmaker’s, Grant & Rosemont Sts. (6-7 p.m.)
November 23, 1999 Dean Armstrong & the Arizona Dance Hands. Country western band. (6-7 p.m.)
December 4, 1999 Eastside Seniors' Choraliers present songs of Christmas and Chanukah. (At Westin La Paloma.) January 18 Cole Porter Revue by UA's Dept. of Theater Arts. ($225 donation needed to
cover cost of performance) (6-7 p.m.)
February 8 Charlie Hartung sings Frank Sinatra favorites (10:30-11:30 a.m.)
February 22 Hot Flashes, Tucson's tap dance troupe of age 50+ dancers. (6-7 p.m.)
March 7 Bobbie Dee. Tales and Tunes of the Big Band era. Keyboard and commentary (10:30-11:30 a.m.)
March 21 Southern Arizona Old Time Fiddlers. (6-7 p.m.)
April 4 Barbecue and western music evening. (5:30-7 p.m.) At Catalina Village Assisted Living.
April 18 Lee Schnebly. Piano-accompanied singalong. (Invited groups not yet confirmed include Tucson H.S. Steel Band and Blues Band; Crosstown Transfer quartet from the Tucson Goodtime Chorus).

 

Scenes from Several Elder Rehab Showtime Concerts Below

Pastor John Witkop from Streams in the Desert Church and DayBreak Hosts Jody and L'Don welcome "Showtime" Concert Guests

L'Don Mans the Coffee pot

 

Haaren Miklovsky directs Sweetheart & her Pals at "Showtime's" Kickoff Concert

 

Elder Rehab Director Sharon Arkin dances with Eleanor, 89 years young!

                   

"Showtime" Concertgoers enjoy refreshments along with the music

 

Elder Rehab - Jacobs YMCA Walking Program at Tucson Mall

Meets Wednesdays at 10 -11 a.m. at Burger King, Tucson Mall Food Court.
Fall season ends December 8. Confirm Time and RSVP: Karen  297-4710
Check with Karen to confirm plans for 2000. 

 

Elder Rehab walkers and volunteer "walking buddies" pause for a break and a photo, water - compliments of Burger King

No cutting corners allowed as walkers circle Tucson Mall!

 

 

 

First Year Outcomes

Outcome information on eleven persons with mild to moderate Alzheimer's Disease who completed the first year of activities in the AD Rehab program:

All eleven participants engaged in physical fitness training and supervised volunteer work or community activity. Seven participants also received specific memory and language stimulation interventions; controls experienced normal conversation with their partners.

Outcome measures used were standardized and project-related tests, administered before treatment onset and after 2nd semester of participation.

• There was no decline in the group as a whole in:

(1) language function, as measured by the ABCD (Arizona Battery for Communication Disorders of Dementia), an abbreviated Boston Namng test, category fluency, and by a comprehensive discourse sample;

(2) cognitive function, as measured by WAIS-R Similarities, Comprehension, and Picture Completion subtests and the WMS Logical Memory I subtest.

• Experimentals showed no change in mental status, as measured by the MMSE, whilecontrols declined significantly.

• Significant gains were made by Experimentals on recall of autobiographical facts.

Physical Fitness

Highly significant improvement on duration of aerobic exercise (p < .001), distance walked on a six-minute walk test (p < .01),  and amount of weight pressed on the leg press machine (p < .01) and chest press machine (p < .01) was achieved by the first year cohort. At the end of the second semester of participation, 10 of the 11 participants had met or exceeded the program’s goal of doing 20 minutes of aerobic exercise (treadmill and stationary bicycle combined) per session. Four were doing 30 minutes of more; one woman, age 85, was doing 44 minutes. Eleven participants who were tested on agility (weaving between a series of cones) at the beginning and end of one semester, significantly reduced their time to complete the task. This skill has been related to avoiding obstacles and falls (Netz & Argov, 1997).

Mood

Three subjects who had scored in the depressed range (12 or more out of 30) on the Geriatric Depression Scale (Yesavage et al., 1983) at pre-test improved after two or three semesters of participation, two of them substantially (from 19 to 11 and from 11 to 6 responses, respectively) in the non-depressed direction. The improvement in mood for the group as a whole was significant (p < .01).

• Caregivers reported gains in participant mood and quality of life                                               

Final Outcomes

In May of 2001, the Elder Rehab program completed its 4th and final intervention year with 14 enrolled participants. During the 4 years, 23 individuals completed one year of participation; 13 completed 2 years; 8 completed 3 years, and 4 completed all 4 years.

Global Functioning

All 4 of the 4-year completers were at the same CDR stage of dementia as they were 4 years ago, 3 at CDR 1 (mild); 1 at CDR 2 (moderate). One 3-year completer went from a baseline CDR of 0.5 (questionable dementia) to a 1; another who completed 6 semesters remained a 2 for the three years – this despite a hospitalization for a broken hip (not project-related!) in her 5th semester. Of the other two 3-year completers, one started and remained a CDR 1, but had to drop out because of physical illness after her third year. The other started as a CDR 2, with an MMSE of only 15, was rated a CDR 3 (severe stage) at the end of year 1 and completed two more years of participation, nevertheless. She was finally terminated from our standard treatment because of her severe aphasia and incontinence. However, she continued to receive individual therapy services at her residence from a student volunteer, and enthusiastically attended all of our social activities during our last year.

The longer participants stayed in the program, the less they tended to decline from one year to the next

One year completers (n=24) showed no significant mean decline on only two measures: Verbal Fluency (Animals) and WAIS-R Similarities between
baseline and end-of- year one testing.

Two year completers (n=13) showed no significant mean decline on five measures: the CDR, Sum of Boxes, Verbal Fluency, Boston Naming, and WAIS-R Similarities between end-of-year one and end-of year two testing.

Three year completers (n=8) showed no significant mean decline on seven measures: the CDR, Sum of Boxes, Verbal Fluency, Boston Naming, Arizona Battery for Communication Disorders of Dementia (ABCD), WAIS-R Similarities, and WAIS-R Comprehension between end-of-year two and end-of-year three testing.

Four year completers (n=4) showed a significant mean improvement on Sum of Boxes (p<.01) and Similarities (p<. 05) between end-of-year three and end-of-year four testing, and no significant mean decline on five measures:  MMSE, CDR, Verbal Fluency, Boston Naming, and WAIS-R Comprehension. 

It is noteworthy that the four year thrivers showed no  significant mean decline from baseline to  end-of- year 4 on six measures: CDR, Sum of Boxes,Verbal Fluency, Boston Naming, WAIS-R Comprehension,  and WAIS-R Similarities. The mean annual rate of decline on the MMSE was:          

2.9 points for the one year completers;
2.5 for the two-year completers;
2.0 for the three-year completers; and
1.0 for the the four- year completers.

Reported annual rate of change on the MMSE cited by the CERAD team (Morris et al., 1989, was 3.9 (0.7). Range of annual rates of decline on the MMSE reported in nine studies reviewed by Aguero-Torres, Fratiglioni, & Winblad, 1998, was 2.7 (2.4) to 4.0 (2.4).

Student Learning Gains

Six cohorts of students (n=69) were given the AD Knowledge Test before and after their participation. Mean score improved from 54% correct answers to 84%; change was highly significant, p < .001. Highly positive course evaluations, personal letters of thanks to the project director, the prominence of this experience as described in students’ graduate school and job applications, and post-program involvement of students with their former partners are further evidence of the positive impact of the program on student participants.

Correspondence: Sharon Arkin, Department of Speech & Hearing Sciences, University of Arizona, Tucson, Arizona, USA 85721. Email: arkinaz@earthlink.net
Phone: (520)760-5595 FAX: (520)760-5596


Alzheimer-Related Publications by Sharon Arkin

 

Arkin, S. (1991) Memory training in early AlzheimerAn optimistic look at the field. American Journal of Alzheimer's & Related Disorders Care & Research, 6, 17-25.

Arkin, S. (1992). Audio-assisted memory training with early Alzheimer’s patients: Two single subject experiments. Clinical Gerontologist, 12, 77-95.

Arkin, S. (1995). Trick or treat? The case for a rehabilitation approach to Alzheimer’s. (Editorial). American Journal of Alzheimer’s Disease, 10, 45-46.

Arkin, S. (1996) Volunteers in Partnership: An Alzheimer’s rehabilitation program delivered by students. American Journal of Alzheimer’s Disease, 11, 12-22.

Arkin, S. (1996). R & R for Alzheimer's caregivers: Plausible idea or fantasy? (Editorial.) American Journal of Alzheimer's Disease,11. 46-47.

Arkin, S. (1997). Alzheimer memory training: Quiz beats repetition, especially for more impaired. American Journal of Alzheimer’s Disease, 12, 147-158.

Arkin, S. (1997) Goodbye Bee (1913-1997) Editorial. American Journal of Alzheimer’s Disease, 12, 235-236.

Arkin, S. (1998). Alzheimer memory training: Positive results replicated. American Journal of Alzheimer’s Disease, 13, 102-104.

Arkin, S. (1999). Elder Rehab: A Student-Supervised Exercise Program for Alzheimer’s Patients. The Gerontologist, 39, 729-735.

Arkin, S. (2000). Alzheimer memory training: Students replicate learning successes. American Journal of Alzheimer’s Disease, 15. 152-162.

Arkin, S. (2000). Take one MMSE with a grain of Salt: Add services PRN. (Editorial) American Journal of Alzheimer’s Disease, 15, 126.

Arkin, S. (2000). Alzheimer memory training: Addendum on longterm retention. American Journal of Alzheimer’s Disease, 15. 314-315.

Arkin, S., Rose, C., & Hopper, T. (2000). Implicit and explicit learning gains in Alzheimer’s patients: Effects of naming and information retrieval training. Aphasiology, 14. 723-742.

Arkin, S. (2001). Alzheimer rehabilitation by students: Interventions and Outcomes. Neuropsychological Rehabilitation (Special issue on Alzheimer rehabilitation), 11, 273-317

Arkin, S. (2001) Website link on Alzheimer’s and Exercise for the National Center for Physical Activity and Disability, Monographs section. http://www.ncpad.org/disability, Click on Alzheimer's Link and Information on Specific Disabilities and Conditions. 2nd listing.

Arkin, S. (2001). Exercise and Alzheimer’s: Mood and health enhancer and context for cognitive stimulation. In Proceedings, 2001 Boston Alzheimer’s Symposium: Interventions that Work. Boston, MA. October 19, 2001. (Contains outcome data on 4 year study and the exercise and language protocol used.) Available from author.

Arkin, S. (2002). Exercise and activity: Antidote to Alzheimer doldrums. Accepted by Dimension, quarterly newsletter of the American Society on Aging. Publication scheduled for summer 2002. Available from author.

Arkin, S. AD Rehab by Students: Third year outcomes and profiles of 4 year survivors. JINS, 7, 411. Abstract of presentation of mid-year annual meeting of the International Neuropsychological Society in Brasilia, July, 2001

Arkin, S. (2003) Student led exercise sessions yield significant fitness gains for Alzheimer’s patients. American Journal of Alzheimer’s Disease, 18, 159-170.

Arkin, S. (2004). Exercise plus cognitive and social intervention slows cognitive decline, improves fitness and mood in Alzheimer patients. Revision under review by Clinical Gerontologist.

Arkin, S. (2005). Language-enriched Exercise for Clients with Alzheimer’s Disease. (Continuing Education course for exercise, activity, and rehab professionals). Desert Southwest Fitness: Tucson, AZ.

Arkin, S. & Mahendra, N. (2001). Discourse analysis of Alzheimer’s patients before and after intervention: Methodology and outcomes. Aphasiology, 15, 533-569

Arkin, S. & Mahendra, N. (2001) Insight in Alzheimer’s patients: Results of a longitudinal study using three assessment methods. American Journal of Alzheimer’s Disease, 16, 211-224

Arkin, S. & Mahendra, N. (2003) Geriatric Depression Scale as insight indicator: Three case examples. Clinical Gerontologist, 26, 171-177.

Mahendra, N. & Arkin, S. (2003) Effects of four years of exercise, language, and social interventions on Alzheimer discourse. Journal of Communication Disorders, 34. 395-422.

Mahendra, N. & Arkin, S. (2003). Move it or lose it: Benefits of exercise for residents with dementia. Activities Directors’ Quarterly, 4, 11-21.

Mahendra, N. & Arkin, S. (2004). Exercise and volunteer work: Contexts for AD language and memory interventions. Seminars in Speech and Language, 25, No. 2. 151-168.

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