Sesión de lenguaje para personas con deterioro cognitivo leve

Language session for people with mild cognitive impairment


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1. Justification

The focus of the intervention is on people without cognitive impairment and people with mild cognitive impairment (MCI).

For the design of the session, the NeuronUP platform has been used, from which all the activities have been chosen, taking into account those that are most appropriate for patients in order to achieve the objectives set.

The cognitive function that we want to stimulate with this intervention is language. In addition, by carrying out each and every one of the activities, immediate memory and sustained attention will also be stimulated.

2. Objectives of the language session for people with mild cognitive impairment

2.1. General objective

The general objective of the cognitive session is to stimulate the language and maximize the preserved linguistic abilities of the users.

2.1. Specific Objectives

A series of specific objectives have been established for each of the activities to be carried out. In the following section “Programmed activities” the activities are explained and the specific objectives of each of them are explained.

Programmed Actividades

The NeuronUP activities selected to perform the language session for people with mild cognitive impairment will be explained below.

1.Matching nouns to images

Duration

10 minutes.

Material

Large room, tables and chairs, computer, projector, NeuronUP program, white paper, pens.

Description

  1. In order to carry out this activity, the users must position themselves together and sit facing the screen on which the projector image is displayed. Pens and paer will be provided.
  2. The professional will open NeuronUP on the computer and select the activity “Matching Nouns to Images”.
  3. The level will be selected with the images of the theme that best suits the group; in our case the advanced level cards have been chosen, in which everyday objects appear, in order to favor reminiscence.
  4. After having prepared the material, we will proceed to explain the activity to be carried out; in which only the images of NeuronUP will appear and the professional will read the words out loud.
  5. Each image will be assigned a number and the patients must write the number of the image they believe to be correct when the therapist says the word.
  6. Every six images will be corrected out loud allowing all patients in the group to participate.

Objectives 

  • Exercise reading-writing comprehension.
  • Encourage verbal fluency.
  • Exercise oral comprehension.
  • Encourage the recognition of objects.
  • Exercise vocabulary level.
  • Maintain memory and semantics through reminiscence through everyday objects.
  • Preserve immediate memory.
  • Encourage spatial orientation.

2. Task Sequencing (text)

Duration

10 minutes.

Material

Large room, tables and chairs, computer, projector, NeuronUP program, white paper, pens.

Description

  1. In order to carry out this activity, users must be seated on the chairs next to the tables, with blank sheets of paper and a pen each (material provided by the occupational therapist).
  2. The professional will open NeuronUP on the computer, and select the activity “Task Sequencing”.
  3. Once the activity has been opened, the desired configuration will be selected, in this case it will be free mode and medium-advanced levels.
  4. After carrying out these steps, the explanation of the activity will continue, since, although the program already gives a brief indication, the therapist, in order to avoid possible confusion, will reinforce the clarification.
  5. Next, the professional will project the sheets that he wants the patients to complete, in such a way that these on an individual level, they will have to put to paper, according to them,  the order of the different steps of the corresponding task.
  6. Bearing in mind that there are sheets that contain many steps, to avoid the patients from becoming bored and tired, it should be made clear that each step will be accompanied by a letter, starting with A. In this way, instead of having to write all the steps, it is enough to place the correct letter on their piece of paper (corresponding to a step of the activity) and next to it, the order number that they believe corresponds to that letter.
  7. Once all the users have finished putting the activity in order, a volunteer will be asked to read it aloud. In this way, the rest of the users will see if the answer coincides or not with what they have written, and if they observe that there are mistakes made, they will correct each other favoring interaction.

Objectives 

    • Improve planning.
    • Favor reasoning.
    • Stimulate the mechanics of reading and writing.
    • Exercise the fine motor skills of the hand.
    • Optimize recognition and numerical comprehension.

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3. Telling the time (numbers)

Duration

10 minutes.

Material

Large room, tables and chairs, computer, projector, NeuronUP, tokens with empty clock dials, pens.

Description

  1. In order to carry out this activity, patients must be seated on the chairs next to the tables, facing the projector screen. Each user will be given a card with empty clock pictures and a pen. The material will be provided by the occupational therapist.
  2. The professional will open the NeuronUP program on the computer, and select the activity “Telling the time”.
  3. The difficulty of the activity will progressively increase.
  4. There will be no maximum time or notices of inactivity, since it will be the therapists who manages the time according to the needs of each patient.
  5. After explaining the activity to the patients, the activity will begin. On the projection a numerical hour will appear, the users will have to try to represent that hour on one of the blank clocks that they will have in their sheet, drawing the hands of the clock and placing them suitably.
  6. Once the therapists have finished the time, we will ask for a volunteer to go to the screen to try to properly place the hands of the clock. It will be corrected in groups and, if any patient is having any difficulty, we will try to help and explain it.
  7. Once each exercise has been corrected, we will move on to the next one.

Objectives 

  • Facilitate recognition and numerical comprehension.
  • Facilitate reading-writing comprehension.
  • Strengthen the spatial relationship.

4. Making Words 

Duration

15 minutes.

Material

Large room, tables and chairs, computer, projector, NeuronUP, white paper, pens.

Description

  1. To carry out this activity, users will be seated on chairs and tables, with a sheet of paper and a pen each.
    The therapist will open NeuronUP on the computer, and select the “Making Words” activity.
  2. Once the activity is opened, a personalized phase will be configured, where the following configurations will be established. The general aspects will have a number of screens of 15 exceeded, so that if any of the words are too complicated, another can be generated, keeping the total of 15 words that we want to work with. On the other hand, no maximum time or inactivity warning will be established, since we will be the ones who control the activity and the time dedicated to it.
  3. The parameters will be of 6 bubbles and will count with letters, having a letter in each bubble.
  4. The mechanics of the activity will consist in projecting a screen with the bubbles that contain the letters, and the users will have to form a word with all the letters that appear in the bubbles. The first user to form the word will say it out loud, and the occupational therapist will select the letters in the correct order on the computer, so that all patients will see the word. patients will be asked to memorize all the right words.
  5. After having matched 5 words, users will be asked to form a phrase with one of the 5 words that have been matched previously, and to write it on the sheet that each of them has. If one of them remembers several words, he or she can combine them in the same sentence, or write several sentences with the different words  remembered.
  6. Once each of them has written a phrase, each patient will read the same phrase aloud.
  7. After this reading, you will go back to the activity, until you get another 5 words right. At that moment the patient will stop again to create the sentence(s). This procedure will be carried out one last time, so that at the end of the activity, a total of 15 words have been correctly formed and a minimum of 3 phrases per user have been written.

Objectives 

  • Strengthen the capacity for repetition.
  • Favor the recognition and association of letters.
  • Promote the capacity of ideation.
  • Strengthen the spatial relationship and heminegligence.
  • Reinforce focused attention.
  • Stimulate short-term memory.

Conclusions from the language session for people with mild cognitive impairment

For this session we have chosen to work on language, as it has been considered one of the most important cognitive functions for the adequate development of daily life and the rest of the occupational areas of all people.

It is considered that in elderly people, the function of language is an area that progressively deteriorates, and it is for this reason that the main objective of the programmed cognitive session is to work on language. In addition, working with this function is especially important in people with mild cognitive impairment, as it is one of the first functions to deteriorate.

The choice of NeuronUP activities has been based on covering all the processes covered by language, including expression, comprehension, fluency, writing and reading, as well as working transversally with other cognitive functions.

Possible difficulties

The difficulties that can arise in the realization of the cognitive session are that the participation could be scarce on the part of some patients, as well as, on the other hand, that the users participate simultaneously, arising conflicts or confrontations. In addition, patients may become frustrated if they are not able to carry out the activities, or if they have numerous failures. Also, that the time programmed for each activity is insufficient. Another aspect to take into account is the technological one, as the Internet or even the computer can fail.

To try to avoid these problems, the first thing that should be done is an organization of the order of the activities, in such a way that the session is going to begin with a simple activity, increasing the level of difficulty in the others, and ending again with another simple activity, to increase the motivation and the personal satisfaction of the users. In case we find ourselves in a situation of low participation, the patients will be chosen to carry out the activity or the correction. If, there is an excess of participation, speaking in turns will be established and mediation will be made between the confrontations that may arise.

If the activities last longer than the established time, an activity will be eliminated from the session, since what is important is that the language is worked on, not the amount of activities that are carried out.

Final assessment

As a final evaluation in relation to this practice, it has been considered very enriching, since it has allowed to design a cognitive session for a group of users in a collective way, something necessary in occupational therapy to intervene in diverse environments or with different collectives.

It has also been considered very interesting, as it has allowed a first contact with the NeuronUP application, a really useful platform for any professional in the field of occupational therapy, as well as beneficial for all those users who make use of it.

Bibliografía

Authors

Olalla Saiz Vazquez, profesora Asociada Universidad de Burgos y sus alumnos Gloria Álvarez, Yasmina Bécares, Rosa Cruz y Álvaro García.

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