Insights into Brain Function Identification: An Interview with Beth Schoenfeld

Posted on: September 29, 2014 | 0 Comments |

portrait_Beth

Beth Schoenfeld is a passionate advocate for dementia education. Our Vice President and the Director of DSG’s Indiana Region, she’s been tireless in her quest to help families with loved ones suffering from dementia. Beth is an RN, MSN, CDP, CDI, and CCP — her compassion and expertise have lead her to develop the Brain Function Identification process (BFI). BFI is a noteworthy method that enables family members to better understand and empathize with dementia sufferers, while improving the lives of the dementia patients themselves.

Today, Beth is here to share some further insights into this unique strategy.

Is the Brain-Function Identification process unique to Dementia Services Group? What are its key components?

It is unique to DSG.   The actual tools we utilize are not unique, but what we do with the information we gain from the instruments is what is unique.  The screening tools help us determine how to help the families and client how to best structure the environment and plan successful and engaging activities that will provide success.

As an example, we have the clients perform visual scanning and visuospatial screens, including ability to interpret color contrast to determine how to modify their environment.  If they have lost depth perception or peripheral vision, caregivers and family can be trained on how to best approach the client and how to make their home safe.  Color can be used to make necessary items more visible.

It is heartbreaking to witness, but quite rewarding when you can see that the family members ‘get it’ and change THEIR behaviors.Beth Schoenfeld

What lead to the development of BFI? How does BFI differ from other diagnostic processes?

The tools were developed because we found time and again that families were blaming client’s for things out of their control.  It was causing angst for both the caregiver and the person with the cognitive impairment.

When you can show a family member why you think that the client is not doing things to be difficult or because of a long-standing personality issue, it makes everyone’s life easier.

A lot of this process was developed just to help the families have a better understanding on why the person with impairment acts a certain way or has difficulties.  Much of dementia does not make intuitive sense.  People with dementia have the ability to move, but the connection from the brain to the muscles may not work consistently or correctly and therefore they can’t move always on cue.  Clients with dementia may be able to respond to what is in front of them at any given time, but can no longer understand how to do something without the visual cues or an outside stimulus.

Cognitive impairment is not just about memory loss — it also affects vision (depth perception, motion interpretation, color and contrast and peripheral vision), creativity, concept formation, planning, foresight, initiation or being able to stop an activity, and motor functions.  Because dementia does not always follow a logical progression, clients can perform some activities, but not others.  Cognition is also affected by sleep, adequate stimulation, hydration and glucose levels, and exercise. Functions may be better at some times of day that others.

This all plays into the family’s thinking that the client is being manipulative and difficult.  It is heartbreaking to witness, but quite rewarding when you can see that the family members “get it” and change THEIR behaviors, which then causes the client to change for the better.  It is not rocket science, but it is also not intuitive and not taught in many books.

Most nurses and doctors can identify dementia, but may not always be the best at helping families know why things may be happening or better yet, what to do differently.  This is why we developed this approach to care.

Just the knowledge that the client was not being difficult was a huge relief for the caregiver and the caregiver burden lessened as a result.Beth Schoenfeld

What occurs after you’ve identified a client’s brain functions? How do you adjust his or her environment or care plan?

Each situation is different and the tools we use are different based on the family goals for our visit.  If a family calls us in for certain “behaviors”, we may alter what we are looking for to determine environmental influences on behavior and how the client’s cognitive processing may contribute to the issue at hand.

Often times, it is eye opening for families who often believe their family member is being “manipulative” or “stubborn”, is really acting so due to their loss of flexible or abstract thinking abilities.  When we can show the results of some of the cognitive screening tools to the family, they have the “aha” moment.

Families are often upset because they feel like their loved one is being “lazy” and refusing to do things they have always done.  One of the things that can be lost is the ability to initiate, except in response to an outside stimulus.  When we can show the family that their loved one has lost this ability to initiate activities, they then know they are not lazy and can be taught how to approach the client to invite them to activities or to set up cues in their environment as reminders.

…we know that cognitive stimulation continues to be good for people, even after they have been diagnosed with a cognitive impairment. Beth Schoenfeld

How has Brain Function Identification helped some of DSG’s clients?

We had a client who could remember some things (but not others) that the caregiver thought they should remember.  Therefore the family thought the client was being manipulative.  When I could show that the client had no visual, or verbal short-term memory, but could remember things that were tied to emotionally charged issues, they understood how to better structure their environment. This included wall calendars with detailed schedules, labelling of what was in a cabinet, and labelling more complicated processes (such as how to change the channel on a tv cable box).  Just the knowledge that the client was not being difficult was a huge relief for the caregiver and the caregiver burden lessened as a result.

We had a client who was calling out and being vocal.  This was seen as a negative behavior as she was living in a nursing home.  It was determined that the client no longer had the ability to have abstract thinking and purposely seek out what she needed.  Because she was able to communicate, the staff assumed she would ask for what she needed, for example drinks of water.  But once we could show the facility that she no longer could purposefully ask for her needs, it made a significant difference in how her care was structured.  She was put on a toileting schedule which eliminated her incontinence, and she was offered drinks and snacks on a regular schedule.  The behavior of “calling out” stopped.

My father-in-law was diagnosed over 3 years ago with Alzheimer’s.  I used some of the cognitive tools for him, along with a thorough social and interest inventory, to come up with (as he calls it) “his brain therapy” that he completes every day.  He looks forward to the activities. Each was chosen to work different parts of his brain.  Some of the items include seek-and-finds to work on visual scanning, Family Feud to work on word recall, Boggle-type games to work on sequencing, and block design activities to work on visuospatial skills.

Also, there are some basic problem solving workbooks and mazes to help his logic and reasoning.  He performs these activities with his home care helper, who knows to alter the types of activities offered.   He looks forward to the activities every day, and even does them some evenings and on weekends when the caregiver is not present.

We know that cognitive stimulation continues to be good for people, even after they have been diagnosed with a cognitive impairment.  We can use these cognitive tools to determine what the client is still good at so that activities can be structured in ways that they enjoy and can be successful.

Thank you, Beth, for sharing your expertise with us!

 

Please Help Us Reach More Families

At DSG, we want to help even more families affected by dementia. We’ve applied for the Mission Main StreetSM Grant, sponsored by Chase and Google, and we need 250 votes by Oct. 16th to move to the next round.

Please help us realize our goal of changing the world of dementia care! This grant would give us the ability to help more families and change the way care is provided to those with dementia.

 

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