Combining music and life story to enhance participation in family interaction in semantic dementia: a longitudinal study of one family's experience

Behavioral Treatment for Speech and Language in Primary Progressive Aphasia and Primary Progressive Apraxia of Speech: A Systematic Review

Primary progressive aphasia (PPA) and primary progressive apraxia of speech (PPAOS) are neurodegenerative syndromes characterized by progressive decline in language or speech. There is a growing number of studies investigating speech-language interventions for PPA/PPAOS. An updated systematic evaluation of the treatment evidence is warranted to inform best clinical practice and guide future treatment research. We systematically reviewed the evidence for behavioral treatment for speech and language in this population. Reviewed articles were published in peer-reviewed journals through 31 May 2021. We evaluated level of evidence, reporting quality, and risk of bias using a modified version of the American Speech-Language Hearing Association (ASHA) Levels of Evidence, an appraisal point system, additional reporting quality and internal/external validity items, and, as appropriate, the Single Case Experimental Design Scale or the Physiotherapy Evidence Database - PsycBITE Rating Scale for Randomized and Non-Randomized Controlled Trials. Results were synthesized using quantitative summaries and narrative review. A total of 103 studies reported treatment outcomes for 626 individuals with PPA; no studies used the diagnostic label PPAOS. Most studies evaluated interventions for word retrieval. The highest-quality evidence was provided by 45 experimental and quasi-experimental studies (16 controlled group studies, 29 single-subject designs). All (k = 45/45) reported improvement on a primary outcome measure; most reported generalization (k = 34/43), maintenance (k = 34/39), or social validity (k = 17/19) of treatment for at least one participant. The available evidence supports speech-language intervention for persons with PPA; however, treatment for PPAOS awaits systematic investigation. Implications and limitations of the evidence and the review are discussed.

Creating and Reliving the Moment: Using Musical Improvisation and Care Aesthetics as a Lens of Connection and Self-Expression for Younger People Living with Dementia

Musical improvisation is a generative process of spontaneously creating music 'in the moment'. For people with young onset dementia, musical improvisation provides an extended opportunity for creative self-expression and connection to one's own body and life story. Using visual research methods, including video elicitation interviews, this paper explores the 'in the moment' musical experiences of five people living with young onset dementia who took part in a 15-week improvised music-making programme (Music in Mind). We frame the exploration of the group's musical experiences through the emerging lens of 'care aesthetics'-a concept that identifies the sensory relations and embodied practices between two (or more) people in a caring relationship. In the context of this analysis, we look to the caring practices by, with, and between people living with dementia, their family members, and the musicians who lead the programme and the relationship of these practices to feelings of self-expression and meaningful connection. Musical improvisation has the potential to support the psychological, social, and spiritual wellbeing of people living with young onset dementia. In applying a lens of care aesthetics, it is possible to observe the micro-level experiences of people living with dementia and their family carers.

Can Occupation-Based Interventions for People Living with Dementia and Their Spousal Caregivers Support Positive Aspects of Caregiving? A Scoping Review

This scoping review aimed to explore the characteristics and outcomes of occupation-based interventions for people living with dementia and their spousal caregivers relating to positive aspects of caregiving. A conceptualization of positive aspects of caregiving was developed based on the existing literature encompassing three domains - quality of the caregiver/care receiver relationship, meaning of the caregiver's role in daily life, and caregiver's feeling of accomplishment. Arksey and O'Malley's guidelines were used and four databases were searched to identify studies discussing occupation-based interventions involving spousal caregivers and persons living with dementia in the community that addressed at least one of three domains of positive aspects of caregiving identified in our conceptualization. After screening 1,560 articles, 18 articles were included for analysis. Three types of interventions were identified (i.e. music therapy, reminiscence therapy and a tailored activity program) involving three components contributing to positive aspects of caregiving: socializing outside the dyad, producing tangible end products, and education for the caregiver or dyad. Findings indicate that occupation-based interventions can support positive experiences for the dyad by improving the quality of the dyadic relationship and caregivers' feelings of accomplishment.

A scoping review of psychosocial interventions to enhance the relationship of couples living with dementia

When dealing with the challenges of dementia, spousal relationships have a central role to play in outcomes such as quality of care and emotional wellbeing. Dementia places strain on these relationships and so it is important to develop interventions to support them. This review maps out what interventions have been employed in this context. Searches of PsycInfo, PsycArticles, CINAHL, Embase, MEDLINE, and Web of Science were conducted to find studies describing interventions that aimed to improve some aspect of the relationship. Thirty-four studies were identified. A wide range and diversity of interventions were described, including life review, psychotherapy and ones focused on communication or creative activity. Reported benefits included meaningful interaction, emotional connection, reduced conflict and negativity, an increase in mutual support, and greater equality in the relationship. However, these can only be considered as potential rather than proven benefits because of the lack of methodological rigour of most of the studies. Future research on this topic would benefit from a closer links with research on the impact that dementia can have on spousal relationships, and from the use of stronger methodology.

Enrichment of dementia caregiving relationships through psychosocial interventions: A scoping review

Objectives

Enrichment, defined as "the process of endowing caregiving with meaning or pleasure for both the caregiver and care recipient" can support relationships between people living with dementia (PLWD) and their caregivers. This study aims to explore (1) the types of psychosocial interventions that may enrich relationships between dementia caregiving dyads, and (2) the components within these psychosocial interventions that may contribute to enrichment.

Methods

A scoping review was conducted based on the Joanna Briggs Institute framework. We operationalized and contextualized core elements from Cartwright and colleagues' enrichment model, which was also used to guide the review. Five electronic databases were searched. Psychosocial intervention components contributing to enrichment were identified and grouped within each core element.

Results

Thirty-four studies were included. Psychosocial interventions generating enrichment among dyads mainly involved supporting dyadic engagement in shared activities, carer education or training, or structural change to the environment around PLWD. Intervention components contributing to the enrichment of dyadic relationships were identified within "acquired symbolic meaning", "performing activity", and "fine tuning". Dyadic communication support and skill-building were common contributors to enrichment.

Conclusion

Our findings may inform the planning and development of interventions to enrich dyadic relationships in the context of dementia. In formal caregiving contexts, future interventions may consider dedicating space for relationships to build and grow through positive interactions. In informal caregiving contexts, existing relationships should be considered to better support dyads engage in positive interactions.

Key Stakeholders' Experiences and Perceptions of Virtual Reality for Older Adults Living With Dementia: Systematic Review and Thematic Synthesis

BACKGROUND

Technology is increasingly being used and evolving in the dementia care landscape. One such technology that has gained traction over the last decade is virtual reality (VR). VR is being applied in many areas of dementia care, including cognitive assessment and training, reminiscence therapy, music therapy, and other recreational VR applications. Despite the plethora of applications, they are often not shaped by the experiences and perceptions of older adults living with dementia. Currently, there is no qualitative evidence synthesis (QES) to explore this area. This review aimed to provide qualitative evidence supporting existing systematic reviews in this area.

OBJECTIVE

The aim of this QES was to explore key stakeholders' experiences and perceptions of VR for older adults living with dementia. It aimed to explore the barriers and facilitators to VR use and provide recommendations for future design and implementation.

METHODS

QES was used, which involved a systematic search of 6 databases to identify studies that qualitatively explored key stakeholders' experiences and perceptions of VR for older adults living with dementia. Thematic synthesis was used to integrate the findings of 14 studies (from 15 reports). The Critical Appraisal Skills Programme tool was used to assess the methodological quality of the included studies. The confidence placed in the review findings was assessed using the GRADE-CERQUAL (Confidence in the Evidence from Reviews of Qualitative research).

RESULTS

A total of 15 reports from 14 studies were included in the review, consisting of a range of levels of VR immersion, stages of dementia, and care contexts. Three analytical themes were generated: stepping into virtuality, a virtual world, and returning to reality. The results indicate the importance of sensitively designing and introducing VR to this population, as older adults living with dementia often have no prior experience of using this technology. VR can be a positive experience for older adults living with dementia and can provide meaningful interactions, positive expressions, and long-term impacts on everyday functioning. However, it should be acknowledged that some negative associations must be accounted for before, during, and after use.

CONCLUSIONS

This review highlights the positive implications as well as negative associations of VR use. It emphasizes the need for VR design and implementation driven by the needs and views of older adults living with dementia as well as with other key stakeholders. Future research needs to explore the vital role that older adults living with dementia can play in the design process and how they can be empowered to meaningfully design and use this technology.

Social Isolation and the Use of Technology in Caregiving Dyads Living With Dementia During COVID-19 Restrictions

Background

People with dementia (PwD) and their informal caregivers (caregiving dyads) face multiple impacts of the COVID-19 pandemic, including restricted social support services and social isolation. With limited opportunities for caregiving dyads to participate in social activities during the pandemic, the potential of social technology to support social participation and dyadic relationships should be explored. As a part of an ongoing feasibility trial, this study assesses how COVID-19 has impacted community-dwelling dyads in a dementia caregiving context. The dyads' use of social technology and their motivations to invite technology into social interactions are explored.

Methods

A pilot case study employing baseline interview data from three community-dwelling caregiving dyads. Each dyad consisted of a husband with a dementia diagnosis and his wife, who performed most caregiving tasks. Interviews were audio-recorded, transcribed verbatim, and subjected to inductive thematic analysis. Two researchers independently coded the data, and collated the codes and themes collaboratively.

Results

Two themes and seven subthemes were identified: (i) living with dementia during COVID-19 (subthemes: social and leisure activities, dyadic interactions, adjusting as caregiver); and (ii) the role of technology in a pandemic (subthemes: facilitating social activities, facilitating dementia care-related activities, barriers and facilitators to using social technology, the underlying motivation to invite technology into interactions). Dyads who were socially active pre-COVID-19, and who managed to make good use of technology to facilitate and maintain their social engagement during COVID-19, reported to have been less negatively impacted by COVID-related social restrictions.

Conclusion

The dyads differed in how COVID-19 restrictions impacted their lives and how they coped with dementia, revealing different motivations for wanting to invite technology into their social interactions. During and beyond this pandemic, social technology can be a valuable tool for promoting social participation in this population, especially when in-person social contact is restricted. Successful uptake of social technology is dependent on customizing it to the individual's needs and conditions. Therefore, efforts are needed to tackle barriers that exist for older adults in using such technology.

Behavioral interventions for primary progressive aphasia

Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by a gradual loss of communication ability. Due to the centrality of communication deficits, speech-language pathologists play a prominent role in the provision of care for individuals with PPA. In this chapter, we outline a person-centered approach to the management of PPA that aims to preserve independence for as long as possible while anticipating future decline in communication and other domains. A growing evidence base supports the utility of speech-language treatment approaches in PPA, including restitutive, compensatory, and communication partner-focused techniques. Restitutive interventions aim to rebuild lost communication skills, such as naming or fluent speech production. Compensatory approaches include training with high- and low-tech augmentative and alternative communication systems that provide complementary means of communication beyond speech. Communication partner interventions focus on education and strategy training in order to equip conversation partners as skilled communication facilitators. Throughout intervention, clinicians should aim to provide treatment that impacts functional communication and promotes social engagement. Given the documented benefits of speech-language intervention in PPA, we are optimistic that such treatment will become the standard of care and that additional research will continue to improve the quality and accessibility of behavioral interventions.

Planting the SEED: A model to describe the functions of music in reminiscence therapy

Music-assisted reminiscence therapy involves the use of music, in any form, to prompt and augment the recollection of autobiographical memories and therapeutic reframing of the meaning of one's life and experiences. The functions of music in reminiscence therapy remains unclear. Drawing on interdisciplinary research in music therapy, psychology, sociology, gerontology, and neuroscience, this paper proposes a theoretical model for understanding the multiple functions of music when used in reminiscence therapy, and describes how music-assisted reminiscence therapy might be used to improve the wellbeing of older people. The SEED model proposes that music, when used together with reminiscence interventions, helps to: 1) summon autobiographical memories; 2) evoke strong emotional reactions; 3) elicit physiological responses; and 4) define identity. Evidence for the four proposed functions of music in reminiscence interventions is presented. The SEED model expands on previous research and theory on music and reminiscence, neural and cognitive processing, and the therapeutic use of music. The SEED model maps the benefits and indicators for the use of music in reminiscence therapy and provides a blueprint for research to test the purported benefits of using music to enhance reminiscence therapy.

In the moment with music: an exploration of the embodied and sensory experiences of people living with dementia during improvised music-making

The term ‘in the moment’ has received growing interest in the context of music programmes for people living with dementia, with music therapists, family carers, health-care professionals and people living with dementia themselves reporting the value of framing musical experiences in the ‘here and now’. Although this term is being used more frequently within the literature, there has yet to be a formal examination of such ‘in the moment’ musical experiences and how they might benefit a person living with dementia. We used a multiple-case study approach to develop a thematic framework of ‘in the moment’ musical experiences within the context of a music-making programme for people living with dementia. The research followed six people living with dementia and four family carers, and used video-observation and video-elicitation interviews to capture and analyse ‘in the moment’ experiences. Four thematic observations were developed which captured ‘in the moment’ musical experiences: Sharing a life story through music, Musical agency ‘in the moment’, Feeling connected ‘in the moment’ and Musical ripples into everyday life. These findings showcase the creativity and musical abilities of people living with dementia whilst affirming music as a medium to connect people living with dementia with their own life story, other people and the environments in which music-making takes place.

Effects of functional communication interventions for people with primary progressive aphasia and their caregivers: a systematic review

Objectives: Primary progressive aphasia (PPA) is a language led dementia characterised by progressive speech and language difficulties. Impairment focused PPA interventions that seek to remediate, alleviate or improve symptoms, dominate the research literature. Yet speech and language therapists (SLTs) report prioritising functional communication interventions (FCIs), which target engagement in an activity and participation in life situations. This systematic review investigates the research literature on FCIs for PPA to identify the key components of these interventions and their effectiveness.Method: A systematic search of databases identified 19 studies published between 1998 and 2018. Data were extracted from the articles using the Intervention Taxonomy adaptation (ITAX).Results: Results show that the two most common components of FCIs are to build on communication strategies people currently use, and to practise these strategies with a communication partner. There are variations in the interventions, such as location and dosage. All 19 studies report improvements, of which eight report statistically significant results. Forty-two different measures are used across the 19 studies.Conclusion: This study highlights that building on existing strategies and practising these with a CP, are key components of FCIs for people with PPA, yet there remains a lack of clarity around optimal dosage. Further rigorous research using a core set of outcome measures is a priority in this area.

‘… This is my home and my neighbourhood with my very good and not so good memories’: The story of autobiographical place-making and a recent life with dementia

As part of the wider Neighbourhoods and Dementia Study, co-researchers from the Open Doors Research Group (based in Salford, UK) produced a series of three films with the title ‘The Changing Face of our Neighbourhood’. These films were subsequently placed on ‘YouTube’ and document co-researchers’ storied experiences of Salford and the industrial, economic and social changes that have occurred over the inquiry group’s lifetime. Drawn directly from this autobiographical and socio-generational work, this article focuses on the experience of lead author Lesley Calvert, who was diagnosed with dementia in 2013 and has been a member of the Open Doors Research Group since 2014. Lesley grew up and worked as a district nurse for almost 40 years, remaining close to her place of birth in Salford all her life. In this article, Lesley draws upon her autobiographical narrative which she shares in the three films to describe the intersections between biography, place-making, belonging and dementia. The article concludes with the importance of democratising the research space and why academic researchers need to create opportunities for personal stories to be told, heard and acted upon.