NET Therapy: Dementia care best practices + Rehab = Success
Dr. Eleanor Feldman Barbera
When I learned about Neurocognitive Engagement Therapy for rehabilitation residents, I had the same reaction I did when I first heard about geriatric emergency rooms: Palm-smack to the forehead, “Why didn't we think of this before?!”
Of course people with dementia aren't going to do well in traditional rehabilitation settings. We've been putting them in large, over-stimulating rooms and asking them to accomplish tasks that are meaningless to them. No wonder they become agitated or withdrawn and are unable to engage in treatment.
Enter NET therapy. Using a $25,000 grant from the Alzheimer's Foundation of America, Phoebe Ministries, in conjunction with various academic partners, developed and studied neurocognitive engagement therapy, which combines the best practices of dementia care with the tasks of occupational, physical and speech therapies.
The elements of NET Therapy
Like geriatric emergency rooms, one aspect of the NET model involves changing the physical environment so that it's calming and more conducive to engagement in treatment, such as working one on one rather than in a group.
Another key point involves reviewing the patient's life history with family members to find activities that are meaningful to the patient. In their video explaining NET therapy, a Phoebe Ministries physical therapist uses an innovative approach with a woman unable to engage in tradition rehab exercises.
Based on information from her family that the woman used to be a dancer, the therapist puts on big band music and invites her to dance. (This reminds me of what my supervisors used to say when I was in training: “Be where the patient is at.”) The physical therapist uses the woman's love of dance to help her become weight bearing again. From there, she progresses enough to be able to return home with her husband.
In order to practice the principles of the NET model, rehabilitation workers are trained by a mental health professional in the basic principles, which, in addition to life review, include using Montessori-based methods and person-centered care planning. In the NET therapy study, rehabilitation staff received 10 hours of NET training and 90 hours of mentoring to familiarize themselves with the techniques.
The research, conducted by Kelly Carney, PhD; Jennifer Howanitz, MSPT; Alice Donlan, PT, MBA, DPT, GCS; Kay Malek, PT, PhD; and Peter Lichtenberg, PhD, involved 46 therapists from the physical therapy, occupational therapy and speech language pathology departments. Their knowledge of dementia and their comfort with working with people with dementia was tested before and after the study.
Patients were assessed on their level of engagement in the therapy and the extent of their functional gains from treatment.
The results of the study* were impressive:
• Patients that received NET therapy were more engaged in the process of therapy.
• Patients that received NET therapy had greater functional gains than those who received traditional therapy services.
• Patients had greater functional gains because they had higher engagement.
• Therapists' training and mentoring in the NET model resulted in an increase in knowledge and self- efficacy in caring for individuals with cognitive impairment.
As we incorporate person-centered care models into various aspects of long-term care, NET therapy holds promise as a technique to bring the benefits of rehab to people with dementia who need a more individualized approach to rehabilitation. For more information, visit Phoebe Ministries Center for Excellence in Dementia Care.
* From a presentation at the 2014 Gerontological Society of America conference, “Changing Hearts and Minds: Neurocognitive Engagement (NET) Therapy and the Challenge of Engaging Rehabilitation Therapists in a New Conceptual Model Serving Individuals with Dementia” by Kelly Carney, PhD; Jennifer Howanitz, MSPT; Alice Donlan, PT, MBA, DPT, GCS; Kay Malek, PT, PhD; and Peter Lichtenberg, PhD
Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A long-term care psychologist, she maintains her own award-winning website at MyBetterNursingHome.com.