Speech-language interventions in Alzheimer's disease. A functional communication approach

Alzheimer's disease is a progressive degenerative neurogenic disease that is more prevalent among the old than the young. The primary symptoms are forgetfulness, repetitiousness, losing one's way, and the loss of ability to perform complex tasks on the job. Diagnostic confirmation of Alzheimer's disease is determined by autopsy. As of this writing, there is no specific drug that can stop or reverse the disease. Medical management is focused on treating behavioral symptoms and managing the individual's general well-being. The communication needs of the Alzheimer's client depend on the individual's level of cognition, degree of independence, circumstance, and communicative abilities. Due to their poor rehabilitation potential, the majority of persons with Alzheimer's disease are not suitable candidates for traditional therapy programs. An alternative to traditional therapies is the Tri-Model system. The Tri-Model philosophy of rehabilitation and service delivery systems (Glickstein and Neustadt, 1992) lends itself readily to the needs of the dementia client because the model is designed to maintain the continuum of rehabilitation care for individuals with "red flag" diagnoses such as dementia. Establishing a treatment protocol based on the Tri-Model philosophy of rehabilitation not only assures the individual treatment based on his or her level of functional ability and rehabilitation need, it provides a framework for the rehabilitation specialist to use as reference for the various stages of disability and change during rehabilitation. The Tri-Model System is a decision tree which allows movement in any direction according to the client's needs (Figure 1). Clients, staff, and families are encouraged to set realistic goals at the outset of the rehabilitation program. By delineating three overlapping phases in the recovery process a base is established which allows the rehabilitation professional to appropriately follow the client after discharge and maintain the continuum of care. Since each restorative phase in the system requires the design of restorative programs which address that particular phase of the rehabilitation process and cooperation of an interdisciplinary team, addressing all three phases of rehabilitation at the time of the initial evaluation maintains the continuity of the client's treatment protocol throughout the course of the disease. Inclusion of Restorative III (functional maintenance) assures the continuum of care. The strength of the Tri-Model philosophy and system of rehabilitation is the inclusion of the definition and delineation of functional maintenance, the most neglected and for many clients the most important part of a complete rehabilitation program. When an incomplete definition of rehabilitation is used, questions regarding the efficacy of treatment is common.(ABSTRACT TRUNCATED AT 400 WORDS)