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Created with Fabric.js 1.4.5 References Cognitive Exercise Progressive Muscle Relaxation Ahmed, S., Leurent, B., & Sampson, E. L. (2014). Risk factors for incident delirium among older people in acute hospital medical units: A systematic review and meta-analysis. , 43(3), 326-333. American College of Physicians (2011). Treatment. , 154(11), 8-13. American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). , 62, 640-641.Cole, M.B., Tufano, R. (2008). Hamden, CT: Slack Incorporated. Dey, A.B., Goel, A., Gupta, V., Kumar, N., Kumar, P., Sreenivas, V., Tripathi, R.K. (2014). Novel occupational therapy interventions may improve quality of life in older adults with dementia. , 7(1), 1-16. doi:10.1186/1755-7682-7-26Griffiths, S., Tandon, U., Treml, J., & Jackson, T. (2014). Delirium in trauma. , 16(2), 87-92. doi:10.1177/1460408614525727Kalish, V., Gillham, J., & Unwin, B. (2014). Delirium in older persons: Evaluation and management. 90(3), 150-158. Sun, J., Kang, J., Wang, P., & Zeng, H. (2013). Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial. , 22(9/10), 1270-1280. doi:10.1111/jocn.12096 INTERVENTIONS Retrieved from: American Journal of Occupational Therapy Trauma Internal Archives of Medicine Journal of Clinical Nursing American Family Physician, Applied theories in occupational therapy: A practical approach. Age and Ageing Individuals suffering from cognitive impairments often experience depression, decreased independence, and psychosocial symptoms which in turn can have a negative effect on quality of life. Cognitive exercises have been proven an effective intervention approach amongindividuals with cognitive impairments similar to those with Delirium. Activities included within the intervention help to maintain and possibly prevent decline in cognition, while also improving overall perceivedquality of life in older adults (Dey et al., 2014). Activities can include but are not limited to the following: unraveling picture puzzles, reading using a loud tone of voice, dual task activities such as coloring or doing ADLs while listening to music or TV, neurobic exercises such as performing a common task with the non-dominant hand. The implemen-tation of enjoyable, client-centered intervention strategies can generatedistraction from the individual's thoughts about their current state of impairment which can help improve overall perceived quality of life (Dey et al., 2014). Occupation based frame of reference: Toglia's Dyna-mic Interactional Approach. The focus of this frame of reference is to restore cognitive function. In the case of Delirium, the goal would be maintaining function and preventing further decrease. Another focus is on areas of concern such as orientation, attention, visual processing, cognition, and motor planning (Cole, M.B., & Tufano, R., 2008). This frame also looks at improving performance through cues and strategies. This approach can help with planning, organization, memory, and atten-tion which are all difficult for individuals with Delirium. Toglia'sapproach fits well with this intervention because it focuses on using strategies to aid in being more functional while helping clients to be aware of what they are struggling with. The goal of this approach is for the client to be more aware of what it going on in their diagnosis, and to gain more control over the symptoms that may be causing them difficulty in being independent. The intervention also has multiple strategies and activities in different contexts. For example, a client may implement strategies for completing ADLs at home, but also may carry over other strategies to use out in the community. Poor sleep can increase risk of morbidities , mortality, and can negatively affect behavior and cognition in older adults (Kang, J., Sun, J., Wang, P., & Zeng, H, 2013). Poor sleep can also impact an individual's quality of life. Progressive muscle relaxation (PMR) has been proven to be an effectiveintervention to improve quality of sleep in older adults (Kang, J., Sun, J., Wang, P., & Zeng, H, 2013). PMR involves training major muscle groups by performing contractions and relaxations of the muscles throughout the body (Kang, J., Sun, J., Wang, P., & Zeng, H, 2013). Occupation based frame of reference: Cognitive Behavioral. Cognitive Behavioral frame focuses on psychological barriers that may interfere with performance and engagement in activities. This also has a focus of using a variety of techniques to address barriers, which in the case of Delirium could be decreased function due to lack of sleep. It also mentions that behavior and adaption involves astimulus and a reinforced response (Cole, M.B., & Tufano, R., 2008). For the intervention, relaxing and sleep routines would be the desired response of progressive muscle relaxation. Self-regulation is also a main component ofthis frame that can aid in sleeping. Strategies for self- regulation for a restful night's sleep include setting a certain time to go to bed each night and engage in occupations that may be calming (Cole, M.B., & Tufano, R., 2008). This intervention and frame of reference both enforce strategies and routines. PMR will aid in utilizing techniques to promote healthy sleeping habits for maximum function and participation. For people who are diagnosed with Delirium, things that they hear and see may feel very real to them even if it is not true reality. It is difficult to change the thoughts and emotions occuring directly, but may be acheived by targetting those triggering thoughts, which is a main component of the cognitive behavioral approach (Cole, M.B., & Tufano, 2008). Annals of Internal Medicine
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