The UK Department of Health NICE guideline on dementia, 2006, states that:
"People with mild/moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation programme. This should be commissioned and provided by a range of health and social care workers with training and supervision. This should be delivered irrespective of any anti-dementia drug received by the person with dementia".
CST is the only non-pharmacological intervention recommended for cognitive symptoms and maintenance of function.
National Institute for Health and Clinical Excellence (2006). Dementia: supporting people with dementia and their carers in health and social care. NICE clinical guideline 42, November 2006. www.nice.org.uk/guidance/cg42
Cognitive stimulation therapy aims to enhance cognitive function and improve wellbeing through the use of media such as music, images, smells and tastes to prompt memory, recall and enjoyment. Practising social, functional and language skills in order to help maintain them is also an important aim.
Weekly or more frequent sessions are arranged, usually for a group of ten or so clients who have a similar ability level and age. This is to avoid highlighting difference and disability (though restrictions to access should be avoided of course), as well as ensure age and interest appropriate activities.
Some key rules of engagement:
- Take time beforehand to get to know the people you are inviting to the group
- Have enough ‘helpers’ to enable individual support if required, for example if someone gets upset or needs communication assistance
- Keep sessions light and fun focused (people with memory problems may not remember the session very well afterwards but the feelings of enjoyment will be longer lasting)
- Try to gear activities to abilities. Aim for people to achieve, not fail. The seemingly most simple well performed skills can be massively rewarding, for example a song or tune remembered or a picture painted
- Highlight achievements and thank people for their participation, but avoid childish or patronising comments
- Never comment critically or highlight failure, instead encourage and reassure
- Physical presence,gesture, smile and carefully judged contact such as handholding can be used to support verbal messages
- Ensure equal status within the group. Staff should wear ‘normal’ clothes. Use preferred names at all times. Break bread together during and after sessions.
Decide the theme for the session (beforehand). State this
Ask members to introduce themselves (with your support if this is difficult)
Ask members to say something about themselves, based on the chosen theme
Sing together the group theme song (previously chosen by the group)
Complete an orientation board together, with day, date, weather, venue and theme on display for the whole session
Bring in newspaper headlines to discuss topical themes, show images
Compare current trends with earlier life
Pass around objects to aid reminiscence
Ask people how their week has been. Share stories
Have a few games ready to hand to play if discussion is limited
Develop a themed music playlist with a few questions or points for discussion for each song
Encourage expression, singing, dancing, laughter
Include songs which are likely to be held in long term memory
Use musical instruments, flags, clapping to get people moving and celebrating
Praise participation (not just verbal), highlight abilities and point out most enjoyed or remembered songs
Try to include a few songs or artists you know members like
Follow this activity with a coffee break and chat
Stay in the same room to allow the enjoyment to flow into social contact
Practical or physical activity:
Move into an adjacent room or area with tables provided
Pre prepare an arts or crafts activity, a baking activity, a gardening activity, a tasting session or fragrances identification session
Alternatively, or if time in addition to the above, play a physical game of skittles, boule, Jenga or whatever else is ready to hand (be mindful of mobility issues)
Or lead a group exercise activity such as chair stretches, Tai Chi moves or a simple pedometer step counted walk
Move back into the lounge area. Play some relaxing, restful songs (classical or meditative) for people to close their eyes and really listen to
Use a script or app to lead a structured relaxation or mindfulness session
Give people time and space to ‘wind down’
Follow this with stretches and yawns before heading back to the tabled area for
Soup and sandwiches eaten together, with nutritional support available as necessary
Talk over refreshments to plan next weeks session
Carers (who have been provided with several hours respite) should be invited to join the refreshments
They can provide support to their relative or friend but also speak with you if they need some information, advice or just to offload.
The following pages of the site aim to equip those facilitating CST sessions with sample Spotify Playlists, activity suggestions, thematic discussion points and possible questions.
Weekly updates will usually be provided, with the Twitter account prompting followers to view new materials.