Non-traditional therapy modalities have been practiced in every setting from home to skilled to independent and assisted living for a long time. But as conventional therapy providers attest, these “softer” modals are increasingly playing an important role complementing evidence-based, patient-centered care.
Therapists have long recognized their place and their value.
“Many of us garden, we play an instrument, we take care of our pets, we do brain puzzles, we love the smell of baking bread and cookies,” says Kathleen Weissberg, a doctor of occupational therapy and education director for Select Rehabilitation. “As these are incorporated into other facets of rehabilitation, they are done not as a different type of therapy or a different intervention, but instead a normal, functional activity that is engaging, meaningful, and fun for a patient. It is another activity that therapists can use to meet their goals.”
Physical and occupational therapists and speech-language pathologists today welcome the supplemental, and at times, pivotal role these non-conventional modalities offer. They include aroma, pet, horticulture and music therapy as well as art, dance, culinary, massage and aqua therapy.
Successfully navigating the sometimes thorny reimbursement rules surrounding them will help assure their role for years to come, experts say.
Conventional complements
Therapists are increasingly convinced these unconventional approaches help achieve better results.
“It’s no accident that we have strategically blended our respective disciplines, expertise and approaches into the content on iN2L systems,” says Christopher Krause, OT/L, director of rehabilitation for It’s Never 2 Late®. “In my experience, the so-called ‘traditional therapies’ get better outcomes when such interest-based or ‘soft’ therapies are part of the rehab protocol.”
Krause says evidence suggests that people are generally more engaged and participate in activities for longer periods of time and report less pain and fatigue when participating in something they find meaningful and fun.
“It stands to reason, and there is growing evidence to support the fact, that combining individualized, person-centered interests and activities with traditional rehabilitative approaches can facilitate improved outcomes in an efficient manner,” he observes.
“Soft” therapies often complement multiple conventional approaches, as Emily Rampmaier, vice president of clinical services for Reliant Rehabilitation, points out. Music therapy is one example.
“Music can be used as a guide breath support and prosody for dysarthric speech patterns, as a prompt for task initiation or rhythm for mobility,” she says. “Music also may be integrated as a calming measure for individuals who experience pain or anxiety associated with traditional therapy tasks or settings.”
At Charles E. Smith Life Communities in Maryland, Music Enrichment Manager Lauren Latessa strives to provide musical opportunities that meet residents where they are. A classically trained cellist, Latessa leads small groups and individual music classes, runs drum circles, conducts choirs and lectures on music history for residents.
“I feel fortunate that I can develop programs to enrich the experience of our patients, and I am often amazed by the impact of these musical interactions,” Latessa says. “A few minutes of live music can change the someone’s entire day and bring brightness to their world.”
Many times, the marriage of conventional and alternative therapies can yield unexpected yet delightful results, as Nettie Harper, MSRS, co-founder of Inspired Memory Care, has discovered.
It happened when Harper’s company was asked to consult on the transition of a continuing care retirement community resident to memory care. The woman feared losing her freedom, as well as the therapy dog she’d been assigned 13 years before, which had since become blind, incontinent and immobile. Yet, social workers were convinced keeping the dog, now as a pet, was essential for a successful transition.
“She agreed to a trial period in memory care, with her dog, and my promise that the team would support their partnership,” Harper says. “And they did! Physical and occupational therapy were able to use the dog to introduce a much needed rollator to Mrs. Smith, as well as a retractable leash to support safer walking.
“Recreation therapists gave the woman a new role greeting the other residents with her dog for pet therapy, which supported the development of friendships in her new environment,” she adds.
Speech therapists even worked with the woman, a retired nurse, to introduce a medication administration record for the dog’s eye drops. At the end of her trial period, Mrs. Smith had developed strong friendships with her peers, therapists and aides. They cried with her when the dog passed away three months later from congestive heart failure.
In many respects, soft and conventional therapies have a symbiotic relationship that can often achieve unique results, says iN2L’s Krause.
While soft therapies focus on activities, life enrichment and recreation, conventional therapies focus on traditional training methods. When one combines the two intervention strategies, “magic can happen.”
“Team and approach methods are built to model best practices based on our experiences as former providers,” Krause adds. “Together, our recreational therapy, art therapy, music therapy, speech therapy, occupational therapy, physical therapy, nursing and administration professionals communicate regularly. The goal is to drive efficient outcomes. The approach is collaborative communication and goal setting. The method is to combine person centered interests with individualized clinical goals.”
Even end-of-life care is providing a place for the intersection of conventional and soft therapies.
Minneapolis-based Grace Home Health & Hospice uses massage, aroma, music and pet therapies as integral parts of its care plan to meet the physical, emotional and spiritual needs of the patients, says Executive Director Sarah Van Winkle, RN. Conventional therapists have often been enlisted to work with the soft therapists.
For example, respiratory therapists worked side-by-side with aromatherapy and music therapy caregivers to ease anxiety and manage pain in a terminally ill resident. Van Winkle’s facility has devoted a great deal of effort employing similar non-pharmacological methods to treat residents and home-bound patients.
Other examples are plentiful. Inspired Memory Care is often called in to consult for residents who are refusing to eat. Harper and her co-founder/partner, Kelly Gilligan, often partner with on-site recreation therapy teams and an occupational therapist to set-up culinary clubs that engage residents to cook.
“Research inspired us that there is more that we can do besides giving seniors who are declining their meals Ensure™,” says Harper. “Often, there are underlying reasons such as depression, lack of taste, wanting independence and control over their meals and/or wanting a choice of meals.”
Harper and Gilligan also integrate music therapy with physical, occupational and speech modalities to provide neurologic music therapy. They also have incorporated horticultural and art therapy modalities with occupational therapy to encourage stretching and strength training.
Tech’s role
Technology’s role in integrating soft therapies has been growing to a host of online person-centered content, Krause says.
Some companies are now experimenting with virtual reality to complement conventional approaches.
“In using these programs, patients are generally motivated and enjoy the engaging bio-feedback-based training games,” says Select Rehabilitation’s Weissberg. “It’s an alternative to traditional interventions that can be used to address the skilled needs of therapists related to balance, fall prevention and strengthening.”
These programs complement traditional therapy as a treatment activity during the course of the therapy skilled intervention or for those with dementia, she adds.
Broader acceptance
For years, memory care has provided a perfect incubator to test soft therapies, many of which target the brain. Skilled nursing facilities and short-term rehab are now making greater use of it, according to Krause and others.
“The benefits of alternative therapy approaches can be seen throughout the aging services community,” Krause says. “The value of personal-interest-driven-intervention is now universally accepted.”
Weissberg was convinced of the value of soft therapy many years ago when her administrator returned from Christmas with a bread machine.
“Every morning, he used the machine to bake a loaf of bread that was served in the lobby to guests and residents alike,” she recalls. He began using the machine to bake cookies for residents and visitors each afternoon.
“Imagine how wonderful the community smelled when you walked through those doors!” she recalls. “Everyone — from nurses to housekeepers to the residents themselves — seemed happier. Those aromas brought memories, invoked certain feelings and impacted our interactions with one another.”
From the August 2019 Issue of McKnight's Long-Term Care News
