HEADPresented by

HomeCare Rehab and Nursing LLC

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HEAD• “HEAD” = thinking, brain• Level 4 of the Allen

Cognitive Scale.• Early Stage Dementia• Medicare “Min Assist”• Goal-directed in function

and may have some limited ability for new learning

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HEAD• Why?

– Loss of inhibitions (frontal lobe).– Unable to self-monitor.– No insight into deficits (nothing is wrong with

them)…problem is with the world.– Loss of independence and dignity, loss of role

in life.– Words are the best fighting tool they have.

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HEAD• Cognitive

skills/Communication: • Understands beginning, middle,

and end of an activity.• Can seek help but may not

remember emergency procedures.• Rigid, likes routine.• Self-centered communication,

confabulates, high verbal output.• Recognizes highly visible striking

cues in the environment.• Limited reading comprehension.• New learning possible with

maximum repetition if highly valued.

• Believe that nothing is wrong with them.

Well, maybe you say it’s wrong but that’s just the way I like it.

My way is the best way.

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HEADPrecautions:• Unable to understand

precautions, complications, hazards.

• Written language is not reliable.

• Signs are not really effective.

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HEADFeeding:• May eat too fast or too

slow.• Annoyed with others

eating near them.• Complains about food.

Grooming:• May neglect unseen

surfaces (back of head).• Sequencing errors.

If you tell me to go brush my teeth I will stay on task.

I just may forget to use toothpaste or rinse out my mouth.

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HEADDressing/Bathing:• Performs familiar self care

with decreased attention to unseen surfaces.

• Follows routine.• Remembers what they are

doing throughout task.• Clothing selection may be

based on striking features (brightest shirt in the closet).

• Quality may not be good.

I am really drawn to bold, striking visual input.Did you ever notice that I choose bright clothing and wear too much make-up?

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HEADToileting:• May neglect parts of

the task.• May require verbal

reminders to initiate task.

• Completes the task although quality may not be good.

This is a huge loss of dignity for me- and a very overwhelming

task at times.

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NO PART OF THIS MATERIAL MAY BE REPRODUCED WITHOUT PERMISSION FROM THE AUTHOR

HEADFunctional Mobility:• Able to navigate using

familiar landmarks.• Transfer skills depend on

familiarity of environment.• Carries walker if

distracted, but will correct with cues.

• Notices barriers above and below knee.

• Trunk becoming more rigid.

I can remember new things with tons of patience and practice!