Personalised therapeutic plans and non-drug interventions

Hello! Today I will tell you about non-pharmacological interventions at Clariane. Before going into detail, I want to say a few words about personalised projects. What we call the personalised project is the cornerstone of our approach to support and care, and that is positive care. Personalised projects are built around three types of patient care, namely medical and pharmacological treatments, non-pharmacological interventions – the topic of this presentation – and, lastly, home, social and leisure activities. 

Whatever the nature of the support and care we provide, it always follows the same clinical regimen, which will be detailed in the second part of this presentation. The regimen includes an initial assessment, which can take various forms, and a scheduling process with medical prescriptions, treatment plans and activity programmes. Everything in a personalised project is mapped out and described, which allows for patient follow-up throughout the treatment or activity. The assessment is crucial because it helps to measure treatment efficacy, review the patient journey and decide whether to continue with a treatment or activity. The NPIS – the Non-Pharmacological Intervention Society – defines a non-pharmacological intervention as ‘an effective, personalised, non-invasive method of health, referenced and supervised by a qualified professional’. Every single word here matters, but my main point is that a non-pharmacological intervention is and must be a treatment or activity whose efficacy has been proven. 

That’s why we call it an effective method of healthcare, supported by several publications. Non-pharmacological interventions are therefore approaches and techniques that have proven to be effective and are subject to several studies that have shown them to benefit patients, especially patients with neurogenerative disorders such as Alzheimer’s disease. As you know, there is no effective drug or treatment to entirely prevent or treat such diseases, which is why support like this is crucial patients and their families. 

At Clariane, we have been working on non-pharmacological interventions for over fifteen years and we have come up with three key therapeutic axes: functional, cognitive and behavioural. The functional axis includes everything to do with strengthening and maintaining physical and motor skills, as well as rehabilitation therapy. As you can imagine, the main focus is on preventing falls and helping patients to recover from a fall or repeated falls. 

We work hard on balance and verticality. The goal is to help patients remain independent for as long as possible as regards their motor skills, which includes simple tasks such as getting dressed but also more challenging actions such as walking and getting around. The cognitive axis is essential for patients with neurogenerative disorders such as Alzheimer’s disease. It includes a wide range of treatments and approaches intended to help patients maintain, strengthen and even re-learn cognitive skills such as attention, concentration, language and anything to do with memory. 

The behavioural axis is especially relevant for us here. This is because patients with neurogenerative diseases often present with behaviour disorders, which manifest as severe agitation or aggressivity and excessive wandering or, on the contrary, prostration and apathy. Faced with such situations, carers are often unable to help or offer support. The range of non-pharmacological treatments and interventions within the behavioural axis is extensive. As a result, healthcare professionals are able to do their job and patients get the relief they need. Here are a few examples of the types of non-pharmacological interventions we use within the Clariane network. 

On the functional side, we have deployed a tool called Silverfit across the entire network. Silverfit is an interactive system that encourages patients to move their entire body by taking part in what is essentially a game. Silverfit can be used standing up or sitting down if the patient is in a wheelchair. There is also what we call dance therapy, which has both a functional and cognitive side and is hugely beneficial, as are many other activities that can be done in groups. Such activities have the added benefit of promoting social interaction. More traditional options include tailored gymnastics programmes. Cognitive therapy covers a whole series of treatments mainly focused on cognitive rehabilitation and reminiscence therapy. 

I also want to mention Formacube, which is an activity used throughout our network. It greatly improves brain plasticity because patients must reproduce shapes of varying complexity in two or three dimensions, which allows for a varied programme and helps patients progress. From a behavioural point of view, what makes Clariane stand out is that we have developed ‘flash activities’ that are often combined within a single resource: a cart. The ‘flash cart’ could be compared to a crash cart used in life-threatening emergencies. In the event of a behavioural emergency, carers can use a flash cart to bring a whole set of activities to patients, interact with them and help them overcome their struggles. Such activities include art therapy and doll therapy, which was developed by our Italian colleagues in particular. 

There is also the ‘ludospace’, which is a play area, with many studies having shown the benefits of games in supporting patients with Alzheimer’s disease, and other techniques such as music therapy and zoo therapy. I’d like to finish this presentation by going back to the importance of the clinical regimen, which is always based on an assessment of needs that can take various forms, for example establishing the patient’s wishes, expectations and desires. It’s crucial to know what patients want and what interests them so that we can guide them towards the most suitable treatment. 

Patient needs are assessed using tools, but we have also developed a resource that summarises, within the same document available to all healthcare professionals, the patient’s skills and abilities, the level of each one, and the help and support that the patient will require every day. The treatment plan is a key part of the clinical regimen because treatment goes hand in hand with prescription, which comes in many forms, for example prescribing drugs. The latter is a highly medical approach, but it’s important to plan – to offer a certain type of treatment at a set frequency, be it weekly or monthly, and for a set duration. 

This is very important. It’s also what helps distinguish between a non-pharmacological intervention and a fun or leisure activity. It’s the idea of prescribing something with a set frequency and duration. At the same time, it’s important to monitor patients throughout an activity and all sessions. This means that when a treatment plan ends, it will be possible to assess whether a goal has been achieved in full or in part, and therefore to decide whether to continue with the plan or amend it. Lastly, here are some examples of functional tests, namely the Tinetti test and the Timed Up and Go test. 

German doctors use an app to perform this functional assessment. Cognitive tests include the MMSE, or the Mini-Mental State Examination, and the five-word test. Behavioural tests include a wide range of international tools such as the NPI-Q, the GDS and the QOLS – the Quality of Life Scale. That is all I wanted to tell you today about non-pharmacological interventions, including examples of a few that we use in our network and the fact that any intervention must ultimately reflect the clinical regimen. Thank you for your attention.