Multidisciplinary Interventions for People with Diverse Needs - A Training Guide for Teachers, Students, and Professionals E-Book
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- Herausgeber: Bentham Science Publishers
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- Sprache: Englisch
Multidisciplinary Interventions for People with Diverse Needs - A Training Guide for Teachers, Students, and Professionals
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Veröffentlichungsjahr: 2020
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FOREWORD
Multidisciplinary Interventions for People with Diverse Needs is a book written from an interdisciplinary perspective that has the objective of helping to understand the problems from people with special needs.
It is an entertaining, well written, didactic book that will be useful for students and professionals interested in studying several and different approaches related to the meaning, evaluation and intervention of the problems related to dementia, language disorders, diabetes, alterations of consciousness, celiac disease and disability in general. The different chapters offer an updated theoretical foundation that allows contextualizing and justifying the development of these issues. For the students it will be a useful work to develop the foundation and justification of research related to the final projects of degrees, master's degrees and doctoral theses.
For teachers and professionals the work will serve as a guide for teaching, for the development of the structure of training courses, for the design of evaluation models and intervention of the topics addressed in the book. The authors of this book are experts, of recognized prestige, who come mainly from the academic world, who have achieved a balance between the rigor and depth of analysis of the different topics, and the development of an accessible text for different profiles of readers and use.
Pedagogues, psychologists, students, teachers and professionals from the Social and Health Sciences, Sports Sciences, among others, will find in this book a place to lean out to discover very interesting academic, professional and human aspects related to the world of special needs.
PREFACE
Human diversity faces several challenges, as there are many people in situations of vulnerability due to personal and environmental factors. Vulnerable populations can experience physical, psychological, and social problems. Those include people who face great precariousness in their life and find themselves in a situation of effective vulnerability. These people need a prompt, effective and a scientific evidence-based response to overcome barriers thrown at them.
This book compiles a set of focused evidence chapters to raise awareness on the particular conditions of special populations, invoking assessment and intervention to promote better life conditions.
In the first chapter we can find an issue that affects contemporary society, the ageing population. Although living longer is an unquestionable gain, the truth is that increasing average life expectancy inevitably entails the onset of dementia, urging the need to slow its progression and minimize its impact. It presents scientifically based physical activity to combat the cognitive decline and extend the years of life with quality.
Chapter 2 raises awareness on people with brain damage with altered consciousness. The uncertainty on the patient’s state of conscience leads to doubts in the course of action to follow in terms of treatment or prolongation of life. Correct assessment plays a vital role to foster best decisions and directed interventions on the patient’s best interest. Situations of misdiagnosis and consequently unachieved interventions are frequent and must be improved through extended and evidence-based approaches.
People with special needs are addressed in the third chapter. We are in a global world where borders fade and anyone can pursue employment and better life outside his/her country. It may seem simple, but there are persons with constraints that cannot fulfil their needs. Not using a common language can prevent social and employment relations. Exclusion is aggravated when learning a language hampered by a functional limitation. Sensory, motor and cognitive disabilities can hinder a truthful inclusion in modern society. EN-ABILITIES is a European project that aims to enable English autonomous learning by people with diverse needs, sustained on a universal design for learning approach.
The fourth chapter focuses on the performance of activities of daily living of children with disabilities. What for many is considered acquired, for others it seems to be a difficult task. Those inattentive, may not realize the impact of having great difficulties, or not being able, to perform everyday tasks can have in the life of a child with functional limitations. Depending on others for several tasks, having reduced options for activities and encountering mobility barriers is a crucial factor for those who experience great difficulties. Knowing this and other issues can structure routines that facilitate their inclusion in the different contexts in which these children are inserted.
Autism Spectrum Disorders are discussed on the fifth chapter. It has been found that children with ASD experience difficulties processing, integrating and responding to sensory stimuli. Consequently, behaviours associated with difficulty processing and integrating sensory information create social isolation for children and their families, restrict participation in daily living activities and impact social engagement. What for some can be misbehaviour is in fact a maladaptive response to the environment and must be carefully addressed to minimize and overcome sensory processing dysfunctions. Specialized interventions such as occupational therapy using sensory integration are in order to help children with ASD respond more adequately to environmental stimuli.
Diabetes, referred in chapter six, is a modern world disease. Although it may be congenital, it also emerges from modern life style and eating habits. Aetiology aside, it can be seen that it can lead to serious problems with loss of independence and drastic reduction of quality of life. The adoption of a strategy to prevent the onset and progression of the disease are imperative. However, when it is already installed, its effects must be minimized. The combination of the intervention of different professionals seems like the procedure to adopt for an optimized approach.
Chapter seven goes through Celiac disease an increasingly visible condition, with frequent identification of more cases. The ordinary citizen is not aware of the difficulties that people suffering from this disease suffer. In catering and collective food services, mistakes that can harm a vulnerable person are frequent. It is important to raise awareness of the effects of the disease, in particular those that can make a difference in the lives of these people, avoiding things as simple as cross-contamination in food distribution, storage and handling, without ever forgetting the need for research and innovation for normalizing the diet of these people.
Animal Assisted Therapy and Developmental Disorders come to us in chapter eight. In it we can read how therapy with animals can assist in the promotion of skills, health-related issues and well-being of persons with developmental disorder. The overview presented shows the array of conditions that can benefit of this type of interventions. The basis of the intervention is the arise of a relationship that liberates the person with developmental disabilities, promoting positive emotional responses that influence neurobiological components and enhances performance in diverse areas, independent functioning, social participation and quality of life of those which are confronted with limitations due to disorders in their development.
Early in this book, physical activity was mentioned as a preventive and therapeutic intervention for people with diverse conditions. Chapter nine addresses again physical activity, but this time in people with disabilities. Due to their functional constraints, people with disabilities tend to perform less, or not to perform, physical activity that would greatly benefit them in a multidimensional way.
It reveals the need to identify the physical activity determinants in order to contribute to conceptual changes, new interventions and policies that increase the levels of physical activity on this population and, consequently, further advance in their full social inclusion.
The final chapter, chapter 10, deepens the theme of physical activity in children with disabilities. It’s well known regular physical activity has a positive impact in health and lifestyle, contributing for functionality and quality of life. It is important to create opportunities for physical activity. In this context, school sports appear as a first line of intervention. Inclusion is a trend that must be completely fulfilled. Legislation protects the rights of functional diverse students and obliges to their inclusion in school activities, of which school sports cannot be an exception. Although it may seem less compelling to mandatorily engage in physical exercise, the truth is that if it is not enforced, it will probably never be performed by those who need it.
For the foregoing, this book assumes as essential when the theme are populations in situations of vulnerability. Academics, technicians, and the general population here have a source for drinking knowledge shed by scientists and based on rigorous scientific evidence.
List of Contributors
Exercise and Physical Activity - Contributions to Intervention in People with Dementia
Jaime Ribeiro1,2,*,Marco Batista3,Samuel Honório3,João Serrano3,Helena Mesquita4Abstract
In the last few decades, the world has undergone profound demographic changes, reflected in life expectancy. We live for much longer, but we cannot say that these growing years are directly proportional to the quality of life. Dementia, in its different aetiologies, is more and more frequent with a consequent decline in the quality of life. However, cognitive decline and the onset of dementia may be delayed with the adoption of healthy lifestyle habits and therapeutic combinations that use non-pharmacological approaches such as activity and physical exercise. This chapter integrates a thorough review of the literature that characterizes ageing, cognitive decline and dementia, and it summarizes scientific evidence on the effects of physical activity on cognitive functions. Finally, recommendations are presented on the prescription of exercise for older people and elderly people with dementia. It is known that there are direct benefits (action on neurotrophic factors and neurotransmitters, among others), as well as indirect ones such as those resulting from a better vascularization of the brain. However, physical exercise requires precautions related to the conditions inherent to normal and pedagogical ageing. It is possible to perform adapted physical activity resulting from the coordination of sports and health professionals, knowledgeable of the needs and idiosyncrasies of the elderly, with cognitive decline or dementia.
INTRODUCTION
This chapter summarizes the effects of physiological and pathological ageing and their cognitive implications. In the most exacerbated cases, we can observe the onset of dementia, which, despite the different aetiologies and possible evolutions, inevitably leads to deterioration of cognitive skills and, consequently, to lesser autonomy, greater dependence on caregivers and loss of quality of life.
In this way, in a multidisciplinary approach that combines Occupational Therapy and Physical Education professionals, it is important to list a set of scientific evidence that describes the benefits of exercise and physical activity in minimizing cognitive deterioration due to ageing. It also aims to submit a proposal for an exercise and physical activity program that helps seniors and their formal and informal caregivers.
Research in the area of exercise and ageing has a relatively short but very active history. There has been a major development in the research of ageing in the last two decades. Among other findings, the researchers provided evidence of potential low-cost alternative therapies for the treatment and prevention of disease and the potential to improve the quality of life, health, and overall vitality of the elderly.
The discussion about ageing-associated cognitive impairment and especially dementia is justified. In this context, we highlight Stone (2011), who stated that it is extremely rare to find an elderly person who does not have cognitive impairment. In this sense, this chapter discusses the benefits of physical activity in the ageing of the individual, in particular on one of the most frequent associated disorders - cognitive compromise.
Sustained by the scientific evidence, we want to contextualize and propose a program of exercise and physical activity as a non-pharmacological intervention for the prevention and reduction of progression of cognitive decline in individuals of advanced age.
Population ageing is a worldwide reality and in particular, in the European context where there is already an ageing index of 123.9, meaning that for every 100 young people, there are 123.9 elderly people (PORDATA, 2016).
The increase in human longevity has been a constant trend worldwide in recent decades. Improved socioeconomic conditions and nutritional resources, together with the prevention and treatment of important pathologies such as infectious, metabolic, vascular and cardiac diseases, have contributed to an increase in longevity from 60 to 80 years old during the 20th century in Western countries (Démonet & Celsis, 2012). However, this dramatic increase in life expectancy was not accompanied by a proportional increase in quality of life for the elderly. On the contrary, generally, the increase of the life expectancy intensifies the risk of disease, deficiency, dementia and advanced ageing before the death. In the particular aspect of dementia, Santana, Farinha, Freitas, Rodrigues and Carvalho (2015) mentioned that the incidence and prevalence of dementia increase with age, doubling every five years after the sixth decade of life. They added that the estimated number of Portuguese over 60 years old and with dementia was 160287, which corresponds to 5.91% of this population. Knowing that Alzheimer's Disease represents 50-70% of the cases, there will be between 80144 and 112201 patients (Santana, Farinha, Freitas, Rodrigues & Carvalho, 2015). Kravitz, E., Schmeidler, J., & Beeri, M. S. (1990) disclosed that in the 85-year age group, more than half will have dementia and that the annual incidence rate doubles every 5 years. In 2010, Corrada, Brookmeyer, Paganini-Hill, Berlau, and Kawas already argued that the incidence of all causes of dementia is very high in people aged 90 years and older and continues to increase exponentially with age in both men and women. In this context arises the need to fight the effects of cognitive impairment and, in its more severe variant, dementia, trying to minimize its effects and delay its setting in so that individuals can live longer, but also with greater autonomy and quality of life. One of the most widely used therapies, along with vitamin supplements, used as the first line of defence against the detection of mild cognitive impairment and against the onset of dementia, is the practice of physical exercise.
However, the elderly population, because of ageing, needs special attention when delineating a program of exercise and physical activity.
Ageing - brief contextualization
The current section provides a brief context for the reader to contact with the conjuncture of ageing, observing the demography and the main physiological changes, in particular, the repercussions on the brain, and the care to be taken when exercising and performing physical activity. It seeks to justify the need for the exploration of the present subject-matter in the context of contemporary society.
Sociodemography
Population ageing is a worldwide concern. There is a growing increase in the elderly population due to two main aspects: the increase in life span and the decrease in the birth rate. Human life expectancy has been increasing rapidly. Due to better health and hygiene, healthier lifestyles, enough food and better medical care, as well as the reduction of infant mortality, we can now expect to live much longer than our ancestors and in just a few generations (Brown, 2015). In this context, it is verified that the number of elderly people over 85 years of age has also been progressing, being designated as the oldest-old. The latest data revealed by The World Bank (2017)1 indicates that the number of people over 65 corresponds to 8.7% of the world population (654,567,936 people). It is noticeable the growing ageing population worldwide and it is believed that by the year 2050, the elderly will be one-fifth of the world's population and out-number children, teenagers and youth (under 10 to 24), (United Nations, 2017).
“Although the process of population ageing is most advanced in Europe and in Northern America, where more than one person in five was aged 60 or over in 2017, the populations of other regions are growing older as well. In 2050, older persons are expected to account for 35 per cent of the population in Europe, 28 percent in Northern America, 25 per cent in Latin America and the Caribbean, 24 per cent in Asia, 23 per cent in Oceania and 9 per cent in Africa.” (United Nations, 2017, p.1)
Physiological Changes of Ageing
Ageing is an inescapable, progressive and irreversible process that occurs from conception until the death of the individual and is usually accompanied by a decline in the biological functions of most organs. All human systems are affected to a greater or lesser degree, and there is a global or particular decline in sensory, motor, perceptive, associative and cognitive competences. Each system begins its ageing at a given time and loses its function (or demonstrates its loss of function) at its own pace, but in a linear way (Fechine & Trompieri, 2015). It is an idiosyncratic process affecting individuals in different ways, different rhythms and different intensities. Structural and physiological changes are observed, with changes occurring at the cellular level, in the tissues, organs and systems. Inevitably, biological degradation causes problems in function. A decline in the function of an organ or system, whether due to a disturbance or to ageing itself, may affect the function of another system (Gilson, 2013). A major example is the cardiovascular system that has under its purview all the remaining organs and systems and that with ageing there is a loss of heart and blood vessel elasticity with consequent reduction of cardiac output and increase of blood pressure. The heart of an elderly person cannot accelerate as fast or pump as fast or as much blood, for example, leading to the occurrence of increased fatigue (Afiune, 2013). Although most functions may remain adequate, decreased function means that older people are less able to cope with stresses, including strenuous physical activity and exacerbated environmental changes. This decline also means that the elderly are more likely to experience side effects of physical activity. It is also known that physical stress and the environment have a greater impact on the function of some organs in particular. These organs include, as already mentioned, the heart and blood vessels, but also the urinary organs (such as the kidneys), and especially the brain.
Table 1 summarizes the main changes related to ageing which should be considered in the intervention with the elderly, in particular, in the use of exercise and physical activity.
Ageing of the Brain and Nervous System
The brain and nervous system are not different from other organs, being subjected to a higher incidence of diseases as the age progresses. Process centres of all human activities, react greatly to ageing, leading to major functional and cognitive limitations. At the neuromotor level, these limitations may translate into slower reaction speed and task performance, changes in praxis ability, poor motor coordination, poor balance and the presence of tremors. At the cognitive level, executive function impairments can be observed, for example, the subtle reduction, after the age of 70, of vocabulary, short-term memory, the ability to learn and the ability to remember words.
It is known that ageing causes changes in brain size, brain vasculature and cognition. Cortical atrophy occurs with increasing age, as well as changes in the micro and macrostructure, from the molecular level. The incidence of stroke, white matter lesions and dementia also increases with age, moreover the impairment of memory, as well as changes in neurotransmitter and hormone levels (Peters, 2006).
The most debated neurotransmitters in relation to ageing are dopamine and serotonin. Dopamine levels decline by about 10% per decade since the onset of adulthood and have been associated with declines in cognitive and motor performance. Serotonin and levels of brain-derived neurotrophic factor also decay with advancing age and may be involved in the regulation of synaptic plasticity and neurogenesis in the adult brain. Monoamine oxidase, an important substance in the homeostasis of neurotransmitter levels, increases with age and may liberate free radicals from reactions that exceed inherent antioxidant reserves and is regarded as a significant factor in involution processes in nervous tissue (Volchegorskii et al., 2004). Other factors that have been implicated in brain ageing include calcium deregulation, mitochondrial dysfunction, and the production of reactive oxygen species. Brain ageing may also suffer from altered glucose metabolism or reduced glucose or oxygen input as cerebrovascular efficiency decreases, although glucose reduction may be partly attributed to atrophy rather than any change in metabolism. Another problem commonly associated with ageing is the change in the vasculature that is associated with transient ischemic attacks, stroke and white matter lesions (Peters, 2006).
Nordon, Guimarães, Kozonoe, Mancilha and Neto (2009) presented well-known processes of cerebral ageing:
- Cerebral atrophy with dilatation of grooves and ventricles;
- Loss of neurons;
- Granulovacuolar degeneration;
- Presence of neuritic plaques;
- Formation of Lewy bodies from alpha-synuclein;
- Formation of beta-amyloid plaques;
- Formation of neurofibrillary tangles.
Ageing and brain consequences are inevitable, and consequently, the implications on one's activities and participation cannot be neglected.
The cortical atrophy, the decreasing amount of neurotransmitters, biochemical changes, oxidative stress and reduced blood flow are crucial aspects for the practice of physical exercise.
There are also situations in which pathological ageing may occur due to acquired lesions as sequelae of vascular accidents or dementia processes and, as already mentioned, they frequently affect the elderly, drastically reducing levels of functionality.
Cognitive Decline and Dementia
Even without an explicit diagnosis of dementia, it is generally accepted that age-related cognitive decline occurs in humans as well as in nonhuman primates (Kravitz, Schmeidler, & Beeri, 2012). The cognitive decline associated with ageing varies in terms of onset and progression, depending on factors such as education, health, personality, overall intellectual level, specific mental capacity, among others (Fechine, & Trompieri, 2015). This cognitive decline may assume different forms with lesser or greater impact on the autonomy and quality of life of the elderly, covering a broad spectrum of intensities that culminates with more serious dementia states such as Alzheimer's disease.
Dementia is the general term for a few neurological conditions, of which the main symptom includes a global decline in brain function. It is a degenerative, progressive and chronic process of the brain (Ropper & Brown, 2005), reaching different areas, resulting in different symptoms and disabilities, throughout its evolution, and uneven among people with the same pathology (Gogia & Rastogi, 2009; Sheehan, 2012; World Health Organization, 2015). It is not a disease but a collection of symptoms that result from brain damage, which are noticeable in functional changes beyond what is expected for normal ageing (World Health Organization, 2015; Gogia & Rastogi, 2009; Vreugdenhil et al., 2012).
There is an impairment of at least two of the following domains: memory, language, executive functions, visuospatial ability, personality or behavioural changes (McKhann et al., 2011). It can also coexist with neuropsychiatric symptoms, which are not explained by delirium or any other major psychiatric disorder, consistently associated with cognitive and / or behavioural decline.
This progressive decline in cognitive function, with greater emphasis on memory loss, deficits in some intellectual functions, behavioural and personality changes translate into loss of the notion of time and space, hamper communication, hinder relationships and quality of life and hamper a person’s autonomy in performing DA’s (Sheehan, 2012; Tabert et al., 2002,Ngo & Holroyd-Leduc, 2015, OECD, 2017, World Health Organization, 2015; Manfrim & Schmidt, 2013).
The main dementias are Alzheimer's disease (50 to 70% of cases), frontotemporal dementia, Lewy body dementia and vascular dementia (of these, the only secondary).
By 2018, it is estimated that there are 50 million people with dementia in the world, with an economic impact of about 1 trillion Dollars (Pickett et al., 2018). With the ageing of the world's population, this number is expected to rise dramatically (Kamiya, Osawa, Kondo, & Sakurai, 2018) to 66 million by 2030 and 115 million by 2050 (Vreugdenhil et al., 2012; Ngo & Holroyd -Leduc, 2015). It is easily observable that it is a public health problem. According to data from the OECD, it is estimated that in 2017, 18.7 million people live with dementia in the countries belonging to that organization, which means that 1 in 69 people worldwide has dementia (OECD, 2017). Age is the main risk factor for dementia (Kamiya et al., 2018), increasing its prevalence rate as age progresses (Demaerschalk, Woodruff, & Caselli, 2007; Fedor, Garcia, & Gunstad, 2015; Santana, Farinha, Freitas, Rodrigues, & Carvalho, 2015). According to data from the OECD (2017), the dementia prevalence rate for people over 90 years of age residing in the OECD countries is 41%, from 2% between 65 and 69, from 4% between 70 and 74 years, 7% between 75 and 79, 12% between 80 and 84, and 20% between 85 and 89.
After a light approach to the diversity of the aetiology of the cognitive decline due to the progression of age, it is interesting to summarize that physical exercise often appears as frontline therapy. Martelli (2013), in his literature review paper, listed cognitive stimulation programs, reality-oriented psychotherapy, occupational therapy, group activities, caregiver training, and other procedures, such as regular physical activity, which have provided beneficial impact for attenuation of cognitive decline and improvement of behavioural disorders in patients with AD.
NEUROPROTECTIVE AND REHABILITATIVE EFFECT OF EXERCISE ON COGNITIVE FUNCTIONS
There is accumulated evidence that exercise brings profound benefits to brain functioning (Van Pragg, 2009). Extensive research in humans suggests that exercise may have benefits to overall health and cognitive function, particularly in adult life, improving cognitive functions and lowers the risk for age-related cognitive decline (Winter, et al., 2009). Still, there are authors who advanced the findings that there is a link between physical activity/exercise and improved cognitive functioning and reduced risk of dementia (Brown, Pfeiffer & Martins, 2013).
There is a consensus that there are protective factors that reduce cardiovascular risks such as regular exercise, a healthy diet and low to moderate alcohol intake, which seem to aid brain ageing, as does increased cognitive effort in the course of education or professional activity.
There are several randomized control trials on the benefits of exercise for those who have Alzheimer's disease. It is therefore pertinent to emphasize that physical inactivity is a modifiable risk factor, which accelerates cognitive decline in the elderly (Fedor et al., 2015).
Although there are several studies on physical exercise for people with Alzheimer's disease, it is difficult to make comparisons between them. However, it has been observed that in longer interventions with higher intensities, the patients show better results (Fedor et al., 2015). However, recently, research has emerged indicating that prolonged intervention is not necessary to achieve positive results (Fedor et al., 2015).
In one study, the effects of an aerobic exercise program versus a non-aerobic stretching and toning (control) program were evaluated for 26 weeks (6 months) relative to memory, executive functions, functional capacity and depression in people in an early stage of Alzheimer's disease.
It has been found that aerobic exercise in these individuals is associated with functional capacity benefits and that improvements in cardiorespiratory fitness lead to improvements in memory and changes in brain volume, that is, reduction in hippocampal atrophy (Morris et al., 2017).
In cognitive terms, physical exercise improves several aspects such as cognition in globality, attention, executive functions and memory (Fedor et al., 2015).
Daily exercise programs and daily walks under the supervision of the caregiver show positive impacts on the physical and cognitive function, as well as on the level of independence in ADL (Vreugdenhil et al., 2012).
It is also known that physical activity induces several neurotransmitters, including serotonin, acetylcholine, dopamine, epinephrine and norepinephrine (Sutoo & Akiyama, 2003). Winter and colleagues (2007) advanced that peripheral levels of catecholamines (dopamine, epinephrine and norepinephrine) increase in humans immediately after exercise. Similarly, it was found that exercise can change cortical activity due to the increase of activity of receptor neurotransmitter subtypes (Sarbadhikari & Saha, 2006).
Voluntary exercise induces the expression of genes associated with plasticity, increasing levels of brain-derived neurotrophic factor (BDNF), as well as other growth factors, in addition to promoting cerebral vascularization, neurogenesis, functional neuronal structure and neuronal resistance to injury. Significantly, these effects occur in the hippocampus, a central brain region for learning and memory (Cotman & Berchtold 2002).
Phillips, Baktir, Srivatsan, and Salehi (2014) developed a review paper that exposed that sustained exercise plays a role in modulating anti-inflammatory effects and may play a role in preserving cognitive function in ageing and neuropathological conditions. They reinforce that recent evidence suggests that myokines released by muscle exercise affect the expression of brain-derived neurotrophic factor synthesis in the dentate gyrus of the hippocampus, justifying the improvement of cognitive conditions in adults suffering from neurodegenerative conditions.
Kravitz, Schmeidler and Beeri (2012) also equated the influence of physical exercise on plasticity and brain reserves but highlighted the effect on the reduction of risk factors for dementia such as diabetes, other metabolic conditions and cardiovascular diseases.
The research conducted by Arcoverde et al. (2008) with 37 elderly patients with AD and that of Petroianu, Capanema, Silva and Braga (2010) with 393 elderly individuals over 80 years of age determined that the association of physical activity with cognitive exercises slows the decline in cognitive functions, reducing the risk of dementia.
Nicola (2009), and Eric et al
