In dementia, insults to the brain effect medial temporal (conscious or declarative memory), frontal cortex (short term memory & conscious cognitive processes) and the pre-frontal cortex (sensory disinhibition). As a result, dementia patients become progressively more confused and disoriented. Due primarily to wounded conscious processing, dementia patients become more easily over stimulated and under stimulated especially when fatigued. Both conditions cause stress which generates an adrenocorticoid reaction and resulting fight or flight behaviors. Stress, particularly during ADLs, is also generated from cognitive dissonance (conflict between wounded conscious processing and healthy procedural processing).

Non-pharmacological interventions to avoid or minimize these behaviors are numerous, range in efficacy, and because many are counter-intuitive, require both caregiver training and practice. Over the last 10 years, Behavior Science, Inc. has refined these interventions and packaged them with training and Engineered Music for both the home and institutional caregiver.

Engineered music is the primary tool by which the caregiver gains control of and manages the patient's wounded conscious processing. Engineered music is a stream of sensory stimulation that is designed to fit through the disinhibted implicit screens of the pre-frontal cortex, fit within truncated short term memory and occupy the wounded consciousness of the dementia patient for long periods of time. When individualized for premorbid music preferences Engineered Music provides a river of stimulation upon which the dementia patient can focus and completely understand. This causes relaxation and avoids adrenocorticoid reactions. When selected by tempo, rhythm, key, lyrics etc. sequencing of songs can induce behavioral change e.g. sedation, mood elevation, concentration, exercise etc.

Because Engineered Music is inexpensive and easy to deploy it provides an easily observable tool caregivers can use to manage or avoid behaviors. When played prior to and during ADLs it helps the patient avoid cognitive dissonance and decreases dependence. When played upon awakening it provides orientation. When played at bedtime, it provides relaxation.

The home care package (Sound and Loving Care) of music and interventions has been tested and approved for Medicaid reimbursement locally and for some Long Term Care insurance nationally. The home care package requires that client caregivers provide us personal information about their loved one and unwanted behaviors. Based on that information they are sent a notebook and 4, eighty minute engineered music CDs and receive a telephone visit during which our case manger reviews materials in the book and helps the client build a daily schedule. Interventions used to avoid or minimize behaviors are built into the schedule. Progress is checked by telephone quarterly and adjustments made as required.

The institutional package is sold in three configurations.

Facilities may solve one behavior problem for one resident at a time using an individual resident package. Like the home care package, after a discussion and optional behavior recording period the nurse or therapist works with our case manager to design an intervention to resolve a behavior. The institution is then sent 4 individualized Engineered Music CDs, training materials for nursing staff and reference materials for the targeted behavior. The facility is provided one week of trial prior to billing. Adjustments are made as required.

After experiencing success with an individual resident the facility usually expands non-pharmacological interventions to a nursing unit. For this the facility and their case manager write a plan for implementation and the facility receives ancillary processes to capture and hold staff attention, in-service slides and scripts, and support programs to insure new interventions take hold. The facility may also request Train the Trainer instruction. The facility's program manager has their choice of also receiving a notebook reference or interactive CD reference to assist in the identification & solving of problems and measuring of efficacy and reporting of non-pharmacological interventions.

Nursing unit programs also include interventions for groups so staff can initiate unit wide dining, low stimulation, pseudo religious group programs. Programs also exist for use by OT/PT/ST to enhance compliance and reimbursement revenue.

With success on a single unit some facilities elect to implement non-pharmacological interventions on all units houseing residents with demntia.

Our company is interested in working with any people interested in the management of behavior for people with cognitive or memory impairment.