Features An Anthropological Approach to an Occupational Intervention : The Exercise and Dementia Project

The growing attention of occupational science/ occupational therapy to issues of social inequality, social marginalization, and representation of diverse voices, as seen in recent publications such as A Political Practice of Occupational Therapy (Pollard, Sakellariou, & Kronenberg 2009) and Occupational Therapy without Borders (Kronenberg, Algado, & Pollard 2005), comes at a time when anthropology also is re-considering its central roles and moral duties as a discipline. A selective integration of these disciplinary approaches may synergize efforts to address the occupational needs of marginalized persons. This paper describes an interdisciplinary attempt to work with one marginalized group, persons with Alzheimer’s disease and their family caregivers, by encouraging the inclusion of physical activity into the daily routines of persons with dementia and enhancing the occupational role of family caregivers. The shift from a purely biomedical perspective of dementia to one that takes into account the potential for personhood of one with the disease (Kitwood 1997) is a critical step toward the de-marginalization of individuals with Alzheimer’s. Using ethnographic methods to examine life experiences of persons with dementia, anthropologists have served a pivotal role in this shift in perspectives (Leibing & Cohen 2006; McLean 2007). Their work has encouraged a comparable shift in models of dementia care, from simple custodial care to an emphasis on the physical and psychosocial factors impacting quality of life (Perkinson 2000). The potential for the experience of personhood, improved quality of life, and engagement in meaningful occupations by persons with dementia were basic assumptions that guided the development of the Exercise and Dementia Project. This project employed an anthropological perspective to develop and evaluate an occupational intervention: a family-supervised, home-based physical activity program for persons with mild dementia (Perkinson 2008). Based on a multi-dimensional set of baseline assessments, an interdisciplinary team (occupational therapist, physical therapist, and medical anthropologist) developed and evaluated individualized physical activity programs for 30 persons with mild dementia and their primary family caregivers. Family exercise supervisors received instructions on the performance and safe supervision of the exercise program and exercised with their relatives three times a week for three months. Follow-up assessments revealed significant improvement on various physical measures and general satisfaction with the program. In addition to collecting traditional, standardized assessments of outcomes, the project evaluation documented and analyzed the processes through which the interventions morphed into personal routines and habits. Ethnographic observations, exercise diaries, in-depth follow-up interviews, and focus groups with family exercise supervisors indicated how participants learned and performed the exercise programs within the context their everyday lives. Data analyses revealed unanticipated physical and social barriers and incentives to performance of and adherence to the intervention. When faced with such barriers, many exercise supervisors adapted by making ad hoc modifications to the exercise programs. They occasionally introduced technical devices to enhance the impact of the program. Family supervisors also developed idiosyncratic criteria to assess the adequacy of exercise performance. The meanings that participants ascribed to their experiences of physical activity and to the occupation of exercise supervision were pivotal to adherence and general impact of the intervention. Anthropological process evaluation research (Butler 2005), with its focus on context, meaning, and process of implementation can provide insight into the manner in which activities of an intervention are integrated into daily occupations and can reveal the meanings and value of OT interventions from the perspectives of its participants. Productive partnership between anthropology and occupational science/occupational therapy holds promise for the development of an evidence-based field of practice and body of knowledge that will address issues such as social and occupational justice, which are central concerns for both fields.


An Anthropological Approach to an Occupational Intervention: The Exercise and Dementia Project
Margaret A. Perkinson, PhD Department of Occupational Science & Occupational Therapy Doisy College of Health Sciences Saint Louis University The growing attention of occupational science/ occupational therapy to issues of social inequality, social marginalization, and representation of diverse voices, as seen in recent publications such as A Political Practice of Occupational Therapy (Pollard, Sakellariou, & Kronenberg 2009) and Occupational Therapy without Borders (Kronenberg, Algado, & Pollard 2005), comes at a time when anthropology also is re-considering its central roles and moral duties as a discipline.A selective integration of these disciplinary approaches may synergize efforts to address the occupational needs of marginalized persons.This paper describes an interdisciplinary attempt to work with one marginalized group, persons with Alzheimer's disease and their family caregivers, by encouraging the inclusion of physical activity into the daily routines of persons with dementia and enhancing the occupational role of family caregivers.
The shift from a purely biomedical perspective of dementia to one that takes into account the potential for personhood of one with the disease (Kitwood 1997) is a critical step toward the de-marginalization of individuals with Alzheimer's.Using ethnographic methods to examine life experiences of persons with dementia, anthropologists have served a pivotal role in this shift in perspectives (Leibing & Cohen 2006;McLean 2007).Their work has encouraged a comparable shift in models of dementia care, from simple custodial care to an emphasis on the physical and psychosocial factors impacting quality of life (Perkinson 2000).
The potential for the experience of personhood, improved quality of life, and engagement in meaningful occupations by persons with dementia were basic assumptions that guided the development of the Exercise and Dementia Project.This project employed an anthropological perspective to develop and evaluate an occupational intervention: a family-supervised, home-based physical activity program for persons with mild dementia (Perkinson 2008).Based on a multi-dimensional set of baseline assessments, an interdisciplinary team (occupational therapist, physical therapist, and medical anthropologist) developed and evaluated individualized physical activity programs for 30 persons with mild dementia and their primary family caregivers.Family exercise supervisors received instructions on the performance and safe supervision of the exercise program and exercised with their relatives three times a week for three months.Follow-up assessments revealed significant improvement on various physical measures and general satisfaction with the program.
In addition to collecting traditional, standardized assessments of outcomes, the project evaluation documented and analyzed the processes through which the interventions morphed into personal routines and habits.Ethnographic observations, exercise diaries, in-depth follow-up interviews, and focus groups with family exercise supervisors indicated how participants learned and performed the exercise programs within the context their everyday lives.Data analyses revealed unanticipated physical and social barriers and incentives to performance of and adherence to the intervention.When faced with such barriers, many exercise supervisors adapted by making ad hoc modifications to the exercise programs.They occasionally introduced technical devices to enhance the impact of the program.Family supervisors also developed idiosyncratic criteria to assess the adequacy of exercise performance.The meanings that participants ascribed to their experiences of physical activity and to the occupation of exercise supervision were pivotal to adherence and general impact of the intervention.
Anthropological process evaluation research (Butler 2005), with its focus on context, meaning, and process of implementation can provide insight into the manner in which activities of an intervention are integrated into daily occupations and can reveal the meanings and value of OT interventions from the perspectives of its participants.Productive partnership between anthropology and occupational science/occupational therapy holds promise for the development of an evidence-based field of practice and body of knowledge that will address issues such as social and occupational justice, which are central concerns for both fields.