CIS Kim Warchol Nov 12 aKim Warchol’s presentation to the attendees at the 2014 Kindred Clinical Impact Symposium: Clinical Excellence in the Care of the Stroke Patient Across the Continuum, began with one important message:


Gone are the days when we can’t serve people with dementia and Alzheimer’s disease.

Warchol, President of Dementia Care Specialists at the Crisis Prevention Institute, remembers a time when, as a young occupational therapist in the late 1980s, she would regularly write the words, “patient not appropriate for occupational therapy secondary to cognitive impairment.” Not the case anymore.

Warchol began by providing some statistics and definitions of dementia.

  • Dementia comprises symptoms that can be related to 70 to 100 diseases or conditions 
  • As dementia advances it affects activities of daily living and then functional capabilities such as speech 
  • Dementia can be reversible if it is caused by a condition such as Lyme disease or hypothryroidism, or can be known as “fixed,” if caused by TBI or a stroke 
  • Over 5 million Americans are now living with Alzheimer’s disease 
  • It’s now an “epidemic” 
  • On average, most people with Alzheimer’s will live most of their time with it in the later stages

She then implored attendees to understand that while decline will happen predictably with all types of dementia, abilities remain. Learning a patient’s cognitive level is as important as something many of us do regularly – assess the developmental stage of a child in determining whether or not he or she is ready for a certain activity, like caring for oneself or driving a car, for example.

“Elders are literally dying of boredom,” Warchol said. “We are not enabling them to use their remaining abilities.”

Warchol introduced the concept of the three C’s:

  • Can Do – describes preserved abilities at each stage 
  • Cognitive Level 
  • Compensatory Care

Using the Allen Cognitive Level model system, therapists can match the patient’s cognitive level to the Three C process. 

For a patient of Cognitive Level 2 – the equivalent of about a 12-18-month-old child – “Can Do” abilities can include sitting, standing, walking, gross motor skills, few-word vocabulary, gross grasp on food/ drink, follows 1 step inconsistently.

Compensatory intervention ideas include: breaking simple, familiar activities into single steps, using cues, encouraging gross motor participation, waiting for response and using safe familiar objects.

Participants were asked to apply the information Warchol presented to the fictional patient, Mary Marton, whose case has been a thread that has tied the symposium together. Mary, a 66-year-old community dweller who has suffered a stroke and is currently in a transitional care center with a feeding tube, since she choked attempting to feed herself. Later, the symposium participants will break into teams to determine how Mary’s case could’ve been handled better.