REALITY ORIENTATION TRAINING IN AN AMNESIC - A CONTROLLED SINGLE-CASESTUDY (N=572 DAYS)

'Reality orientation training' (ROT) is a well-established therapy use d with the elderly, especially those with dementia. It aims to improve orientation and reduce negative behaviours, e.g. confusion. ROT has b een recommended for non-demented patients with acquired neurological i mpairment. However, this suggestion has not been investigated further in controlled trials. This paper describes an informal 24 h ROT progra mme with an amnesic subject (H.J.). It combined single-case experiment al designs derived from behaviour therapy. Target behaviours were item s of temporal orientation-current time/time of day, year, season, mont h and day of week. Orientation regarding the current date was not trai ned, and thus served as control variable for non-specific effects (e.g . spontaneous recovery). In order to improve oriented behaviour in dif ferent relevant situations outside the clinic, we chose 24 h ROT inste ad of formal therapeutic sessions. The patients' spouse offered 24 h R OT at home 7 days a week. This consisted of reminding the patient of o rientation information, e.g. the current day of the week in different situations. Furthermore, negative behaviours such as irrelevant questi ons were ignored. The patients' spouse was trained and supervised to c arry out this task in 27 sessions each lasting 10 min. For 14 weeks su pervision was provided twice a week in the clinic (i.e. 2 X 10 min). A fterwards the spouse continued to apply ROT at home without further su pervision in two follow-up periods. As expected, learning was slow but reliable. Generalization of improvement to another setting was shown (home vs clinic). Stable therapeutic gains over a long follow-up perio d could be demonstrated. Temporal orientation neither improved nor wor sened after cessation of supervision, suggesting that booster sessions would be crucial for further improvement.